%0 Journal Article %~ Pubmed %A Halperin, Scott A %A Bettinger, Julie A %A Greenwood, Brian %A Harrison, Lee H %A Jelfs, Jane %A Ladhani, Shamez N %A McIntyre, Peter %A Ramsay, Mary E %A S?fadi, Marco A P %T The changing and dynamic epidemiology of meningococcal disease. %B Vaccine %D 2012 %V %N %P %@ 1873-2518 %X The epidemiology of invasive meningococcal disease continues to change rapidly, even in the three years since the first Meningococcal Exchange Meeting in 2008. Control of disease caused by serogroup C has been achieved in countries that have implemented meningococcal C or quadrivalent meningococcal ACWY conjugate vaccines. Initiation of mass immunization programs with meningococcal A conjugate vaccines across the meningitis belt of Africa may lead to the interruption of cyclical meningococcal epidemics. A meningococcal B vaccination program in New Zealand has led to a decrease incidence of high rates of endemic serogroup B disease. Increases in serogroup Y disease have been observed in certain Nordic countries which, if it persists, may require consideration of use of a multiple serogroup vaccine. The imminent availability of recombinant broadly protective serogroup B vaccines may provide the tools for further control of invasive meningococcal disease in areas where serogroup B disease predominates. Continued surveillance of meningococcal disease is essential; ongoing global efforts to improve the completeness of reporting are required. %Z FOR Codes: 110309 111706 %0 Journal Article %~ Pubmed %A Wood, Nicholas %A Sheppeard, Vicky %A Cashman, Patrick %A Palasanthiran, Pamela %A Casacelli, Margot %A Cannings, Kathryn %A McIntyre, Peter %T Influenza Vaccine Safety in Children Less Than 5 Years Old. The 2010 and 2011 Experience in Australia. %B The Pediatric Infectious Disease Journal %D 2012 %V %N %P %@ 1532-0987 %X In August 2010 the United States Advisory Committee on Immunization Practices recommended that the 2010-11 CSL seasonal vaccine (Afluria??) not be administered to children 6 months through 8 years of age because of the risk of febrile convulsion following immunization. This study reports a low rate (6-7%) of fever following two non CSL brands of 2011 seasonal influenza vaccine in Australian children less than 5 years old. These data are reassuring for parents and healthcare workers regarding 2011 influenza vaccination in the northern hemisphere. %Z FOR Codes: 111403 %0 Journal Article %~ Pubmed %A Song, Ning %A Gao, Zhanhai %A Wood, James G %A Hueston, Linda %A Gilbert, Gwendolyn L %A Macintyre, C Raina %A Quinn, Helen E %A Menzies, Robert %A McIntyre, Peter %T Current epidemiology of rubella and congenital rubella syndrome in Australia: Progress towards elimination. %B Vaccine %D 2012 %V 30 %N 27 %P 4073-8 %@ 1873-2518 %X This study evaluates the evidence for elimination of rubella and congenital rubella syndrome (CRS) in Australia, drawing on three national serosurveys conducted between 1996 and 2007 and supported by statutory notification and vaccine coverage data. Anti-rubella IgG seropositivity was defined as ???10IU/ml by EIA. Between 1998 and 2007, rubella notifications fell >100-fold, to an average of 2 cases per million and there were five confirmed cases of CRS, two of which were locally acquired in 2003. Weighted overall seropositivity remained constant among 1-49 year-olds (89.6% in 1999; 88.1% in 2007). Between 2002 and 2009, 95% of children received at least one dose of the measles-mumps-rubella (MMR) vaccine. All three serosurveys provided estimates for R less than 0.5, well below the epidemic threshold of 1. All available data are supportive of Australia being considered for elimination status. Further reductions in incidence of CRS will require continued attention to vaccine coverage in overseas-born women, as well as the maintenance of current high coverage level of two-dose MMR vaccination. %Z FOR Codes: 111706 110702 %0 Journal Article %~ Pubmed %A Foxwell, Alice Ruth %A McIntyre, Peter %A Quinn, Heleh %A Roper, Katrina %A Clements, Mark S %T Severe pertussis in infants: estimated impact of first vaccine dose at 6 versus 8 weeks in australia. %B The Pediatric Infectious Disease Journal %D 2011 %V 30 %N 2 %P 161-3 %@ 1532-0987 %X We estimated the potential benefits of advancing the first dose of pertussis vaccine for infants from 8 to 6 weeks of age, using Australian national disease databases. Infants had notification rates 3-fold greater than the general population and accounted for 52% of recorded hospitalizations. Infants 1 and 2 months of age had notification rates 3.5 times (95% CI: 2.7-4.5) higher than infants 3 to 11 months of age. Estimation of acceleration of the vaccine to 6 weeks of age reduced average notifications, hospitalizations, and hospital bed-days by 8%, 9%, and 12%, respectively, with larger reductions in an epidemic year. %Z FOR Codes: 111403 %0 Journal Article %~ Pubmed %A Garland, Suzanne M %A Brotherton, Julia M L %A Condon, John R %A McIntyre, Peter B %A Stevens, Matthew P %A Smith, David W %A Tabrizi, Sepehr N %A , WHINURS study group %T Human papillomavirus prevalence among indigenous and non-indigenous Australian women prior to a national HPV vaccination program. %B BMC medicine [electronic resource] %D 2011 %V 9 %N %P 104 %@ 1741-7015 %X Indigenous women in Australia have a disproportionate burden of cervical cancer despite a national cervical screening program. Prior to introduction of a national human papilloma virus (HPV) vaccination program, we determined HPV genotype prevalence by Indigenous status and residence in remote areas. %Z FOR Codes: 110702 111701 111706 %0 Journal Article %~ Pubmed %A Quinn, Helen E %A Mahajan, Deepika %A Hueston, Linda %A Campbell, Patricia %A Menzies, Robert I %A Gilbert, Gwendolyn L %A McIntyre, Peter B %T The seroepidemiology of pertussis in NSW: fluctuating immunity profiles related to changes in vaccination schedules. %B NSW Public Health Bulletin %D 2011 %V 22 %N 11-12 %P 224-9 %@ 1034-7674 %X The pertussis epidemic experienced in NSW in 2008-2009 was likely to be in part due to changes in diagnostic practice since 2007, which amplified disease notifications. We used population-based seroepidemiology as a less biased means of interpreting age-specific pertussis infection patterns in NSW from three serosurveys undertaken in 1997-98 (during an epidemic), 2002 (post-epidemic) and 2007 (inter-epidemic), using a standardised pertussis toxin IgG enzyme-linked immunosorbent assay (ELISA). There was a decrease in the proportion of high anti-pertussis toxin IgG titres (>62.5ELISAUnits/mL) across all age groups in the 2007 serosurvey compared to the previous two serosurveys. In the 2007 serosurvey, the proportion of undetectable (<5ELISAUnits/mL) anti-pertussis toxin IgG titres increased in many age groups. The seroepidemiological profiles of the three serosurveys demonstrate fluctuating immunity profiles related to changes in vaccination schedules. %Z FOR Codes: 110702 110309 %0 Journal Article %~ Pubmed %A Van Damme, Pierre %A McIntyre, Peter %A Grimprel, Emmanuel %A Kuriyakose, Sherine %A Jacquet, Jeanne-Marie %A Hardt, Karin %A Messier, Marc %A Van Der Meeren, Olivier %T Immunogenicity of the reduced-antigen-content dTpa vaccine (Boostrix(?)) in adults 55 years of age and over: a sub-analysis of four trials. %B Vaccine %D 2011 %V 29 %N 35 %P 5932-9 %@ 1873-2518 %X Older adults, especially those over 65 years, are at risk of more severe morbidity from diphtheria, tetanus and pertussis and may transmit pertussis to unvaccinated or not yet fully vaccinated infants, but data on their response to reduced-antigen-content tetanus, diphtheria and acellular pertussis (dTpa) vaccines are lacking. %Z FOR Codes: 110702 %0 Journal Article %~ Pubmed %A Quinn, Patrick %A Gold, Michael %A Royle, Jenny %A Buttery, Jim %A Richmond, Peter %A McIntyre, Peter %A Wood, Nick %A Lee, Su-San %A Marshall, Helen %T Recurrence of extensive injection site reactions following DTPa or dTpa vaccine in children 4-6 years old. %B Vaccine %D 2011 %V 29 %N 25 %P 4230-7 %@ 1873-2518 %X The aim of this study was to compare the immunogenicity and reactogenicity of a lower dose diphtheria, tetanus and pertussis vaccine (dTpa) with the recommended vaccine (DTPa) given as a fifth dose to 4-6-year old children who previously experienced an extensive injection site reaction (ISR). %Z FOR Codes: 111403 110702 %0 Journal Article %~ Pubmed %A Quinn, Helen E %A McIntyre, Peter B %T The impact of adolescent pertussis immunization, 2004-2009: lessons from Australia. %B Bulletin of the World Health Organization %D 2011 %V 89 %N 9 %P 666-74 %@ 1564-0604 %X To compare the impact of three strategies for delivering a booster dose of adult-formulated tetanus-diphtheria-pertussis (Tdap) vaccine to adolescents in Australia. These comprise: (i)??administering Tdap to: a one-year age cohort; (ii)??administering Tdap to the entire high school and to subsequent entrant cohorts; and (iii) administering Tdap to the entire high school but without continuing to immunize entrant cohorts. %Z FOR Codes: 1114 1117 %0 Journal Article %~ Pubmed %A Buttery, J P %A Danchin, M H %A Lee, K J %A Carlin, J B %A McIntyre, P B %A Elliott, E J %A Booy, R %A Bines, J E %A , PAEDS/APSU Study Group %T Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. %B Vaccine %D 2011 %V 29 %N 16 %P 3061-6 %@ 1873-2518 %X In Australia, post-marketing surveillance for intussusception following vaccination commenced with funding of RotaTeq(?) and Rotarix(?) vaccines under the National Immunization Program (NIP) in July 2007. %Z FOR Codes: 111709 110309 %0 Journal Article %~ Pubmed %A Helms, Charles %A Leask, Julie %A Robbins, Spring Cooper %A Chow, Maria Yui Kwan %A McIntyre, Peter %T Implementation of mandatory immunisation of healthcare workers: Observations from New South Wales, Australia. %B Vaccine %D 2011 %V 29 %N 16 %P 2895-901 %@ 1873-2518 %X To identify factors influencing implementation of a state-wide mandatory immunisation policy for healthcare workers (HCWs) in New South Wales (NSW), Australia, in 2007. Vaccines included were measles, mumps, rubella, varicella, hepatitis B, diphtheria, tetanus and pertussis, but not influenza. %Z FOR Codes: 111709 %0 Journal Article %~ Pubmed %A Mahajan, Deepika %A Cook, Jane %A McIntyre, Peter B %A Macartney, Kristine %A Menzies, Rob I %T Annual report: surveillance of adverse events following immunisation in Australia, 2010. %B Communicable Diseases Intelligence Quarterly Report %D 2011 %V 35 %N 4 %P 263-80 %@ 0725-3141 %X This report summarises Australian passive surveillance data for adverse events following immunisation (AEFI) reported to the Therapeutic Goods Administration (TGA) for 2010, and describes reporting trends over the 11-year period 2000 to 2010. There were 3,894 AEFI records for vaccines administered in 2010, the highest number reported in any year, and a 63% increase over the 2,396 in 2009. The increase was almost entirely attributable to the large number of reports following seasonal influenza (n = 2,354) and pandemic H1N1 (pH1N1) influenza vaccines (n = 514). In children < 7 years of age, the number of reports following influenza vaccine increased almost 100-fold from 17 in 2009 to 1,693 in 2010 and, for people aged > or =18 years, from 135 to 496. For seasonal influenza vaccine, a disproportionate number of reports were from Western Australia (34%), consistent with more widespread influenza vaccination of children in that state, and 79% were identified as being associated with Fluvax or Fluvax junior (CSL Biotherapies). For pH1N1 vaccine, the number of reports in children < 7 years of age increased from 23 in 2009 to 329 in 2010, but was available for this age group for only 1 month (December) in 2009. In those aged > or = 18 years, for whom the pH1N1 vaccine was available from late September 2009, pH1N1 vaccine reports decreased from 1,209 in 2009 to 109 in 2010. For influenza vaccines, 79% of reports included fever, 45% allergic reactions and 15% malaise. In children aged < 7 years, there were 169 reports of convulsions (127 febrile), compared with 19 in 2009. In contrast, for non-influenza vaccines, reporting rates in children < 7 years of age increased only marginally from 14.1 per 100,000 in 2009 to 19.3 per 100,000 in 2010. Four deaths temporally associated with immunisation were reported but none were considered to have a causal association. %Z FOR Codes: 110799 111706 %0 Journal Article %~ Pubmed %A Mahajan, Deepika %A Menzies, Rob %A Cook, Jane %A Macartney, Kristine %A Mclntyre, Peter %T Supplementary report: surveillance of adverse events following immunisation among children aged less than 7 years in Australia, 1 January to 30 June 2010. %B Communicable Diseases Intelligence Quarterly Report %D 2011 %V 35 %N 1 %P 21-8 %@ 0725-3141 %X %Z FOR Codes: 111403 111716 %0 Journal Article %~ Pubmed %A Hull, Brynley %A Dey, Aditi %A Campbell-Lloyd, Sue %A Menzies, Robert I %A McIntyre, Peter B %T NSW annual immunisation coverage report, 2010. %B NSW Public Health Bulletin %D 2011 %V 22 %N 9-10 %P 179-95 %@ 1034-7674 %X This annual report, the second in the series, documents trends in immunisation coverage in NSW for children, adolescents and the elderly, to the end of 2010. Methods: Data from the Australian Childhood Immunisation Register, the NSW School Immunisation Program and the NSW Population Health Survey were used to calculate various measures of population coverage, coverage for Aboriginal children and vaccination timeliness for all children. Results: Over 90% coverage has been reached for children at 12 and 24 months of age. For children at 5 years of age there was an improvement during 2010 in timeliness for vaccines due at 4 years and coverage almost reached 90%. Delayed receipt of vaccines is still an issue for Aboriginal children. For adolescents, there is good coverage for the first and second doses of human papillomavirus vaccine and the dose of diphtheria, tetanus and acellular pertussis. The pneumococcal vaccination rate in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. Conclusion: Completion of the recommended immunisation schedule at the earliest appropriate age should be the next public health goal at both the state and local health district level. Official coverage assessments for 'fully immunised' should include the 7-valent pneumococcal conjugate and meningococcal C vaccines, and wider dissemination should be considered. %Z FOR Codes: 111711 111403 %0 Journal Article %~ Pubmed %A Hull, Brynley %A Dey, Aditi %A Mahajan, Deepika %A Menzies, Rob %A McIntyre, Peter B %T Immunisation coverage annual report, 2009. %B Communicable Diseases Intelligence Quarterly Report %D 2011 %V 35 %N 2 %P 132-48 %@ 0725-3141 %X This, the third annual immunisation coverage report, documents trends during 2009 for a range of standard measures derived from Australian Childhood Immunisation Register data, including overall coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP). Coverage by Indigenous status and mapping by smaller geographic areas as well as trends in timeliness is also summarised according to standard templates. With respect to overall coverage, the Immunise Australia Program targets have been reached for children at 12 and 24 months of age but not for children at 5 years of age. Coverage at 24 months of age exceeds that at 12 months of age, but as receipt of varicella vaccine at 18 months is excluded from calculations of 'fully immunised' this probably represents delayed immunisation, with some contribution from immunisation incentives. Similarly, the decrease in coverage estimates for immunisations due at 4 years of age from March 2008 is primarily due to changing the assessment age from 6 years to 5 years of age from December 2007. With respect to individual vaccines, a number of those available on the NIP are not currently assessed for 'fully immunised' status or for eligibility for incentive payments. These include pneumococcal conjugate and meningococcal C conjugate vaccines, for which coverage is comparable with vaccines that are assessed for 'fully immunised' status, and rotavirus and varicella vaccines for which coverage is lower. Coverage is also suboptimal for vaccines recommended for Indigenous children only (i.e. hepatitis A and pneumococcal polysaccharide vaccine) as previously reported for other vaccines for both children and adults. Delayed receipt of vaccines is an important issue for vaccines recommended for Indigenous children and has not improved among non-Indigenous children despite improvements in coverage at the 24-month milestone. Although Indigenous children in Australia have coverage levels that are similar to non-Indigenous children at 24 months of age, the disparity in delayed vaccination between Indigenous and non-Indigenous children remains a challenge. %Z FOR Codes: 111711 111403 %0 Journal Article %~ Pubmed %A Lamand?, Shireen R %A Yuan, Yuan %A Gresshoff, Irma L %A Rowley, Lynn %A Belluoccio, Daniele %A Kaluarachchi, Kumara %A Little, Christopher B %A Botzenhart, Elke %A Zerres, Klaus %A Amor, David J %A Cole, William G %A Savarirayan, Ravi %A McIntyre, Peter %A Bateman, John F %T Mutations in TRPV4 cause an inherited arthropathy of hands and feet. %B Nature Genetics %D 2011 %V 43 %N 11 %P 1142-6 %@ 1546-1718 %X Familial digital arthropathy-brachydactyly (FDAB) is a dominantly inherited condition that is characterized by aggressive osteoarthropathy of the fingers and toes and consequent shortening of the middle and distal phalanges. Here we show in three unrelated families that FDAB is caused by mutations encoding p.Gly270Val, p.Arg271Pro and p.Phe273Leu substitutions in the intracellular ankyrin-repeat domain of the cation channel TRPV4. Functional testing of mutant TRPV4 in HEK-293 cells showed that the mutant proteins have poor cell-surface localization. Calcium influx in response to the synthetic TRPV4 agonists GSK1016790A and 4??PDD was significantly reduced, and mutant channels did not respond to hypotonic stress. Others have shown that gain-of-function TRPV4 mutations cause skeletal dysplasias and peripheral neuropathies. Our data indicate that TRPV4 mutations that reduce channel activity cause a third phenotype, inherited osteoarthropathy, and show the importance of TRPV4 activity in articular cartilage homeostasis. Our data raise the possibility that TRPV4 may also have a role in age- or injury-related osteoarthritis. %Z FOR Codes: 110314 60412 %0 Journal Article %~ Pubmed %A McIntyre, Peter B %A Durrheim, David N %A Campbell-Lloyd, Sue %T The NSW Immunisation Strategy 2008-2011: how are we doing? %B NSW Public Health Bulletin %D 2010 %V 21 %N 9-10 %P 193-5 %@ 1034-7674 %X %Z FOR Codes: 111706 111709 %0 Journal Article %~ Pubmed %A Ladhani, S %A Heath, P T %A Slack, M P E %A McIntyre, P B %A Diez-Domingo, J %A Campos, J %A Dagan, R %A Ramsay, M E %A , Participants of the European Union Invasive Bacterial Infections Surveillance Network %T Haemophilus influenzae serotype b conjugate vaccine failure in twelve countries with established national childhood immunization programmes. %B Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases %D 2010 %V 16 %N 7 %P 948-54 %@ 1469-0691 %X The present study describes the clinical and immunological features of children with Hib vaccine failure, who were identified through national surveillance between 1996 and 2001 in Europe, Israel and Australia. True vaccine failure was defined as invasive Hib disease occurring ?2 weeks after one dose, given after the first birthday, or ?1 week after ?2 doses, given at <1 year of age. Of the 423 cases (representing 0.2 cases per 100,000 child-years at risk) reported, 330 (78%) had received three doses in the first year of life and developed disease at a median age of 28 months. Of the remaining 93, 48 had received two doses in infancy, 34 had received four doses including a booster, and 11 had received a single dose after 12 months of age. These children developed disease at a median age of 12, 33 and 71 months, respectively. In total, 47 out of 258 children (18%) with available information had an underlying medical problem (including prematurity) and 53 out of 161 (33%) had immunoglobulin deficiency. Convalescent Hib antibody concentrations were above the putative protective concentration of 1.0 mg/L in 147/194 (76%) children; low concentrations were associated with both the presence of an underlying medical problem and young age at the time of Hib disease. Almost all children who received an additional vaccine dose developed antibodies at protective concentrations. Thus, Hib vaccine failure is rare, but can occur with any immunization schedule. Children with Hib vaccine failure should have immunoglobulin and convalescent Hib antibody concentrations measured after infection and receive additional vaccination, if required. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Leask, Julie %A Helms, Charles M %A Chow, Maria Y %A Robbins, Spring C Cooper %A McIntyre, Peter B %T Making influenza vaccination mandatory for health care workers: the views of NSW Health administrators and clinical leaders. %B NSW Public Health Bulletin %D 2010 %V 21 %N 9-10 %P 243-7 %@ 1034-7674 %X The challenges of maintaining high influenza vaccination rates in health care workers have focused worldwide attention on mandatory measures. In 2007, NSW Health issued a policy directive requiring health care workers to be screened/vaccinated for certain infectious diseases. Annual influenza vaccine continued to be recommended but not required. This paper describes the views of NSW Health administrators and clinical leaders about adding influenza vaccination to the requirements. Of 55 staff interviewed, 45 provided a direct response. Of these, 23 supported inclusion, 14 did not and eight were undecided. Analysis of interviews indicated that successfully adding influenza vaccination to the current policy directive would require four major issues to be addressed: (1) providing and communicating a solid evidence base supporting the policy directive; (2) addressing the concerns of staff about the vaccine; (3) ensuring staff understand the need to protect patients; and (4) addressing the logistical challenges of enforcing an annual vaccination. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Mahajan, Deepika %A Roomiani, Ilnaz %A Gold, Michael S %A Lawrence, Glenda L %A McIntyre, Peter B %A Menzies, Rob I %T Annual report: surveillance of adverse events following immunisation in Australia, 2009. %B Communicable Diseases Intelligence Quarterly Report %D 2010 %V 34 %N 3 %P 259-76 %@ 0725-3141 %X This report summarises Australian passive surveillance data for adverse events following immunisation (AEFI) reported to the Therapeutic Goods Administration (TGA) for 2009, and describes reporting trends over the 10-year period 2000 to 2009. There were 2,396 AEFI records for vaccines administered in 2009, the highest number reported, a 46% increase over the 1,638 in 2008. The increase was almost entirely due to reports related to the introduction of pandemic H1N1 (pH1N1) 2009 influenza vaccine from September 2009 (n = 1,312) largely from the members of the public. The pH1N1 AEFI reporting rate for people aged > or = 18 years was 34.2 per 100,000 administered doses compared with 2.8 for seasonal influenza vaccine. The rates in > or = 65 year-olds were 28.0, 1.6 and 13.3 for pH1N1, seasonal influenza and polysaccharide pneumococcal, respectively. The high reporting rate for pH1N1 vaccine is likely to be at least partly due to enhanced reporting seen for all new vaccines and greater levels of reporting from members of the public in response to the implementation of strategies to encourage reporting, as part of the pH1N1 program. For children < 7 years, AEFI reporting rates in 2009 (14.1 per 100,000 administered doses) were similar to previous years. There were 193 (8%) AEFI reports classified as serious; 6 deaths temporally associated with immunisation were reported but none were judged to have a causal association. As in previous years, the most commonly reported reactions were allergic reaction, injection site reaction, fever, headache, malaise, nausea and myalgia. The most commonly reported reactions following pH1N1 influenza vaccine were allergic reaction (n = 381), headache (n = 289), fever (n = 235), pain (n = 186), nausea (n = 180) and injection site reaction (n = 178). The data within the limitation of passive surveillance provide a reference point for ongoing reporting of trends in AEFI by age group, severity and vaccine type and illustrate the value of the national TGA database as a surveillance tool for monitoring AEFI nationally. %Z FOR Codes: 111799 %0 Journal Article %~ Pubmed %A Hull, Brynley P %A Mahajan, Deepika %A Dey, Aditi %A Menzies, Rob I %A McIntyre, Peter B %T Immunisation coverage annual report, 2008. %B Communicable Diseases Intelligence Quarterly Report %D 2010 %V 34 %N 3 %P 241-58 %@ 0725-3141 %X This, the 2nd annual immunisation coverage report, documents trends during 2008 for a range of standard measures derived from Australian Childhood Immunisation Register data, including overall coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP). Coverage by indigenous status and mapping by smaller geographic areas as well as trends in timeliness are also summarised according to standard templates. With respect to overall coverage, Immunise Australia Program targets have been reached for children at 12 and 24 months of age but not for children at 5 years of age. Coverage at 24 months of age exceeds that at 12 months of age, but as receipt of varicella vaccine at 18 months is excluded from calculations of 'fully immunised' this probably represents delayed immunisation, with some contribution from immunisation incentives. Similarly, the decrease in coverage estimates for immunisations due at 4 years of age from March 2008, is primarily due to changing the assessment age from 6 years to 5 years of age from December 2007. A number of individual vaccines on the NIP are not currently assessed for 'fully immunised' status or for eligibility for incentive payments. These include pneumococcal conjugate and meningococcal C conjugate vaccines for which coverage is comparable to vaccines which are assessed for 'fully immunised' status, and rotavirus and varicella vaccines for which coverage is lower. Coverage is also suboptimal for vaccines recommended for Indigenous children only (i.e. hepatitis A and pneumococcal polysaccharide vaccine) as previously reported for other vaccines for both children and adults. Delayed receipt of vaccines is an important issue for vaccines recommended for Indigenous children and has not improved among non-Indigenous children despite improvements in coverage at the 24-month milestone. Although Indigenous children in Australia have coverage levels that are similar to non-indigenous children at 24 months of age, the disparity in delayed vaccination between Indigenous and non-indigenous children, which is up to 18% for the 3rd dose of DTP, remains a challenge. %Z FOR Codes: 111799 %0 Journal Article %~ Pubmed %A Brotherton, Julia %A Kaldor, John M %A McIntyre, Peter %T HPV related surveillance activities in Australia. %B Vaccine %D 2010 %V 28 %N 47 %P 7453-4 %@ 1873-2518 %X %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Hull, Brynley %A Dey, Aditi %A Mahajan, Deepika %A Campbell-Lloyd, Sue %A Menzies, Robert I %A McIntyre, Peter B %T NSW Annual Immunisation Coverage Report, 2009. %B NSW Public Health Bulletin %D 2010 %V 21 %N 9-10 %P 210-23 %@ 1034-7674 %X Aims: This is the first in a series of annual immunisation coverage reports that document trends in NSW for a range of standard measures derived from Australian Childhood Immunisation Register data, including overall coverage at standard age milestones and for individual vaccines. This report includes data up to and including 2009. Methods: Data from the Australian Childhood Immunisation Register, the NSW Health Survey and the NSW School Immunisation Program were used to calculate various measures of population coverage relating to childhood vaccines, adult influenza and pneumococcal vaccines and adolescent vaccination, respectively. Results: Immunise Australia Program targets have been reached for children at 12 and 24 months of age but not for children at 5 years of age. Delayed receipt of vaccines is an issue for vaccines recommended for Aboriginal children. Pneumococcal vaccination in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. For adolescents, there is better coverage for the first and second doses of human papillomavirus vaccine and the dose of dTpa than for varicella. Conclusion: This comprehensive analysis provides important baseline data for NSW against which future reports can be compared to monitor progress in improving immunisation coverage. Immunisation at the earliest appropriate age should be a public health goal for countries such as Australia where high levels of vaccine coverage at milestone ages have been achieved. %Z FOR Codes: 111799 %0 Journal Article %~ Pubmed %A Wood, Nicholas %A McIntyre, Peter %A Marshall, Helen %A Roberton, Don %T Acellular pertussis vaccine at birth and one month induces antibody responses by two months of age. %B The Pediatric Infectious Disease Journal %D 2010 %V 29 %N 3 %P 209-15 %@ 1532-0987 %X Infants less than 3 months of age are at highest risk of hospitalization and death from pertussis. Several studies have examined antibody responses to pertussis vaccines at birth but no previous study has evaluated 2 doses of monovalent acellular pertussis vaccine (aPV) before 2 months of age. %Z FOR Codes: 111403 110309 %0 Journal Article %~ Pubmed %A Jardine, Andrew %A Deeks, Shelley L %A Patel, Mahomed S %A Menzies, Robert I %A Gilbert, Gwendolyn L %A McIntyre, Peter B %T An evaluation of the Australian National Serosurveillance Program. %B Communicable Diseases Intelligence Quarterly Report %D 2010 %V 34 %N 1 %P 29-36 %@ 0725-3141 %X The Australian National Serosurveillance Program (ANSP) was established in 1997 to provide national estimates of population immunity to vaccine preventable diseases and inform immunisation policy in Australia. The 1st round tested opportunistically collected sera from pathology laboratories across Australia, a 2nd round was carried out in 2002, and a 3rd round of testing is currently ongoing using sera from 2007-08. This is the 1st systematic evaluation of the ANSP since its inception. Existing information and outputs from the ANSP were reviewed and used in conjunction with data collected from a survey of the program operators to evaluate the overall utility of the ANSP and the following system attributes; acceptability, stability, simplicity, flexibility, data quality, sensitivity, representativeness and timeliness. So far the ANSP has generated 26 peer-reviewed publications and provided useful data that have influenced and provided an evidence base for immunisation policy in Australia; for example informing mathematical models, which identified the need for the young adult measles-mumps-rubella immunisation campaign. However, difficulties have been encountered with obtaining enough samples for testing in the 3rd round currently being undertaken. This is a concern that has the potential to undermine the representativeness and stability of the system, and other methods of sample collection must be investigated. Serological surveillance is an important component of any comprehensive system for monitoring population immunity to vaccine preventable diseases and evaluating the effectiveness of immunisation programs. However, an effective ongoing program requires strong support to ensure it remains sustainable in an era when laboratory based population health research for the public good is becoming increasingly challenging. %Z FOR Codes: 110324 %0 Journal Article %~ Pubmed %A Burgess, Margaret A %A McIntyre, Peter B %A Hellard, Margaret %A Ruff, Tilman A %A Lefevre, Inge %A Bock, Hans L %T Antibody persistence six years after two doses of combined hepatitis A and B vaccine. %B Vaccine %D 2010 %V 28 %N 10 %P 2222-6 %@ 1873-2518 %X Persistent immunity to hepatitis A and hepatitis B antibodies six years after vaccination of adolescents (aged 12-15 years) with a combined hepatitis A and B (HAB) vaccine following a 0, 6 month or a 0, 12 month schedule was assessed. Yearly (Year-2-6) serum samples were tested for anti-HAV and anti-HBs using EIA. Subjects with anti-HBs concentrations <10 mIU/mL (14/23) at Year-5 or Year-6, received an additional HBV vaccine dose approximately 12 months after Year-6. Blood samples were collected pre-booster and 1 month post-booster to assess booster response. 240 subjects were vaccinated in the study; at Year-6, data were available from 88 subjects. At that time 84.8% (39/46; 0, 6 month) and 92.9% (39/42; 0, 12 month) of subjects had anti-HBs concentrations > or = 10 mIU/mL. All but one of the 14 boosted subjects responded to the additional HBV vaccine dose with anti-HBs concentrations > or = 100 mIU/mL. All seroconverted subjects who returned at Year-6 were seropositive for anti-HAV. Simplification, reduced number of doses and similar long-term persistence of immunity make the 0, 6 month and 0, 12 month schedule preferable for immunization against HAV/HBV in this population. %Z FOR Codes: 110309 %0 Journal Article %~ Pubmed %A Chiu, Clayton %A Dey, Aditi %A Wang, Han %A Menzies, Robert %A Deeks, Shelley %A Mahajan, Deepika %A Macartney, Kristine %A Brotherton, Julia %A Jardine, Andrew %A Quinn, Helen %A Jelfs, Jane %A Booy, Robert %A Lawrence, Glenda %A Jayasinghe, Sanjay %A Roberts-Witteveen, April %A Senanayake, Sanjaya %A Wood, Nicholas %A McIntyre, Peter %T Vaccine preventable diseases in Australia, 2005 to 2007. %B Communicable Diseases Intelligence Quarterly Report %D 2010 %V 34 Supp %N %P S1-167 %@ 0725-3141 %X %Z FOR Codes: 111706 %0 Journal Article %~ Isi %A Marshall, H. %A McIntyre, P. %A Roberton, D. %A Dinan, L. %A Hardt, K. %T Primary and booster immunization with a diphtheria, tetanus, acellular pertussis, hepatitis B (DTPa-HBV) and Haemophilus influenzae type b (Hib) vaccine administered separately or together is safe and immunogenic %B International Journal of Infectious Diseases %D 2010 %C United Kingdom, Unit %I Elsevier Ltd %V 14 %N 1 %P E41-E49 %@ 1201-9712 %X %Z FOR Codes: 111706 110702 %0 Journal Article %~ Pubmed %A Gold, Michael S %A McIntyre, Peter %T Human papillomavirus vaccine safety in Australia: experience to date and issues for surveillance. %B %D 2010 %V 7 %N 3 %P 320-4 %@ 1448-5028 %X Australia was one of the first countries to licence a quadrivalent human papillomavirus (HPV) vaccine, rapidly followed by a federally funded program of universal vaccination of a broad age group of females through schools (12 to 18 years) and primary care (19 to 26 years). As of August 2009, more than 5.8 million doses of Gardasil((R)) (quadrivalent; Merck, New Jersey, USA) have been distributed in Australia and a total of 1394 suspected adverse events following immunisation (AEFI) have been reported to the passive surveillance system. Most reports are of common and expected reactions. Case series of more uncommon and serious AEFI, both known to be potentially vaccine related (anaphylaxis, conversion disorders and lipoatrophy) and otherwise (multiple sclerosis and pancreatitis) have been published. %Z FOR Codes: 111716 %0 Book Section %A McIntyre, Peter %A Gilroy, Nicole %A Lester, Rosemary %A Macartney, Kristine %T Immunisation %B Infectious diseases: a clinical approach. 3rd ed %D 2010 %C Melbourne %I IP Communications Pty Ltd %V %N %P 648-666 %@ 9780980458695 %E Yung, Allen %E Spelman, Denis %E Street, Alan %E McCormack, Joe %E Johnson, Paul %X %Z FOR Codes: 110309 111716 %0 Journal Article %~ Pubmed %A Quinn, H E %A McIntyre, P B %A Backhouse, J L %A Gidding, H F %A Brotherton, J %A Gilbert, G L %T The utility of seroepidemiology for tracking trends in pertussis infection. %B Epidemiology and Infection %D 2010 %V 138 %N 3 %P 426-33 %@ 1469-4409 %X Comparing pertussis epidemiology over time and between countries is confounded by differences in diagnostic and notification practices. Standardized serological methods applied to population-based samples enhance comparability. Population prevalence of different levels of pertussis toxin IgG (PT IgG) antibody, measured by standardized methods, were compared by age group and region of Australia between 1997/1998 and 2002. The proportion of 5- to 9-year-olds with presumptive recent pertussis infection (based on IgG levels >or=62.5 ELISA units/ml) significantly decreased in 2002, consistent with notification data for the same period and improved uptake of booster vaccines following the schedule change from whole-cell to acellular vaccine. In contrast, recent presumptive infection significantly increased in adults aged 35-49 years. Population-based serosurveillance using standardized PT IgG antibody assays has the potential to aid interpretation of trends in pertussis incidence in relation to vaccine programmes and between countries. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Wood, Nicholas %A McIntyre, Peter %T Epiglottitis: Going, going, but not gone yet. %B Journal of Paediatrics and Child Health %D 2010 %V 46 %N 7-8 %P 446 %@ 1440-1754 %X %Z FOR Codes: 111403 %0 Journal Article %A Wood, Nicholas %A McIntyre, Peter %T 1st International Neonatal and Maternal Immunization Symposium %B Expert Review of Obstretrics and Gynecology %D 2010 %C United Kingdom %I Expert Reviews Ltd. %V 5 %N 5 %P 507-509 %@ 1747-4108 %X %Z FOR Codes: 111403 %0 Journal Article %~ Pubmed %A Ridda, I %A Macintyre, C R %A Lindley, R %A McIntyre, P B %A Brown, M %A Oftadeh, S %A Sullivan, J %A Gilbert, G L %T Lack of pneumococcal carriage in the hospitalised elderly. %B Vaccine %D 2010 %V 28 %N 23 %P 3902-4 %@ 1873-2518 %X There have been few surveys of Streptococcus pneumoniae and Neisseria meningitidis carriage in sick or frail elderly people who, with the very young, comprise the group who are at highest risk for pneumococcal disease. We studied pneumococcal carriage among participants in a pneumococcal immunisation study in the frail elderly. %Z FOR Codes: 110801 110308 111716 %0 Journal Article %~ Pubmed %A Leask, Julie %A Booy, Robert %A McIntyre, Peter B %T MMR, Wakefield and The Lancet: what can we learn? %B Medical Journal of Australia %D 2010 %V 193 %N 1 %P 5-7 %@ 0025-729X %X Vaccine scares are inevitable and we need to plan accordingly. %Z FOR Codes: 111704 %0 Journal Article %~ Isi %A White, O. J. %A Rowe, J. %A Richmond, P. %A Marshall, H. %A McIntyre, P. %A Wood, N. %A Holt, P. G. %T Th2-polarisation of cellular immune memory to neonatal pertussis vaccination %B Vaccine %D 2010 %C United Kingdom %I Elsevier Ltd %V 28 %N 14 %P 2648-2652 %@ 0264-410X %X %Z FOR Codes: 110702 %0 Journal Article %~ Pubmed %A Jardine, Andrew %A Menzies, Robert I %A McIntyre, Peter B %T Reduction in hospitalizations for pneumonia associated with the introduction of a pneumococcal conjugate vaccination schedule without a booster dose in Australia. %B The Pediatric Infectious Disease Journal %D 2010 %V 29 %N 7 %P 607-12 %@ 1532-0987 %X Postmarketing surveillance of heptavalent pneumococcal conjugate vaccine (7vPCV) has shown significant reductions in admissions coded as pneumonia in countries where a booster dose is given in the second year of life. In Australia, a 3-dose primary schedule at 2, 4, and 6 months of age without a booster has been funded nationally for non-Indigenous children since 2005. %Z FOR Codes: 111716 111706 110309 %0 Journal Article %~ Pubmed %A Brouwer, Matthijs C %A McIntyre, Peter %A de Gans, Jan %A Prasad, Kameshwar %A van de Beek, Diederik %T Corticosteroids for acute bacterial meningitis. %B Cochrane Database of Systematic Reviews %D 2010 %V %N 9 %P CD004405 %@ 1469-493X %X In experimental studies, the outcome of bacterial meningitis has been related to the severity of inflammation in the subarachnoid space. Corticosteroids reduce this inflammatory response. %Z FOR Codes: 110309 %0 Journal Article %~ Pubmed %A McIntyre, Peter %T Adjunctive dexamethasone in meningitis: does value depend on clinical setting? %B Lancet. Neurology %D 2010 %V 9 %N 3 %P 229-31 %@ 1474-4465 %X %Z FOR Codes: 110309 %0 Journal Article %A Isaacs, David %A Macartney, Kristine %A McIntyre, Peter %T Rapid Response: Benefits and risks of childhood influenza vaccination %B BMJ %D 2010 %C United Kingdom, United States %I BMJ Group %V June 28 %N %P 1 %@ 1468-5833 %X %Z FOR Codes: 110702 111403 %0 Journal Article %~ Pubmed %A Leask, Julie %A McIntyre, Peter B %T Vaccine refusal and the risks of vaccine-preventable diseases. %B New England Journal of Medicine %D 2009 %V 361 %N 7 %P 723; author reply 723-4 %@ 1533-4406 %X %Z FOR Codes: 111799 %0 Journal Article %~ Pubmed %A Ridda, I %A Macintyre, C R %A Lindley, R %A Gao, Z %A Sullivan, J S %A Yuan, F F %A McIntyre, P B %T Immunological responses to pneumococcal vaccine in frail older people. %B Vaccine %D 2009 %V 27 %N 10 %P 1628-36 %@ 0264-410X %X Advanced age has been associated with a wide range of defects in both the innate and adaptive immune systems including diminished specific antibody responses that increase the risk of invasive pneumococcal disease (IPD) and limit the effectiveness of vaccines. However, the elderly are a heterogeneous group and measures of overall frailty may be a better indicator of disease susceptibility (or vaccine response) than chronological age alone. %Z FOR Codes: 110701 111702 %0 Journal Article %~ Pubmed %A Simpkins, Daniel %A Wood, Nicholas %A Jelfs, Jane %A McIntyre, Peter %A Menzies, Robert %A Lawrence, Glenda %A Booy, Robert %T Modern trends in mortality from meningococcal disease in Australia. %B The Pediatric Infectious Disease Journal %D 2009 %V 28 %N 12 %P 1119-20 %@ 1532-0987 %X Between 1979 and 2006, there were 610 deaths recorded as due to meningococcal disease in Australia. Mortality rates per capita consistently increased on average by 6% per annum between 1979 and 2002, but then fell significantly in 2003, coinciding with the introduction of the meningococcal C conjugate vaccine. In 2002, the mortality rate was 0.24 per 100,000. In the 4 years since, it fell progressively to 0.06 per 100,000. Since the introduction of conjugate Hib and pneumococcal vaccines, meningococcal disease has emerged as the number 1 infectious cause of death in children but conjugate meningococcal C vaccine appears to have greatly reduced total meningococcal disease deaths. %Z FOR Codes: 110309 111403 %0 Journal Article %~ Pubmed %A Hull, Brynley P %A Deeks, Shelley L %A McIntyre, Peter B %T The Australian Childhood Immunisation Register-A model for universal immunisation registers? %B Vaccine %D 2009 %V 27 %N 37 %P 5054-60 %@ 1873-2518 %X The Australian Childhood Immunisation Register (ACIR) was established in 1996 as an opt-out register built on the platform of Medicare, the universal national health insurance scheme. Introduction of financial incentives for providers and parents, linked to the ACIR, followed from 1998. Over the subsequent decade, national levels for receipt of all vaccines by 12, 24 and 72 months of age have risen to 91%, 93%, and 88%, respectively. Conscientious objection to immunisation can be registered, with retention of eligibility for incentives. The ACIR has been important in implementation of a range of measures to improve childhood immunisation coverage in Australia. Linkage of a universal childhood immunisation register to national health insurance schemes has potential applicability in a variety of settings internationally. %Z FOR Codes: 111711 %0 Journal Article %~ Pubmed %A Gunasekera, Hasantha %A Morris, Peter S %A McIntyre, Peter %A Craig, Jonathan C %T Management of children with otitis media: a summary of evidence from recent systematic reviews. %B Journal of Paediatrics and Child Health %D 2009 %V 45 %N 10 %P 554-62; quiz 562-3 %@ 1440-1754 %X Health-care professionals who manage children are regularly confronted with clinical questions regarding the management of the full spectrum of otitis media: acute otitis media; otitis media with effusion; and chronic suppurative otitis media. Given the variety of potential therapies available, the wide spectrum of middle ear disorders, and the lack of consensus about management strategies, clinicians are in a difficult position when managing these children. In this review, we seek to summarise the current best evidence for answering otitis media management questions by collating existing systematic reviews. %Z FOR Codes: 1114 %0 Journal Article %~ Pubmed %A Wood, James G %A Gidding, Heather F %A Heywood, Anita %A Macartney, Kristine %A McIntyre, Peter B %A Macintyre, C Raina %T Potential impacts of schedule changes, waning immunity and vaccine uptake on measles elimination in Australia. %B Vaccine %D 2009 %V 27 %N 2 %P 313-8 %@ 0264-410X %X The second dose of MMR vaccine (MMR2) is scheduled at 4 years in Australia and the USA but earlier in some European countries. We modelled the effect on measles elimination status and population susceptibility of shifting delivery of MMR2 from 4 years to 18 months using relevant Australian data. Susceptibility in young children was reduced but elimination was not sustainable past 2015 if 6% of vaccinated seroconverters became susceptible after 10 years. One-dose MMR coverage of 96% or greater maintained elimination more effectively than modelled changes in scheduling, suggesting that maximising one-dose MMR coverage should be the highest priority. %Z FOR Codes: 110309 111716 %0 Journal Article %~ Pubmed %A McIntyre, Peter B %A Burgess, Margaret A %A Egan, Annemarie %A Schuerman, Lode %A Hoet, Bernard %T Booster vaccination of adults with reduced-antigen-content diphtheria, Tetanus and pertussis vaccine: immunogenicity 5 years post-vaccination. %B Vaccine %D 2009 %V 27 %N 7 %P 1062-6 %@ 0264-410X %X At 60 months post-vaccination, adults (mean age 45.6 years) randomised to receive combined reduced-antigen-content diphtheria-tetanus and acellular pertussis vaccine (dTpa) versus tetanus-diphtheria (Td)+monovalent acellular pertussis (pa) were seroprotected against diphtheria (> or =0.016IU/mL Vero cell assay) and tetanus (> or =0.1IU/mL ELISA assay) in 94.4% and 96.2%, respectively (dTpa), compared with 93.7% and 90.6% (Td+pa). Anti-FHA, anti-PT and anti-PRN antibodies (> or =5EL.U/mL) were maintained in 100%, 89.5% and 95.0% of dTpa versus 100%, 85.5% and 90.6% of pa vaccine recipients. At 5 years post boosting, antibody levels to diphtheria and tetanus are similar amongst adults receiving a dTpa or dT, and pertussis antibodies remain above pre-booster levels in at least 85%. %Z FOR Codes: 110799 110799 110799 111716 %0 Journal Article %~ Pubmed %A Rank, Claudia %A Quinn, Helen %A McIntyre, Peter %T Pertussis vaccine effectiveness after mass immunization of high school students in Australia. %B The Pediatric Infectious Disease Journal %D 2009 %V 28 %N 2 %P 152-3 %@ 0891-3668 %X Vaccine effectiveness in the first large-scale use of adolescent pertussis vaccine in Australia was evaluated by the screening method. Vaccine effectiveness was 78.0% (95% CI: 60.7-87.6%) for all study cases (n = 167), increasing to 85.4% (95% CI: 83.0-87.5%) for laboratory-confirmed cases (n = 155). Effectiveness should be comparable in settings with similar programs, such as the United States and Canada. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Menzies, Rob %A Mahajan, Deepika %A Gold, Michael S %A Roomiani, Ilnaz %A McIntyre, Peter %A Lawrence, Glenda %T Annual report: surveillance of adverse events following immunisation in Australia, 2008. %B Communicable Diseases Intelligence Quarterly Report %D 2009 %V 33 %N 4 %P 365-81 %@ 0725-3141 %X This report summarises Australian passive surveillance data for adverse events following immunisation (AEFI) reported to the Therapeutic Goods Administration (TGA) for 2008, and describes reporting trends over the 9-year period 2000 to 2008. There were 1,542 AEFI records for vaccines administered in 2008. This was an annual AEFI reporting rate of 7.2 per 100,000 population, a 5% decrease compared with 2007. The majority of AEFI reports described non-serious events while 10% (n = 152) were classified as serious. Two deaths temporally associated with immunisation were reported; there was no evidence to suggest a causal association. The most commonly reported reactions were injection site reaction, allergic reaction, fever and headache. AEFI reporting rates in 2008 were 2.7 events per 100,000 administered doses of influenza vaccine for adults aged > or = 18 years, 18.9 per 100,000 administered doses of pneumococcal polysaccharide vaccine for those aged > or = 65 years, and 17.2 per 100,000 administered doses of scheduled vaccines for children aged < 7 years. Reports for infants increased in 2008, mainly related to gastrointestinal system events temporally associated with receipt of rotavirus vaccine in the 1st full year of the rotavirus immunisation program, while there was a substantial decrease in AEFI reports for human papilIoma virus vaccine in adolescents compared with 2007 when the program commenced. Increases in reports in children and adults were also partly attributed to the implementation of enhanced passive surveillance in Victoria. The consistently low reporting rate of serious AEFI highlights the safety of vaccines in Australia and illustrates the value of the national TGA database as a surveillance tool for monitoring AEFIs nationally. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Hull, Brynley %A Deeks, Shelley %A Menzies, Rob %A McIntyre, Peter %T Immunisation coverage annual report, 2007. %B Communicable Diseases Intelligence Quarterly Report %D 2009 %V 33 %N 2 %P 170-87 %@ 0725-3141 %X %Z FOR Codes: 111712 110309 %0 Journal Article %~ Pubmed %A Gidding, Heather F %A Wallace, Cate %A Lawrence, Glenda L %A McIntyre, Peter B %T Australia's national Q fever vaccination program. %B Vaccine %D 2009 %V 27 %N 14 %P 2037-41 %@ 0264-410X %X A nationally funded Q fever vaccination program was introduced in Australia in 2002. The evaluation of this unique program included measures of program uptake, safety, and notification and hospitalisation rates for Q fever pre- and post-program implementation. Program uptake ranged from close to 100% amongst abattoir workers to 43% in farmers. The most commonly reported adverse event was injection site reaction. Q fever notification rates declined by over 50% between 2002 and 2006, particularly in young adult males, consistent with the profile of the abattoir workforce. Hospitalisation data showed similar trends. Available evidence suggests a significant impact of Australia's Q fever vaccination program; such a program merits consideration in other countries with a comparable Q fever disease burden. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Jardine, Andrew %A Menzies, Robert %A Deeks, Shelley %A Patel, Mahomed %A McIntyre, Peter %T The impact of pneumococcal conjugate vaccine on rates of myringotomy with ventilation tube insertion in Australia. %B The Pediatric Infectious Disease Journal %D 2009 %V 28 %N 9 %P 761-5 %@ 1532-0987 %X In randomized controlled trials and postmarketing studies the heptavalent pneumococcal conjugate vaccine (7vPCV) has been shown to reduce myringotomy with ventilation tube insertion (MVTI) procedures in a 4-dose schedule. In Australia, a 3-dose schedule at 2, 4, and 6 months of age is routinely used in non-Indigenous children. Our aim was to determine if a reduction in MVTI comparable to that documented in the United States occurred in Australia despite the absence of the booster dose. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Heywood, Anita E %A Gidding, Heather F %A Riddell, Michaela A %A McIntyre, Peter B %A MacIntyre, C Raina %A Kelly, Heath A %T Elimination of endemic measles transmission in Australia. %B Bulletin of the World Health Organization %D 2009 %V 87 %N 1 %P 64-71 %@ 1564-0604 %X Elimination of endemic measles transmission is the culmination of a range of control measures at a national level. Current documentation of elimination proposed by WHO's regional offices requires achieving specific targets for surveillance process indicators. We demonstrate how Australia, although not meeting these specific targets, has satisfied multiple criteria that justify the formal declaration of measles elimination. Our review shows that few countries previously declaring measles elimination have satisfied the current WHO surveillance targets. We argue that the requirements for recognition of measles elimination should not restrict countries to a particular type of surveillance system or surveillance criteria. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A McIntyre, Peter %A Wood, Nicholas %T Pertussis in early infancy: disease burden and preventive strategies. %B Current opinion in infectious diseases %D 2009 %V 22 %N 3 %P 215-23 %@ 1535-3877 %X PURPOSE OF REVIEW: Severe pertussis disease in early infancy remains a significant problem, both in developed countries with long-standing pertussis immunization programs and in poor countries. We review current understanding of the disease burden and potential prevention strategies. RECENT FINDINGS: Even with intensive care support, infants with pertussis pneumonia still die, so prevention is the key. The source of pertussis in infants under 3 months of age is often not clear, but in countries with high childhood immunization coverage, the sources are usually adults. Strategies to protect these infants may be indirect (timely primary immunization and boosters for older children and adults) and direct (mother during pregnancy or infant soon after birth). 'Cocooning' by immunizing all potential adult contacts is probably the most effective indirect strategy but needs funding and programmatic support for successful implementation. Maternal immunization is attractive but unproven and has significant practical hurdles. The evidence on immunization at birth is conflicting and impact, including interference with response to other infant vaccines, is unclear. SUMMARY: Adult booster immunization, either universal or targeted (mothers during pregnancy or 'cocoon'), would probably be effective but is challenging to implement. If shown to be safe and effective, immunization at birth has significant practical advantages. Different strategies (alone or combined) may be needed in different settings. %Z FOR Codes: 110309 110309 %0 Journal Article %~ Pubmed %A McIntyre, Peter B %A Brotherton, Julia M L %A Burgess, Margaret A %A Kemp, Andrew S %T More data from Australia on sensitivity to HPV vaccine. %B BMJ %D 2009 %V 338 %N %P b26 %@ 1468-5833 %X %Z FOR Codes: 110702 %0 Journal Article %~ Pubmed %A McIntyre, Peter %A Leask, Julie %T Improving uptake of MMR vaccine. %B BMJ %D 2008 %V 336 %N 7647 %P 729-30 %@ 1468-5833 %X %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Brotherton, Julia M L %A Gold, Mike S %A Kemp, Andrew S %A McIntyre, Peter B %A Burgess, Margaret A %A Campbell-Lloyd, Sue %A , New South Wales Health HPV Adverse Events Panel %T Anaphylaxis following quadrivalent human papillomavirus vaccination. %B CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne %D 2008 %V 179 %N 6 %P 525-33 %@ 1488-2329 %X BACKGROUND: In 2007, Australia implemented the National human papillomavirus (HPV) Vaccination Program, which provides quadrivalent HPV vaccine free to all women aged 12-26 years. Following notification of 7 presumptive cases of anaphylaxis in the state of New South Wales, Australia, we verified cases and compared the incidence of anaphylaxis following HPV vaccination to other vaccines in comparable settings. METHODS: We contacted all patients with suspected anaphylaxis and obtained detailed histories from telephone interviews and a review of medical records. A multidisciplinary team determined whether each suspected case met the standardized Brighton definition. Some participants also received skin-prick allergy testing for common antigens and components of the HPV vaccine. RESULTS: Of 12 suspected cases, 8 were classified as anaphylaxis. Of these, 4 participants had negative skin-prick test results for intradermal Gardasil. From the 269 680 HPV vaccine doses administered in schools, 7 cases of anaphylaxis were identified, which represents an incidence rate of 2.6 per 100 000 doses (95% CI 1.0-5.3 per 100 000). In comparison, the rate of identified anaphylaxis was 0.1 per 100 000 doses (95% CI 0.003-0.7) for conjugated meningococcal C vaccination in a 2003 school-based program. INTERPRETATION: Based on the number of confirmed cases, the estimated rate of anaphylaxis following quadrivalent HPV vaccine was significantly higher than identified in comparable school-based delivery of other vaccines. However, overall rates were very low and managed appropriately with no serious sequelae. %Z FOR Codes: 1107 1117 %0 Journal Article %A Begg, Kylie %A Roche, Paul %A Owen, Rhonda %A Liu, Conan %A Kaczmarek, Marlena %A Hii, Aurysia %A Stirzaker, Stefan %A McDonald, Ann %A Fitzsimmons, Gerard %A McIntyre, Peter %A Menzies, Robert %A East, Iain %A Coleman, David %A O'Neill, Krissa %T Australia's notifiable diseases status, 2006, Annual Report of the National Notifiable Diseases Surveillance System %B Communicable Diseases Intelligence %D 2008 %C Canberra, Australia %I Australian Government %V 32 %N %P 139-207 %@ 0725-3141 %X %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Wood, Nicholas %A Warlow, Margaret %A Quinn, Helen %A Selvey, Christine %A Lum, Gary %A McIntyre, Peter %A Kaldor, John %T Establishment of a surveillance system (utilising Midwifes Data Collection Systems) for monitoring the impact of hepatitis B vaccination on the population prevalence of chronic hepatitis B virus infection in Australia. %B Australian and New Zealand Journal of Public Health %D 2008 %V 32 %N 3 %P 272-5 %@ 1326-0200 %X Objective: To examine how routine hepatitis B surface antigen (HBsAg) testing of antenatal women (as identified on the NT Midwifes Data Collection System) can be used to track the impact of hepatitis B (HBV) vaccination on the prevalence of chronic HBV infection in the Northern Territory (NT). Methods: Women who gave birth between 01 July 2002 and 30 June 2004 were identified from the NT Midwives Data Collection System (MDCS). For each woman, the unique hospital record number (HRN) was linked to the information system of the NT Government pathology service to obtain the results of serological tests for hepatitis B. The prevalence of HBsAg was calculated by age, Indigenous status, and maternal country of birth. Results: During the study period, 1061 records of women from the NT MDCS could be linked to HBsAg results. Overall, 33 (3.1%) were positive for HBsAg, of whom 29 were recorded as Indigenous and the remaining four were born outside Australia. Conclusions: Linking data from the NT MDCS and HBsAg results from government pathology service is a feasible means to monitor the impact of HBV vaccination policy. Implications: Routine inclusion of HBsAg results in all state and territory midwives data collections should be pursued. %Z FOR Codes: 111711 %0 Journal Article %~ Pubmed %A Lawrence, Glenda %A Gold, Michael S %A Hill, Richard %A Deeks, Shelley %A Glasswell, Amy %A McIntyre, Peter B %T Annual report: surveillance of adverse events following immunisation in Australia, 2007. %B Communicable Diseases Intelligence Quarterly Report %D 2008 %V 32 %N 4 %P 371-87 %@ 0725-3141 %X This report summarises Australian passive surveillance data for adverse events following immunisation (AEFI) reported to the Therapeutic Goods Administration for 2007, and describes reporting trends over the 8-year period 2000 to 2007. There were 1,538 AEFI records for vaccines administered in 2007. This is an annual AEFI reporting rate of 7.3 per 100,000 population, the highest since 2003 and an 85% increase compared with 2006 (835 AEFI records; 4.0 records per 100,000 population). The increase was almost entirely due to reports following the commencement of the national 3-dose human papillomavirus (HPV) vaccine program for females aged 12 to 26 years in April 2007 (n = 705 reports) and the national infant rotavirus vaccine program in July 2007 (n = 72 reports). AEFI reporting rates in 2007 were 2.3 per 100,000 administered doses of influenza vaccine for adults aged > or = 18 years, 18.6 per 100,000 administered doses of pneumococcal polysaccharide vaccine for those aged > or = 65 years and 12.7 per 100,000 administered doses of scheduled vaccines for children aged < 7 years. The majority of the 1,538 AEFI reports for 2007 described non-serious events while 9% (n = 141) were classified as serious. Two deaths temporally associated with immunisation were reported; there was no evidence to suggest a causal association. The most significant AEFI reported following HPV vaccine were anaphylaxis (n = 11) and convulsion (n = 18), mostly associated with syncope. The most commonly reported reactions were allergic reaction, injection site reaction, headache and nausea. The data confirm that, despite the low rate of AEFI reporting in Australia, the passive surveillance system is sufficiently robust to detect safety signals which are expected following changes in the immunisation program, allowing these to be investigated further. %Z FOR Codes: 111716 111716 %0 Journal Article %~ Pubmed %A Wood, Nicholas %A Quinn, Helen E %A McIntyre, Peter %A Elliott, Elizabeth %T Pertussis in infants: preventing deaths and hospitalisations in the very young. %B Journal of Paediatrics and Child Health %D 2008 %V 44 %N 4 %P 161-5 %@ 1440-1754 %X Pertussis is a particular concern in infants under 6 months of age. They have the highest rates and severity of disease resulting in hospitalisation or death but are too young to be protected by current vaccination schedules. We outline the current epidemiology of pertussis in Australia and four potential strategies to prevent pertussis in the very young. First, universal adult and or adolescent vaccination; second, indirect protection of infants by immunisation of parents and possibly others in close contact with the newborn, such as grandparents and health-care workers; third, newborn and early infant vaccination (from birth to 1 month of age) and fourth maternal vaccination. %Z FOR Codes: 111403 %0 Journal Article %~ Pubmed %A Aratchige, Padmasiri E %A McIntyre, Peter B %A Quinn, Helen E %A Gilbert, Gwendolyn L %T Recent increases in mumps incidence in Australia: the "forgotten" age group in the 1998 Australian Measles Control Campaign. %B Medical Journal of Australia %D 2008 %V 189 %N 8 %P 434-7 %@ 0025-729X %X OBJECTIVES: To describe the epidemiology of mumps and examine potential factors underlying the recent increase in the incidence of mumps in Australia. DESIGN, SETTING AND PARTICIPANTS: Analytical descriptive study, for all Australian states and territories, of mumps notifications (1994-2007); hospitalisations for mumps (1994-2005); and mumps seroprevalence in a nationally representative sample of 2787 subjects (1997). MAIN OUTCOME MEASURES: Incidence of notifications and hospitalisations for mumps; seropositivity by birth cohort. RESULTS: Notified mumps cases increased from 60 in 2002 to 231 in 2005 and 512 in 2007. Between 1994 and 2005, there were 605 hospitalisations for mumps. Mumps seropositivity in all states and territories in 1997 was high (range, 87.1%-94.3%). The predominant age group affected by mumps shifted to adults over time: between 2005 and 2007, 41% of cases occurred among people aged 20-29 years. Cases were concentrated among the birth cohort of 1978 to 1982, who had higher rates of notifications and hospitalisations for mumps and a lower seropositivity rate (92% [95% CI, 89%-94%]) than other birth cohorts. CONCLUSIONS: The birth cohort of 1978 to 1982 was too old to reliably receive a second dose of measles-mumps-rubella (MMR) vaccine in the 1998 Australian Measles Control Campaign and too young to have had mumps infection. Renewed efforts to maximise two-dose MMR coverage are important for prevention of mumps and measles in young adults. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Macartney, Kristine %A McIntyre, Peter %T Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. %B Cochrane Database of Systematic Reviews %D 2008 %V %N 3 %P CD001833 %@ 1469-493X %X BACKGROUND: Live attenuated varicella vaccines for the prevention of varicella (chickenpox) has been demonstrated both in randomised controlled trials (RCTs) and in population-based immunisation programmes in countries such as the United States. However, many countries do not routinely immunise children against varicella, and exposures continue to occur. Although the disease is often mild, complications such as secondary bacterial infection, pneumonitis and encephalitis occur in about 1% of cases, usually leading to hospitalisation. The use of varicella vaccine in persons who have recently been exposed to the varicella zoster virus has been studied as a form of post-exposure prophylaxis (PEP). OBJECTIVES: To assess the efficacy and safety of vaccines for use as PEP for the prevention of varicella in children and adults. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, Issue 1); MEDLINE (1966 to February 2008); and EMBASE (January 1990 to February 2008). SELECTION CRITERIA: RCTs and quasi-RCTs of varicella vaccine for PEP compared with placebo or no intervention. The outcome measures were efficacy in prevention of clinical cases and/or laboratory-confirmed clinical cases and adverse effects following vaccination. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted and analysed data using Review Manager software. MAIN RESULTS: Three studies involving 110 healthy children who were siblings of household contacts were identified as suitable for inclusion. The studies varied in quality, study design, vaccine used, and outcomes measured and, as such, were not suitable for meta-analysis. Overall, 13 out of 56 vaccine recipients (18%) developed varicella compared with 42 out of 54 placebo (or no vaccine) recipients (78%). Of the vaccine recipients who developed varicella, the majority only had mild disease (with less than 50 skin lesions). In the three studies, most subjects received PEP within three days following exposure; too few subjects were vaccinated four to five days post exposure to ascertain the efficacy of vaccine given more than three days after exposure. No included studies reported on adverse events following immunisation. AUTHORS' CONCLUSIONS: These small trials suggest varicella vaccine administered within three days to children following household contact with a varicella case reduces infection rates and severity of cases. No RCTs for adolescents or adults were identified. However safety was not adequately addressed. %Z FOR Codes: 111403 110309 %0 Journal Article %~ Pubmed %A Ridda, I %A Motbey, C %A Lam, L %A Lindley, I R %A McIntyre, P B %A Macintyre, C R %T Factors associated with pneumococcal immunisation among hospitalised elderly persons: a survey of patient's perception, attitude, and knowledge. %B Vaccine %D 2008 %V 26 %N 2 %P 234-40 %@ 0264-410X %X AIM: To investigate attitudes, perceptions and knowledge of elderly hospital patients in regard to vaccination in general and pneumococcal vaccination in particular. SETTING: A hospital-based patient survey in Sydney, Australia. PARTICIPANTS: Patients aged 60 years and older who are admitted to selected wards in an 800-bed tertiary referral hospital in Sydney, Australia. METHODS: A face-to-face interview administered to 200 inpatients. RESULTS: Approximately half (49%) of the patients had a positive attitude to vaccination whereas 59% had less positive perception. There were 35% of the patients who were unvaccinated against influenza and pneumococcal disease. Positive perception (OR 2.9, 95% C.I.=1.3-6.5) and attitude (OR 4.4, 95% C.I.=2.0-9.4) significantly predicted vaccination with both vaccines. Similarly the odds of receiving pneumococcal vaccination for those who had a more positive attitude and more correct knowledge were significant (OR=2.3, 95% C.I.=1.0-5.4; OR=2.7, 95% C.I.=1.1-6.8). We explored reasons for non-vaccination. Physician recommendation was listed as an important factor by patients. CONCLUSIONS: Positive perception and attitude towards vaccination are significant factors associated with immunisation status. For the pneumococcal vaccination, having influenza vaccination is related to pneumococcal vaccination. %Z FOR Codes: 111716 %0 Journal Article %A Chiu, Clayton %A Ridley, Greta %A Menzies, Robert %A McIntyre, Peter %T Update on childhood pneumococcal vaccination %B Pediatric Health %D 2008 %C United Kingdom %I Future Medicine Ltd. %V 2 %N 3 %P 351-365 %@ 1745-5111 %X %Z FOR Codes: 111403 %0 Journal Article %~ Pubmed %A Wang, Han %A Deeks, Shelley %A Glasswell, Amy %A McIntyre, Peter %T Trends in invasive haemophilus influenzae type B disease in Australia, 1995-2005. %B Communicable Diseases Intelligence Quarterly Report %D 2008 %V 32 %N 3 %P 316-25 %@ 0725-3141 %X The epidemiology of invasive Haemophilus influenzae type b (Hib) disease and its prevention by vaccination is reviewed for the period 1995 to 2005, comparing surveillance data for 1995-2000, when both PRP-OMP and HbOC vaccines were used, with 2000-2005, when only PRP-OMP vaccine was used. Over the whole time period, notifications of invasive Hib disease have declined dramatically. In the second time period, a greater decline in Hib cases was seen. This could be due to either the different vaccines being used, differences in vaccine coverage or both. Although disease incidence has decreased markedly in both Indigenous and non-Indigenous populations, Indigenous people are still at significantly greater risk. It is also concerning that almost 60% of invasive Hib cases in children are preventable, in that they are occurring in unimmunised or incompletely immunised children among whom the incidence of Hib disease is estimated to be about 15 times that of fully immunised children. Australia is now in the third era of Hib vaccine use, during which both PRP-T and PRP-OMP vaccines are used, depending on ethnicity or jurisdiction of residence. Continued enhanced surveillance for invasive Hib disease is important for optimal monitoring of trends into the future. %Z FOR Codes: 111706 111706 %0 Journal Article %~ Pubmed %A Ridda, I %A Lindley, I R %A Gao, Z %A McIntyre, P %A Macintyre, C R %T Differences in attitudes, beliefs and knowledge of hospital health care workers and community doctors to vaccination of older people. %B Vaccine %D 2008 %V 26 %N 44 %P 5633-40 %@ 0264-410X %X Pneumococcal disease and influenza are major causes of morbidity and mortality particularly among the elderly. Influenza and pneumococcal vaccination are recommended for people aged 65 years and older or persons with chronic illness. However, despite the burden of disease related to pneumococcus and influenza and the availability safe, efficacious and cost-effective vaccines, health care providers continue to have doubts about these vaccines. Little is known about barriers for pneumococcal vaccination in the health care providers particularly in the primary health care setting. Since 2005 a publicly funded program offering free pneumococcal vaccine for elderly people over 65 years has been implemented in Australia. %Z FOR Codes: 110308 110309 %0 Journal Article %~ Pubmed %A Ward, Kate A %A McIntyre, Peter B %A Kirkwood, Carl D %A Roche, Paul W %A Ferson, Mark J %A Van Buynder, Paul G %A Roberts-Witteveen, April R %A Kesson, Alison M %A Krause, Vicki L %A McAnulty, Jeremy M %T Rotavirus surveillance in Australia. %B Communicable Diseases Intelligence Quarterly Report %D 2008 %V 32 %N 1 %P 82-7 %@ 0725-3141 %X %Z FOR Codes: 110309 %0 Journal Article %~ Pubmed %A Hull, Brynley P %A Deeks, Shelley %A Menzies, Robert %A McIntyre, Peter B %T What do we know about 7vPCV coverage in Aboriginal and Torres Strait Islander children? A 2007 update. %B Communicable Diseases Intelligence Quarterly Report %D 2008 %V 32 %N 2 %P 257-60 %@ 0725-3141 %X In 2001, a publicly funded 7 valent pneumococcal conjugate vaccine (7vPCV) program commenced for Aboriginal and Torres Strait Islander children aged less than 2 years. This study updates early estimates of 7vPCV coverage in Aboriginal and Torres Strait Islander children using Australian Childhood Immunisation Register data between 31 December 2004 and 30 September 2007. We chose four 3-month birth cohorts of children and assessed their immunisation status at 12 months of age for pneumococcal conjugate vaccine and for 'fully immunised'. After the introduction of universal childhood conjugate pneumococcal vaccination in 2005, 7vPCV coverage increased substantially among Aboriginal and Torres Strait Islander children nationally, and in all jurisdictions but remained lower than among non-Indigenous children. The results re-emphasise the greater impact of universal, compared with targeted, programs on vaccine coverage among Indigenous children. %Z FOR Codes: 111701 %0 Journal Article %~ Pubmed %A Wood, Nicholas %A McIntyre, Peter %T Pertussis: review of epidemiology, diagnosis, management and prevention. %B Paediatric Respiratory Reviews %D 2008 %V 9 %N 3 %P 201-11; quiz 211-2 %@ 1526-0550 %X Bordetella pertussis--the cause of pertussis or whooping cough--is an exclusively human pathogen. Disease elimination by vaccination should, therefore, be possible, but has proved elusive. Many industrialised countries with long established immunisation programs are currently seeing a resurgence of pertussis, despite universal vaccination with high uptake, with the highest burden in the least immunised age groups (infants under 6 months of age and persons over 10 years old). However, low recognition and reporting and insensitive diagnostic tests mean that the true burden of pertussis is still underestimated. Recently, efforts to improve diagnostic yield include the expanded use of polymerase chain reaction and serological tests but both have significant limitations. The range of antibiotics available for treatment and prophylaxis has expanded to include the newer macrolides, azithromycin and clarithromycin, and a range of universal and targeted vaccination strategies have been implemented or proposed. This paper reviews the current epidemiology of pertussis in developed countries, including modes of clinical presentation, diagnosis, management and potential vaccination strategies. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Newall, Anthony T %A Brotherton, Julia M L %A Quinn, Helen E %A McIntyre, Peter B %A Backhouse, Josephine %A Gilbert, Lynn %A Esser, Mark T %A Erick, Joanne %A Bryan, Janine %A Formica, Neil %A MacIntyre, C Raina %T Population seroprevalence of human papillomavirus types 6, 11, 16, and 18 in men, women, and children in Australia. %B Clinical infectious diseases : an official publication of the Infectious Diseases Society of America %D 2008 %V 46 %N 11 %P 1647-55 %@ 1537-6591 %X BACKGROUND: Representative population-based data on human papillomavirus (HPV) epidemiology are important for public health decision making but are difficult to obtain. Seroepidemiology is a valuable tool, although the relationship between HPV infection and seropositivity is incomplete. METHODS: We obtained a large representative sample using residual diagnostic test serum samples obtained from individuals aged 0-69 years (1247 samples from male patients and 1523 samples from female patients) in Australia. Serum antibody levels to HPV types 6, 11, 16, and 18 were measured using an immunoassay. RESULTS: Overall, seroprevalence of HPV types 6 and 16 was higher than seroprevalence of HPV types 11 and 18. Among female patients, peak HPV seropositivity occurred among those who were 30-39 years of age for types 6, 16, and 18 (22%, 22%, and 10.5%, respectively) and among those who were 40-49 years of age for HPV 11 (11.8%). Among male subjects, peak HPV seropositivity occurred among those who were 40-49 years of age for types 6 and 11 (15.4% and 9.1%, respectively) and among those who were 50-59 years of age for types 16 and 18 (14.3% and 8.2%, respectively). No cases of HPV seropositivity were detected in individuals <10 years of age. CONCLUSIONS: Australian seroepidemiological data, showing differing age-specific patterns of HPV seropositivity in male and female patients, are likely to be generalizable to other developed countries and add to other data supporting completion of HPV vaccination before adolescence. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Yuan, Fang Fang %A Marks, Katherine %A Wong, Melanie %A Watson, Sarah %A de Leon, Ellen %A McIntyre, Peter Bruce %A Sullivan, John Stephen %T Clinical relevance of TLR2, TLR4, CD14 and FcgammaRIIA gene polymorphisms in Streptococcus pneumoniae infection. %B Immunology and Cell Biology %D 2008 %V 86 %N 3 %P 268-70 %@ 0818-9641 %X Streptococcus pneumoniae is the most common cause of community-acquired pneumonia and a major cause of morbidity and mortality throughout the world. It has been a major research priority to identify gene polymorphisms responsible for/associated with susceptibility and severity of S. pneumoniae infection to gain a better understanding of host genetic variants and their influence and clinical relevance to pneumococcal infections. In the present study, polymorphisms in several candidate genes, including TLR2-Arg/Gln753, TLR4-Asp/Gly299, TLR4-Thr/Ile399, CD14-159C/T and FcgammaRIIA-R/H131, were examined in 85 children with pneumococcal sepsis as an invasive pneumococcal disease and 409 healthy blood donors as controls. The prevalence of the TLR4-299/399 polymorphisms was significantly lower in the patient population than in controls (4 vs 11%; P<0.05; odds ratio (OR) 0.3; 95% confidence interval (CI) 0.1-1), while the prevalence of the CD14-159CC and FcgammaRIIA-R/R131 genotypes was significantly higher (35 vs 25%; P<0.05; OR 1.7; 95% CI 1-2.8 and 39 vs 21%; P<0.001; OR 2.5; 95% CI 1.4-4, respectively). Further, only 35% of patients carried either low-risk genotypes or protective genotypes in contrast to 61% of controls (P<0.0001; OR 2.8; 95% CI 1.7-4.6). We conclude that genetic variability in the TLR4, CD14 and FcgammaRIIA genes is associated with an increased risk of developing invasive disease in patients who are infected with S. pneumoniae. %Z FOR Codes: 1103 %0 Journal Article %~ Pubmed %A Menzies, Robert %A Turnour, Caroline %A Chiu, Clayton %A McIntyre, Peter %T Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2003 to 2006. %B Communicable Diseases Intelligence Quarterly Report %D 2008 %V 32 Suppl %N %P S2-67 %@ 0725-3141 %X This, the second report on vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, brings together the relevant sources of routinely collected data on vaccine preventable diseases--notifications, hospitalisations, deaths, and childhood and adult vaccination coverage. As a result of continued improvements in the collection of data on Indigenous status, this second report is considerably more comprehensive, with data available from more jurisdictions, and more detailed presentation, including time trends and vaccination coverage by jurisdiction. Vaccination coverage data provide evidence of successful program delivery and highlight some areas for improvement. For universally funded vaccines in children, coverage is similar in Indigenous and non-Indigenous children by 24 months of age. However, delayed vaccination is more common in Indigenous children, with 6%-8% fewer children fully vaccinated at 12 months of age. More timely vaccination, particularly within the first six months of life, is particularly important in reducing the disproportionate burdens of disease due to pertussis and Haemophilus influenzae type b (Hib). For vaccination programs targeted specifically at Aboriginal and Torres Strait Islander children and adults, coverage is substantially lower than for those programs targeted at all Australians. This is true for hepatitis A and polysaccharide pneumococcal vaccine for children, and influenza and polysaccharide pneumococcal vaccine for adults. Targeted vaccination programs present a particular challenge for health services in urban areas. Nevertheless, the impact of vaccination programs in preventing disease and reducing the disparity of disease burden between Aboriginal and Torres Strait Islander and non-Indigenous people has been substantial. This is evident in data on notifications, hospitalisations and deaths. Diseases which, in the past, have had devastating and often disproportionately high impact on Indigenous people, such as diphtheria, measles, poliomyelitis, smallpox and tetanus, are now completely or almost completely absent from Australia. Hepatitis B infection, another disease responsible for high levels of infection and substantial serious illness and death in the pre-vaccine era, is also now well controlled in age groups eligible for vaccination. Although invasive Hib disease is now rare in Australia since the introduction of vaccination in 1993, higher rates of disease persist in Aboriginal and Torres Strait Islander children. More research is needed into the contribution of environmental factors, delayed vaccination and vaccine failure to this continued disparity. Hepatitis A has disproportionately affected Aboriginal and Torres Strait Islander children in the past. Vaccination programs in north Queensland and in various other countries have been very successful in reducing the burden of hepatitis A. It is too early to assess the impact of the vaccination program for Aboriginal and Torres Strait Islander children that commenced in regions outside north Queensland in November 2005. For some other diseases the situation is more complicated. The substantial impact of the national meningococcal C vaccination program since 2003 is evident in this report, although the higher proportion of non-vaccine preventable serotype B disease in Aboriginal and Torres Strait Islander people underlines the need for a new vaccine to cover this serotype. Pneumonia remains the most important communicable disease contributor to premature mortality in Aboriginal and Torres Strait Islander people of all ages. In young Indigenous adults, the eightfold higher rate of hospitalisation compared with their non-Indigenous peers, and the 11-fold higher rate of invasive pneumococcal disease, suggest the need for more widespread use of influenza and pneumococcal vaccines in this age group. Current coverage for Indigenous 15-49 year olds, where influenza and pneumococcal vaccines are funded only for those with risk factors, is low even though some 70% of this age group have one or more risk factors. Overall, the data presented in this report provide powerful evidence for the impact of vaccines in reducing disease in Aboriginal and Torres Strait Islander people, and also point to areas for further improvement. Immunisation programs are an example of how preventive health programs in general can be enhanced to close the gap in morbidity and mortality between Indigenous and non-Indigenous Australians. %Z FOR Codes: 111701 %0 Journal Article %~ Pubmed %A Cagney, Michelle %A McIntyre, Peter B %A Heron, Leon %A Giammanco, Anna %A Macintyre, C Raina %T The relationship between pertussis symptomatology, incidence and serology in adolescents. %B Vaccine %D 2008 %V 26 %N 44 %P 5547-53 %@ 0264-410X %X Adolescents have an unknown true incidence of pertussis and are important reservoirs of transmission. We evaluated the incidence of coughing illnesses, serologic evidence of recent infection and the relationship between symptomatology and serology in adolescents. A retrospective respiratory questionnaire and anti-pertussis toxin immunoglobulin G measurement was undertaken in a convenience sample of adolescents and was repeated one year later. The US Centers for Disease Control clinical case definition of pertussis was used. At least a third of coughing illnesses met the CDC clinical case definition. Symptoms correlated with serology. Pertussis was endemic with a high annual incidence of new infections. %Z FOR Codes: 110309 111403 %0 Journal Article %~ Pubmed %A Gunasekera, Hasantha %A Knox, Stephanie %A Morris, Peter %A Britt, Helena %A McIntyre, Peter %A Craig, Jonathan C %T The spectrum and management of otitis media in Australian indigenous and nonindigenous children: a national study. %B The Pediatric Infectious Disease Journal %D 2007 %V 26 %N 8 %P 689-92 %@ 0891-3668 %X BACKGROUND: Indigenous children have the highest reported prevalence and severity of otitis media in the world, but whether their clinical management varies accordingly is unknown. METHODS: Using a representative Australia-wide cluster survey of consecutive primary healthcare consultations, we compared practitioners' investigation, treatment, and referral practices for otitis media in indigenous and nonindigenous children (0-18 years), after adjusting for clustering. RESULTS: Over 8 years (1998-2006), 7991 practitioners managed 141,693 problems during 119,503 consultations with children, including 2856 (2%) with indigenous children. Ear problems were the fourth most common problems managed overall, with otitis media seen more commonly in indigenous than in nonindigenous children (10% versus 7% consultations, P < 0.001). Indigenous children were significantly more likely to have severe otitis media (chronic and/or suppurative and/or perforation, 8% versus 2%, P < 0.001); discharging ears (4% versus 0.1%, P < 0.001); ear swabs [4%, 95% confidence interval (CI): 2%-6% versus 0.8%, 95% CI: 0.6%-0.9%]; and topical eardrops administered (11%, 95% CI: 7%-15% versus 5%, 95% CI: 4%-5%); but not more likely to receive oral antibiotics (72% versus 76%); have ear syringing (1% versus 0.2%); be referred to an otolaryngologist (6% versus 3%) or audiologist (2% versus 1%); all P > 0.05. CONCLUSIONS: In the Australian primary healthcare setting, indigenous children are 5 times more likely to be diagnosed with severe otitis media than nonindigenous children, but reported management is not substantially different, which is inconsistent with established national guidelines. This spectrum-management discordance may contribute to continued worse outcomes for indigenous children with otitis media. %Z FOR Codes: 111701 %0 Journal Article %~ Pubmed %A Owen, Rhonda %A Roche, Paul W %A Hope, Kirsty %A Yohannes, Keflemariam %A Roberts, April %A Liu, Conan %A Stirzaker, Stefan %A Kong, Fiona %A Bartlett, Mark %A Donovan, Basil %A East, Iain %A Fitzsimmons, Gerard %A McDonald, Ann %A McIntyre, Peter B %A Menzies, Robert I %T Australia's notifiable diseases status, 2005: annual report of the National Notifiable Diseases Surveillance System. %B Communicable Diseases Intelligence Quarterly Report %D 2007 %V 31 %N 1 %P 1-70 %@ 0725-3141 %X In 2005, 60 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 125,461 cases of communicable diseases to the National Notifiable Diseases Surveillance System: an increase of 10% on the number of notifications in 2004. In 2005, the most frequently notified diseases were sexually transmissible infections (51,557 notifications, 41% of total notifications), gastrointestinal diseases (29,422 notifications, 23%) and bloodborne diseases (19,278 notifications, 15%). There were 17,753 notifications of vaccine preventable diseases; 4,935 notifications of vectorborne diseases; 1,826 notification of other bacterial infections (legionellosis, leprosy, meningococcal infections and tuberculosis) and 687 notifications of zoonotic diseases. %Z FOR Codes: 110309 %0 Journal Article %~ Pubmed %A Gidding, Heather F %A Warlow, Margaret %A Macintyre, C Raina %A Backhouse, Josephine %A Gilbert, Gwendolyn L %A Quinn, Helen E %A McIntyre, Peter B %T The impact of a new universal infant and school-based adolescent hepatitis B vaccination program in Australia. %B Vaccine %D 2007 %V 25 %N 51 %P 8637-41 %@ 0264-410X %X We compared the results of two national serosurveys in Australia to evaluate the impact of universal infant vaccination and school-based programs for adolescents. Immunity improved significantly overall, especially in 1-year-olds (40.0% versus 86%; p<0.0001); in adolescents it was significantly higher in regions with established school-based programs (56.6% versus 38.8%; p=0.0008). 6.1% of 1-59-year-olds were positive for HBcAb and 0.7% for HBsAg. We have demonstrated successful implementation of universal infant hepatitis B vaccination in Australia and that school-based programs for adolescents are effective. This experience should be applicable to low prevalence countries in northern Europe which have not implemented universal hepatitis B immunisation. %Z FOR Codes: 111706 110702 110804 %0 Journal Article %~ Pubmed %A Quinn, Helen E %A McIntyre, Peter B %T Pertussis epidemiology in Australia over the decade 1995-2005--trends by region and age group. %B Communicable Diseases Intelligence Quarterly Report %D 2007 %V 31 %N 2 %P 205-15 %@ 0725-3141 %X Important changes have occurred in the National Immunisation Program for pertussis during the decade 1995-2005, including the introduction of acellular pertussis vaccine for all doses, removal from the schedule of the booster dose at 18 months, and the introduction of a booster dose for adolescents. In addition, the coverage of pertussis vaccine at 12 and 24 months has substantially increased as recorded by Australian Bureau of Statistics surveys and the Australian Childhood Immunisation Register. There were 75,458 notifications nationally between 1995 and 2005, with little change in the annual number of notifications at the national level but with periodic and dramatic changes in the age distribution of notified cases. Pertussis is well controlled in the 1-4 and 5-9 year age groups, and the highest annual notification rates continue to be in infants under 6 months of age. Adolescents aged 10-19 years had high notification rates in all states and territories, over this period, but 63% of notifications are now in the 20-59 year age range. Following the introduction of a fifth dose for adolescents, the current focus should be on protecting infants too young to be vaccinated and further defining the true morbidity of the disease in the elderly population. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Heywood, Anita E %A Macartney, Kristine K %A MacIntyre, C Raina %A McIntyre, Peter B %T Current developments in varicella-zoster virus disease prevention. A report on the varicella-zoster virus workshop convened by the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases on 16-17 November 2006. %B Communicable Diseases Intelligence Quarterly Report %D 2007 %V 31 %N 3 %P 303-10 %@ 0725-3141 %X %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Hull, Brynley P %A McIntyre, Peter B %T Compliance with three simultaneous vaccinations due at the one visit at 12 months of age in Australia. %B Communicable Diseases Intelligence Quarterly Report %D 2007 %V 31 %N 2 %P 198-202 %@ 0725-3141 %X The introduction of meningococcal C conjugate vaccine (Men C) into the National Immunisation Program Schedule in January 2003 was the first time that 3 simultaneous vaccine injections were recommended for all Australian children. This study aimed to assess the level of simultaneous vaccination at 12 months of age for 4 cohorts of Australian children. The percentage of children with all 3 vaccinations given simultaneously by jurisdiction increased for all states and territories across the 4 study cohorts, however some jurisdictions fared better than others. The percentage of children with all 3 vaccinations given simultaneously varied by the provider type of the Men C vaccine, being lower for general practitioner providers than other providers. Men C vaccine was the vaccine most commonly delayed. The percentage of children who received all 3 vaccinations simultaneously in Australia also varied by indigenous status, with Indigenous children more likely to receive immunisations simultaneously. The study suggests that some children in Australia are at risk of receiving Men C vaccine late, especially children in jurisdictions where general practitioners give the majority of vaccinations. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Lawrence, Glenda L %A Aratchige, Padmasiri E %A Boyd, Ian %A McIntyre, Peter B %A Gold, Michael S %T Annual report on surveillance of adverse events following immunisation in Australia, 2006. %B Communicable Diseases Intelligence Quarterly Report %D 2007 %V 31 %N 3 %P 269-82 %@ 0725-3141 %X This report summarises Australian passive surveillance data for adverse events following immunisation (AEFI) reported to the Adverse Drug Reactions Advisory Committee for 2006, and describes reporting trends over the seven-year period 2000 to 2006. There were 779 AEFI records for vaccines administered in 2006. This is an annual AEFI reporting rate of 3.8 per 100,000 population, the lowest since 2002 and a 10% decrease compared with 2005 (869 AEFI records; 4.3 records per 100,000 population). Dose-based AEFI reporting rates in 2006 were 1.9 per 100,000 doses of influenza vaccine for adults aged > or = 18 years, 19.1 per 100,000 doses of pneumococcal polysaccharide vaccine for those aged > or = 65 years and 12.5 per 100,000 doses of scheduled vaccines for children aged < 7 years. Trend data showed transient increases in reporting of AEFI following the introduction of DTPa-IPV combination vaccines in November 2005 for children aged < 7 years. The majority of the 779 AEFI records for 2006 described non-serious events while 11% (n = 85) described AEFIs defined as serious. There was one report of death temporally associated with receipt of dTpa-IPV and typhoid vaccines in an adult with a history of a chronic medical condition. The most frequently reported individual AEFI was injection site reaction in children following a fourth or fifth dose of acellular pertussis-containing vaccine (70 reports per 100,000 doses). The data confirm the low rate of AEFI reported in Australia and demonstrate the ability of the system to detect and investigate signals such as those associated with changes in immunisation programs. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Gidding, Heather F %A Wood, James %A MacIntyre, C Raina %A Kelly, Heath %A Lambert, Stephen B %A Gilbert, Gwendolyn L %A McIntyre, Peter B %T Sustained measles elimination in Australia and priorities for long term maintenance. %B Vaccine %D 2007 %V 25 %N 18 %P 3574-80 %@ 0264-410X %X We used the 2002 national serosurvey to evaluate a primary care-based young adult vaccination campaign, measure the reproductive number (R) and, together with vaccination coverage estimates, predict R until 2012. The campaign had no impact on immunity in young adults. R was estimated to be 0.69 and predicted to stay well below the epidemic threshold of 1 until at least 2012, indicating that Australia should remain free of endemic measles in the medium term. To maintain elimination in the longer term, the timeliness and coverage of childhood vaccinations must improve and innovative strategies will be required to improve measles immunity among young adults. This experience is likely to apply to developed countries that have achieved or are approaching measles elimination. %0 Journal Article %~ Pubmed %A van de Beek, D %A de Gans, J %A McIntyre, P %A Prasad, K %T Corticosteroids for acute bacterial meningitis. %B Cochrane Database of Systematic Reviews %D 2007 %V %N 1 %P CD004405 %@ 1469-493X %X BACKGROUND: In experimental studies, the clinical outcome of acute bacterial meningitis has been related to the severity of the inflammatory process in the subarachnoidal space. Treatment with corticosteroids can reduce this inflammatory response and thereby may improve outcome. We conducted a meta-analysis of randomised controlled trials (RCTs) of adjuvant corticosteroids in the treatment of acute bacterial meningitis. OBJECTIVES: We conducted a systematic review examining the efficacy and safety of adjuvant corticosteroid therapy in acute bacterial meningitis. SEARCH STRATEGY: In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006); MEDLINE (1966 to July 2006); EMBASE (1974 to June 2006); Current Contents (2001 to June 2006); and reference lists of all articles. We also contacted manufacturers and researchers in the field. SELECTION CRITERIA: Eligible published and non-published RCTs on corticosteroids as adjuvant therapy in acute bacterial meningitis. Patients of any age and in any clinical condition, treated with antibacterial agents and randomised to corticosteroid therapy (or placebo) of any type, could be included. At least case fatality rate or hearing loss had to be recorded for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. Adverse effects were collected from the trials. Additional analyses were performed for children and adults, causative organisms, and low-income and developed countries. MAIN RESULTS: Eighteen studies involving 2750 people were included. Overall, adjuvant corticosteroids were associated with lower case fatality (relative risk (RR) 0.83, 95% CI 0.71 to 0.99), lower rates of severe hearing loss (RR 0.65, 95% CI 0.47 to 0.91) and long-term neurological sequelae (RR 0.67, 95% CI 0.45 to 1.00). In children, corticosteroids reduced severe hearing loss (RR 0.61, 95% CI 0.44 to 0.86). In adults, corticosteroids gave significant protection against death (RR 0.57, 95% CI 0.40 to 0.81) and short-term neurological sequelae (RR 0.42, 95% CI 0.22 to 0.87). Subgroup analysis for causative organisms showed that corticosteroids reduced mortality in patients with meningitis due to Streptococcus pneumoniae (RR 0.59, 95% CI 0.45 to 0.77) and reduced severe hearing loss in children with meningitis due to Haemophilus influenzae (RR 0.37, 95% CI 0.20 to 0.68); subgroup analysis for patients with meningococcal showed a nonsignificant favourable trend in mortality (RR 0.71, 95% CI 0.31 to 1.62). Sub analyses for high-income and low-income countries of the effect of corticosteroids on mortality showed RRs of 0.83 (95% CI 0.52 to 1.05) and 0.87 (95% CI 0.72 to 1.05), respectively. Corticosteroids were protective against short-term neurological sequelae in patients with bacterial meningitis high-income countries (RR 0.56, 95% CI 0.3 to 0.84); in low-income countries this RR was 1.09 (95% CI 0.83 to 1.45). For children with bacterial meningitis admitted in high-income countries, corticosteroids showed a protective effect of on severe hearing loss (RR 0.61, 95% CI 0.41 to 0.90) and favourable point estimates for severe hearing loss associated with non-Haemophilus influenzae meningitis (RR 0.51, 95% CI 0.23 to 1.13) and short-term neurological sequelae (RR 0.72, 95% CI 0.39 to 1.33). For children in low-income countries, the use of corticosteroids was neither associated with benefit nor with harmful effects. Overall, adverse events were not increased significantly with the use of corticosteroids. AUTHORS' CONCLUSIONS: Overall, corticosteroids significantly reduced rates of mortality, severe hearing loss and neurological sequelae. In adults with community-acquired bacterial meningitis, corticosteroid therapy should be administered in conjunction with the first antibiotic dose. In children, data support the use of adjunctive corticosteroids in children in high-income countries. We found no beneficial effect of corticosteroids for children in low-income countries. %Z FOR Codes: 110309 %0 Journal Article %~ Pubmed %A MacIntyre, C Raina %A Burgess, Margaret %A Isaacs, David %A McIntyre, Peter B %A Menzies, Robert %A Hull, Brynley %T Epidemiology of severe hepatitis A in Indigenous Australian children. %B Journal of Paediatrics and Child Health %D 2007 %V 43 %N 5 %P 383-7 %@ 1034-4810 %X AIMS: To describe the epidemiology of hepatitis A in Indigenous Australian children. METHODS: Analysis and mapping of national notification and hospitalisation data. RESULTS: Indigenous Australian children are at far higher risk of clinical hepatitis A than their non-Indigenous counterparts, particularly in the age group 0-4 years. Rates of hospitalisation (15.5 vs. 0.3 per 100,000) and notification (24.4 vs. 1.8 per 100,000) were higher in Indigenous children aged 0-4 years compared with other children in the same age group. In the age group 5-14 years, the rates were 4.4 per 100,000 (Indigenous) versus 0.6 per 100,000 (non-Indigenous) hospitalisations. This excess morbidity falls sharply with age. Rates were the highest in the Northern Territory, South Australia, Western Australia and North Queensland. CONCLUSIONS: Indigenous children are at risk of hepatitis A, particularly early in life. Mapping shows that rates were the highest in jurisdictions with the largest Indigenous populations. This study presents baseline data against which to measure the success of new hepatitis A vaccination programme for Indigenous Australian children which commenced in 2005. %0 Journal Article %~ Pubmed %A Ridda, Iman %A MacIntyre, Raina C %A Lindley, Richard I %A McIntyre, Peter B %A Sullivan, John %A Gilbert, Gwendolyn %A Kovoor, Pramesh %A Manolios, Nicholas %A Fox, John %T Predictors of pneumococcal vaccination uptake in hospitalized patients aged 65 years and over shortly following the commencement of a publicly funded national pneumococcal vaccination program in Australia. %B %D 2007 %V 3 %N 3 %P 83-6 %@ 1554-8600 %X In January 2005, Australia became the first country to introduce a publicly funded pneumococcal vaccination program for persons 65 years and older which is free at point of service, although the vaccine cost had previously been partially subsidized. Hospitalization in this age group is an important indicator of risk of invasive pneumococcal disease but vaccine uptake has been suboptimal. To determine vaccination rates and predictors of vaccination in the elderly hospitalised patients before and after January 2005. We validated vaccination status against general practitioner (GP) records for patients aged > or = 65 years admitted to a large teaching hospital in Sydney between 16th of May 2005 and the 20th of February 2006 and examined predictors of vaccination. Commencement of the new program resulted in a significant increase in vaccination uptake from 39% of inpatients prior to the free program to 73% in the same cohort of inpatients post January 2005. We found that patient recall of vaccination status was not reliable. Self-report of pneumococcal vaccination had a sensitivity of 0.53 and a specificity of 0.55, highlighting that validation of vaccination status is required. Age over 80 years and dementia significantly predicted under-vaccination. This highlights the importance of integrating free vaccine supply and delivery in primary care to achieve high vaccination coverage. However, demented patients and the very elderly remain under-vaccinated, despite being admitted to hospital for active management of acute conditions. %0 Journal Article %~ Pubmed %A Brotherton, Julia %A Wang, Han %A Schaffer, Andrea %A Quinn, Helen %A Menzies, Robert %A Hull, Brynley %A Lawrence, Glenda %A Wood, James %A Wood, Nicholas %A Rosewell, Alexander %A Newall, Anthony %A MacIntyre, Raina %A Macartney, Kristine %A Gidding, Heather %A McIntyre, Peter %A Booy, Robert %T Vaccine preventable diseases and vaccination coverage in Australia, 2003 to 2005. %B Communicable Diseases Intelligence Quarterly Report %D 2007 %V 31 Suppl %N %P S1-152 %@ 0725-3141 %X %Z FOR Codes: 110309 %0 Journal Article %~ Pubmed %A Menzies, Rob %A McIntyre, Peter %A Reid, Ray %A O'brien, Katherine %A Santosham, Mathu %A Watt, James %A Angeles, Geoffrey %A Brown, Alex %A Dunbar, Melissa %A Leach, Amanda %A Crengle, Sue %A Lennon, Diana %A Mason, Henare %A Grim, Charles %A Nolan, Leo %A Smith, Phil %A Dumaresq, Gina %A Richardson, Ruth %A Moberley, Sarah %A Stirling, Janelle %A Gooda, Mick %A Green, Michael %T Vaccine preventable diseases in indigenous populations - International perspectives. Satellite Symposium of the 5th International Symposium on Pneumococci and Pneumococcal Diseases, April 2006, Alice Springs, Australia. %B Vaccine %D 2007 %V 25 %N 42 %P 7281-4 %@ 0264-410X %X %Z FOR Codes: 111701 %0 Journal Article %A Wood, N %A McIntyre, Peter %A Elliott, Elizabeth %T Pertussis in infancy: a review of strategies for prevention %B SII Csalud %D 2007 %C Argentina %I Sociedad Iberoamericana de Informacion Cientifica %V 0 %N %P 0 %@ 1667-9008 %X %Z FOR Codes: 111403 %0 Journal Article %~ Pubmed %A Watson, M %A Gilmour, R %A Menzies, R %A Ferson, M %A McIntyre, P %A , New South Wales Pneumococcal Network %T The association of respiratory viruses, temperature, and other climatic parameters with the incidence of invasive pneumococcal disease in Sydney, Australia. %B Clinical infectious diseases : an official publication of the Infectious Diseases Society of America %D 2006 %V 42 %N 2 %P 211-5 %@ 1537-6591 %X BACKGROUND: Increases in incidence of invasive pneumococcal disease (IPD) during the colder months of the year in temperate regions are well recognized, but few detailed studies of possible interactions are available. We examined the relationship between virus activity, climatic parameters, and IPD during a winter in which there were separate peak incidences of influenza and respiratory syncytial virus (RSV) infection. METHODS: We performed an ecological study that correlated population-based data on IPD and respiratory virus activity in the year 2000 in metropolitan New South Wales, Australia, with climatic parameters, including weekly mean maximum and minimum temperature, relative humidity, rainfall, and wind speed. RESULTS: In children, RSV activity was significantly positively correlated with IPD activity (r = 0.578; P = .002) but not with influenza virus activity. There was a weak inverse relationship between parainfluenza virus activity and IPD activity (r = -0.401; P = .043) and a stronger inverse relationship between weekly mean maximum temperature (r = -0.458; P = .001), weekly mean minimum temperature (r = -0.437; P = .001), and IPD activity. In adults, there was no significant correlation between RSV or influenza virus activity alone and IPD, but the combination of RSV and influenza was significantly correlated with IPD (r = 0.481; P = .013). CONCLUSIONS: This study suggests that RSV infection and influenza contribute to IPD incidence peaks differently for children than for adults. Data from other geographic areas and more rigorous study designs are required to confirm these findings. %0 Journal Article %~ Pubmed %A Beard, F %A McIntyre, P %A Gidding, H %A Watson, M %T Influenza related hospitalisations in Sydney, New South Wales, Australia. %B Archives of Disease in Childhood %D 2006 %V 91 %N 1 %P 20-5 %@ 1468-2044 %X BACKGROUND: Routine influenza vaccination for children aged 6-23 months has recently been recommended in the United States. Accurate assessment of influenza related burden of illness in children could support similar recommendations in other settings. However, routinely available data underestimate the role of influenza in causing hospitalisation, and indirect estimation methods face difficulties controlling for the concurrent circulation of respiratory syncytial virus (RSV). Recent studies from Hong Kong and the United States have used differing methods to estimate the true burden of influenza related hospitalisation, with disparate results. METHODS: Retrospective population based study of children less than 18 years of age from Sydney, Australia, 1994 to 2001. Using two previously reported methods, estimates of annual hospitalisation rates attributable to influenza were derived by comparison of mean hospitalisation rates for acute respiratory disease during periods of high influenza activity and low RSV activity (defined using virological surveillance data) and periods where both influenza and RSV activity were low. These estimates were compared to rates of hospitalisation where influenza was recorded as the principal discharge diagnosis. RESULTS: Hospitalisation rates attributable to influenza were up to 11 times higher, depending on the age group and method used, compared to rates calculated from principal discharge diagnosis codes. CONCLUSIONS: Although there remains considerable uncertainty in estimating influenza related morbidity by methods using excess hospitalisations, even minimum estimates of disease burden warrant consideration of routine influenza immunisation for all children less than 2 years of age. Such estimates, derived from principal discharge diagnosis codes, are available in most settings. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Quinn, Helen E %A McIntyre, Peter B %T Tetanus in the elderly--An important preventable disease in Australia. %B Vaccine %D 2006 %V 25 %N 7 %P 1304-9 %@ 0264-410X %X Notification trends from countries with well-established immunisation programs show increasing tetanus cases among the elderly, corresponding to seroepidemiologic data showing declining immunity with advanced age. We examined Australian trends in tetanus to review the likely value of routine funded immunisation at 65 years. Since 1993, 62% (36/58) of notifications, 44% (67/151) of hospitalisations and 83% (10/12) of deaths were in people aged over 65 years. Taking into account higher vaccine coverage at 65 years, versus the current recommended age in Australia of 50 years, we estimate that routine funded tetanus vaccine would prevent 9% more hospitalisations and 28% more deaths than the most favourable outcome from the current unfunded recommendation at 50 years. This is likely to be applicable to other industrialised countries. %0 Journal Article %~ Pubmed %A Wood, Nicholas %A McIntyre, Peter %A Wong, Melanie %T Vaccination for the paediatrician. %B Journal of Paediatrics and Child Health %D 2006 %V 42 %N 11 %P 665-673 %@ 1034-4810 %X In most of Australia, general practitioners manage routine childhood vaccination schedules. However, paediatricians have an important role and need to have a thorough understanding of vaccination, particularly as it interfaces with other medical care. This is challenging as the Australian Standard Vaccination Schedule has undergone some substantial changes over the past 4 years, with the addition of meningococcal C conjugate, 7 valent pneumococcal conjugate, varicella and inactivated polio vaccines. Paediatricians are frequently the first port of call for advice on vaccination schedules for children with special needs, in relation to either vaccine efficacy or the risk of side effects. Categories include children with a range of chronic diseases, immunosuppression, premature infants and immigrant children. Advice about specific vaccines such as varicella, inactivated polio, influenza or multivalent vaccines and revaccination after adverse events is also often sought. The aim of this article is to update paediatricians on vaccination recommendations and relevant reference sources. The first part of this article discusses groups with special vaccination requirements. The second part discusses the use of individual vaccines in these children. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Cagney, M %A Macintyre, C R %A McIntyre, P %A Puech, M %A Giammanco, A %T The seroepidemiology of pertussis in Australia during an epidemic period. %B Epidemiology and Infection %D 2006 %V 134 %N 6 %P 1208-16 %@ 0950-2688 %X Studying the epidemiology of pertussis and impact of differing vaccine schedules is difficult because of differing methods of case ascertainment. The advent of internationally standardized serological diagnosis for recent infection has allowed comparison of age-specific pertussis infection among European countries and was applied in Australia at the time of a major national epidemic. In 1997 and 1998, a nationally representative serum bank using residual sera from diagnostic laboratories was established. Measurement of pertussis toxin (PT) IgG level was conducted by a reference laboratory using an enzyme-linked immunosorbent assay standardized for a number of European countries. A titre of 125 EU/ml was interpreted as indicative of recent pertussis infection. The serological data were correlated with age, gender, region and disease epidemiology in Australia. The highest prevalence of recent pertussis infection was in the 5-9 years age group, and the lowest in 1-4 and 25-64 years age groups. In the 5-14 years age group, 29.7% (5-9 years) and 14.6% (10-14 years) of the sample had serological evidence of recent infection, correlating with the pattern of epidemic notifications. The 15- to 24-year-olds had similar high titres but the same notification rate as 25- to 44-year-olds, suggesting ascertainment bias may result in under-notification in the former age group. The prevalence of high titres observed was up to 20-fold higher than some European countries during a similar time period. Although vaccination has reduced the transmission of pertussis in the youngest and most vulnerable age group, pertussis is still endemic in Australia, particularly in older children and the elderly. The Australian vaccination schedule has been changed in an attempt to address this problem, by spacing doses more widely, with the fifth dose at 15-17 years of age. Seroepidemiology for pertussis offers the potential to compare patterns of pertussis between countries and examine the impact of vaccine schedule changes independent of notification and diagnostic bias. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Gubbay, Jonathan B %A McIntyre, Peter B %A Gilmour, Robin E %T Cellulitis in childhood invasive pneumococcal disease: a population-based study. %B Journal of Paediatrics and Child Health %D 2006 %V 42 %N 6 %P 354-8 %@ 1034-4810 %X AIM: There are few detailed data on the age-specific incidence and clinical pattern of pneumococcal cellulitis in children. We conducted a retrospective review of cellulitis as a subset of prospectively collected laboratory-identified invasive pneumococcal disease (IPD) and performed a systematic review of published literature. METHODS: Prospective laboratory surveillance in urban regions of New South Wales, Australia, 1 June 1997-31 December 2001. Medical notes reviewed for each identified case and defined literature search strategy applied. RESULTS: There were 1067 cases of IPD in children aged 0-17 years; 38 (3.3%) were cellulitis (32 periorbital, 6 buccal). Compared with other types of IPD, a greater proportion of cellulitis cases occur in children<2 years (30/38, 79% vs. 617/1029, 60.0%; P=0.004) in whom underlying illness was less common (0/30, 0% vs. 53/590, 9%; P=0.06). Initially, another diagnosis was made in 13 (34%) of cases; only five had a lumbar puncture, all normal. Of the 239 cases of pneumococcal cellulitis documented in the literature, 28 (11.7%) had the diagnosis made by means other than positive blood culture and 95% were facial or orbital with underlying illness (6%) and associated meningitis (1.9%) uncommon. CONCLUSION: Cellulitis is an uncommon focus in IPD in children, and is almost always facial. Most cases occur under 2 years of age, are seldom associated with meningitis or other complications, and are frequently not recognised on admission. %0 Journal Article %~ Pubmed %A Menzies, Robert %A McIntyre, Peter %T Vaccine preventable diseases and vaccination policy for indigenous populations. %B Epidemiologic reviews %D 2006 %V 28 %N %P 71-80 %@ 0193-936X %X Compared with nonindigenous people, indigenous people in first-world countries have experienced much higher rates of many vaccine preventable diseases. This systematic review of published scientific literature, government reports, and immunization guidelines from Australia, Canada, New Zealand, and the United States compares pre- and postvaccination disease rates and vaccination policy for indigenous people in these four countries. Nationally funded universal vaccination programs are clearly the most effective way of reducing disease in indigenous populations. Most successful have been programs for viral diseases in which strain variations are not important and herd immunity is high, such as measles and hepatitis B. For bacterial infections, strain variations (pneumococcal disease), heavy nasopharyngeal colonization of young infants (pneumococcal and Haemophilus influenzae type b disease), low vaccine effectiveness in adults with a high prevalence of risk factors (polysaccharide pneumococcal vaccine), and waning immunity (pertussis) have been associated with continuing or widening disparities between indigenous and nonindigenous populations. However, universal vaccination programs are not always possible. Geographic targeting of all persons in certain regions with high disease rates has been successful, as has targeting of indigenous populations in regions where they constitute larger proportions of the population. In national programs targeting only indigenous people, it has been difficult to achieve high coverage, particularly in urban areas. Innovative program approaches are particularly needed in these situations. %Z FOR Codes: 111716 111701 %0 Journal Article %~ Pubmed %A Lawrence, Glenda %A Boyd, Ian %A McIntyre, Peter %A Isaacs, David %T Annual report: Surveillance of adverse events following immunisation in Australia, 2005. %B Communicable Diseases Intelligence Quarterly Report %D 2006 %V 30 %N 3 %P 319-33 %@ 0725-3141 %X This report summarises Australian passive surveillance data for adverse events following immunisation (AEFI) reported to the Adverse Drug Reactions Advisory Committee for 2005, and describes reporting trends over the six year period 2000 to 2005. There were 839 AEFI records for vaccines received in 2005. This is an annual AEFI reporting rate of 4.1 per 100,000 population, the lowest since 2000 and a 22 per cent decrease compared with 2004 (1,081 records; 5.4 AEFI records per 100,000 population). The decrease was not consistent across age groups. Reporting of AEFI increased for children aged <1 year in 2005 (60.7 versus 50.3 per 100,000 population) and decreased for the 7 to <20 year age group (0.9 versus 8.9 per 100,000 population). Dose-based AEFI reporting rates in 2005 were 11.0 per 100,000 doses of scheduled vaccines for children aged <7 years and 2.0 per 100,000 doses of influenza vaccine for adults aged >18 years. The majority of records described non-serious events while 9 per cent (n=72) described AEFIs defined as serious. There was one report of death in an older person following influenza vaccine and one of non-polio acute flaccid paralysis in an infant, both temporally associated with immunisation. The most frequently reported individual AEFI was injection site reaction in children following a fifth dose of diphtheria-tetanus-acellular pertussis vaccine (79 reports per 100,000 doses). The increase in the population-based AEFI reporting rate for children aged <1 year in 2005 coincided with the introduction of national immunisation programs for conjugate pneumococcal vaccine in January 2005 and inactivated poliovirus vaccine in November 2005. The fall in reporting rates for older children and adolescents follows the completion of the national meningococcal C catch-up program in early 2005. The consistently low reporting rate of serious AEFIs demonstrates the high level of safety of vaccines in Australia. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Backhouse, J L %A Gidding, H F %A McIntyre, P B %A Gilbert, G L %T Evaluation of two enzyme immunoassays for detection of immunoglobulin g antibodies to mumps virus. %B %D 2006 %V 13 %N 7 %P 764-7 %@ 1556-6811 %X To determine suitability for national serosurveys, we compared two commercial enzyme-linked immunosorbent assays (ELISAs) for mumps antibody, Enzygnost Anti-Parotitis-Virus/IgG (which uses a whole-virus antigen) and Microimmune Mumps IgG Screen ELISA (which uses a recombinant nucleoprotein antigen), by testing 1,915 opportunistically collected sera submitted to diagnostic laboratories across Australia in 1997 to 1998. The proportion of positive results increased with age in both ELISAs but was significantly higher with the Microimmune than with the Enzygnost ELISA overall (88% versus 63%; P < 0.01) and in all age groups. However, the proportion of equivocal results was significantly higher with the Enzygnost than with the Microimmune ELISA (9% versus 4%; P < 0.01). Of the 572 sera with discrepant or equivocal results, 508 had sufficient sample remaining to perform the neutralization test (NT). A proportion with concordant results in both ELISAs were also tested by the NT. For sera with discrepant results, there was significantly better agreement between the NT and Microimmune than between the NT and Enzygnost (310/444 [70%] versus 135/348 [39%]; P < 0.01). Of 64 sera with equivocal Microimmune results, 45 (70%) were positive in the NT compared with 140 of 160 (88%) equivocal Enzygnost results (P < 0.01). Compared with the NT, the Microimmune ELISA is more sensitive (96% versus 80%) but apparently less specific (36% versus 85%) than the Enzygnost ELISA. However, this is likely to be due to the generally lower sensitivity of the NT, since the Microimmune results reflect expected seroprevalence, based on vaccine uptake in the age groups studied. We conclude that the Microimmune ELISA is a more appropriate assay than the Enzygnost ELISA for estimation of mumps seroprevalence. %Z FOR Codes: 110804 %0 Journal Article %~ Pubmed %A Backhouse, J L %A Gidding, H F %A Macintyre, C R %A McIntyre, P B %A Gilbert, G L %T Population-based seroprevalence of Neisseria meningitidis serogroup C capsular antibody before the introduction of conjugate vaccine, in Australia. %B Vaccine %D 2006 %V 25 %N 7 %P 1310-5 %@ 0264-410X %X Neisseria meningitidis serogroup C (NMC) conjugate vaccine was introduced, in Australia, in 2003. Our aims were to determine pre-immunisation IgG NMC seroprevalence and evaluate an enzyme-linked immunosorbent assay (ELISA), previously validated against the serum bactericidal assay (SBA). 2409 sera, collected in 2002, from subjects aged 2-34 years, were tested. The geometric mean concentration (GMC) of NMC anticapsular IgG was 0.38 U/mL in subjects under 19 years and it increased to 0.67 U/mL for those aged 30-34 years. Variation in GMC correlated with reported NMC disease incidence and was higher in males than females (0.52 U/mL versus 0.41 U/mL; p=0.005). The ELISA appears suitable for serosurveillance but the IgG level that correlates with protection needs further investigation. Serosurveys will be repeated to monitor the impact of vaccination. %0 Journal Article %~ Isi %A Clements, C. J. %A McIntyre, P. B. %T When science is not enough - a risk/benefit profile of thiomersal-containing vaccines. %B Expert Opinion on Drug Safety %D 2006 %C United Kingdom %I Informa Healthcare %V 5 %N 1 %P 17-29 %@ 1474-0338 %X %0 Journal Article %A Yohannes, Keflemariam %A Roche, Paul W %A Roberts, April %A Liu, Conan %A Firestone, Simon M %A Bartlett, Mark %A East, Iain %A Hull, Brynley P %A Kirk, Martyn D %A Lawrence, Glenda L %A McDonald, Ann %A McIntyre, Peter %A Menzies, Robert I %A Quinn, Helen %A Vadjic, Claire %T Australia?s notifiable diseases status, 2004, Annual report of the National Notifiable Diseases Surveillance System %B Communicable Diseases Intelligence %D 2006 %C Australia %I Australian Government %V 30 %N %P 1-79 %@ 0725-3141 %X %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Hull, Brynley P %A McIntyre, Peter B %T Timeliness of childhood immunisation in Australia. %B Vaccine %D 2006 %V 24 %N 20 %P 4403-8 %@ 0264-410X %X There are few data, especially outside the United States, examining the timeliness of childhood vaccination, although it is of key importance for diseases such as pertussis, and invasive disease due to Haemophilus influenzae type b and Streptococcus pneumoniae. The aim of this study was to use the unique resource of the Australian Childhood Immunisation Register (ACIR) to examine trends in and factors associated with timeliness of infant vaccination at the national level. As in previous studies, age-appropriate immunisation was defined as within 30 days of the recommended age. Vaccination delays became more common for later doses, given at an older age, but long delay (greater than 6 months) occurred in only 1-2%. Although immunisation coverage increased over time, timeliness did not improve. Among Indigenous infants, long delays occurred in 5-12% of those residing in very remote areas, but by 2 years of age, overall immunisation coverage was similar to non-Indigenous children. With immunisation coverage at the key indicator ages of 12 and 24 months now high in most industrialised countries including Australia, timeliness of vaccine doses should be the next benchmark to aim for in program performance, especially in specific sub-groups such as Indigenous children who stand to gain most from prevention of early onset disease. %Z FOR Codes: 111716 %0 Journal Article %~ Pubmed %A Kolos, Veronica %A Menzies, Robert %A McIntyre, Peter %T Higher pertussis hospitalization rates in indigenous Australian infants, and delayed vaccination. %B Vaccine %D 2006 %V 25 %N 4 %P 588-90 %@ 0264-410X %X This ecological study aimed to identify possible reasons for higher pertussis hospitalization rates in indigenous Australian infants. Two national datasets were analysed: the Hospital Morbidity Database and the Australian Childhood Immunisation Register (ACIR). Most (52%) pertussis hospitalizations in indigenous infants occurred at 0-2 months of age, and rates in these indigenous infants were significantly higher in remote areas. Indigenous infants had higher hospitalization rates and more frequently delayed vaccination than non-indigenous infants of the same age. These data suggest that residence in a remote area, as a proxy for poorer living conditions for indigenous people, and delayed vaccination, both contribute to higher pertussis hospitalization rates in indigenous infants. %Z FOR Codes: 111706 111701 %0 Journal Article %~ Pubmed %A Lawrence, Glenda L %A Boyd, Ian %A McIntyre, Peter B %A Isaacs, David %T Annual report: surveillance of adverse events following immunisation in Australia, 2004. %B Communicable Diseases Intelligence Quarterly Report %D 2005 %V 29 %N 3 %P 248-62 %@ 0725-3141 %X This report summarises Australian passive surveillance data on adverse events following immunisation (AEFI) for 2004 and describes reporting trends over the five years, 2000 to 2004. AEFIs are notified to the Adverse Drug Reactions Advisory Committee by state and territory health departments, hospitals, doctors and other health providers, vaccine manufactures, and the public. There were 975 AEFI records for vaccines received in 2004. This is an annual AEFI reporting rate of 4.8 per 100,000 population, the lowest since 2000, and a 33 per cent decrease compared with 2003 (1,460 records; 7.1 AEFI records per 100,000 population). Dose-based AEFI reporting rates in 2004 were 1.8 per 100,000 doses of influenza vaccine for adults aged > or = 18 years and 11.8 per 100,000 doses of scheduled vaccines for children aged < 7 years. The majority of records described non-serious events while nine per cent (n = 88) described AEFIs defined as 'serious'. There were no reports of death related to immunisation. The most frequently reported individual AEFI was injection site reaction in children following a fifth dose of an acellular pertussis-containing vaccine (67 reports per 100,000 doses). The marked reduction in the AEFI reporting rate in 2004 coincided with the removal of the fourth dose of acellular pertussis vaccine, due at 18 months of age, from the vaccination schedule in September 2003 and fewer people receiving meningococcal C vaccine through the national catch-up vaccination program for those aged 1-19 years in 2004, compared with 2003. The consistently low reporting rate of serious AEFIs demonstrates the high level of safety of vaccines in Australia. %0 Journal Article %~ Pubmed %A Gilbert, Gwendolyn L %A Gidding, Heather F %A Backhouse, Josephine %A McIntyre, Peter B %T Varicella seroprevalence and vaccine uptake in preschool children. %B Medical Journal of Australia %D 2005 %V 182 %N 1 %P 42 %@ 0025-729X %X %0 Journal Article %~ Pubmed %A Cagney, M %A MacIntyre, C R %A McIntyre, P B %A Peat, J %T Childhood asthma diagnosis and use of asthma medication. %B Australian Family Physician %D 2005 %V 34 %N 3 %P 193-6 %@ 0300-8495 %X AIM: To determine the burden of asthma in children. METHODS: A cross sectional, randomised, computer assisted telephone survey of a community based sample of 2020 children aged 5-14 years in western Sydney (New South Wales) over a 20 day period from June 2000 to July 2000. RESULTS: Main outcome measures were carer reported history of asthma diagnosis, hospital presentation/admission for asthma, recent use of anti-asthma medications, and recent respiratory symptoms. Diagnosed asthma was reported in 31% (of whom 42% were diagnosed aged 2 years or under) and asthma medications used in the previous year by 21% of children. Factors significantly associated with a reported asthma diagnosis included: male gender (OR: 1.51), birth in Australia (OR: 1.64), living in an English speaking household (OR: 1.47), Aboriginality (OR: 2.32), possession of a health care card (OR: 1.28), previous pneumonia (OR: 2.4) or pertussis (OR: 2.0), and a recent episode of croup (OR: 1.9). Exposure to tobacco smoke and immunisation status were not significant. DISCUSSION: We confirm a high prevalence of asthma and medication use for asthma. The high proportion of children diagnosed asthmatic at 2 years or under (when asthma cannot be diagnosed reliably) suggests overdiagnosis of asthma may contribute to the apparent high prevalence. %0 Journal Article %~ Pubmed %A McIntyre, Peter B %A Menzies, Robert I %T Immunisation: reducing health inequality for Indigenous Australians. %B Medical Journal of Australia %D 2005 %V 182 %N 5 %P 207-8 %@ 0025-729X %X Vaccination programs can act as a paradigm for effective health programs in Indigenous people. %Z FOR Codes: 111704 %0 Book Section %A McIntyre, Peter %A Lester, Rosemary %T Immunisation %B Infectious Diseases: A Clinical Approach %D 2005 %C Australia %I IP Communications Pty Ltd %V %N %P 560-577 %@ 9780957861770 %E Yung, A %E McDonald, M %E Spelman, D %E Street, A %E Johnson, P %E Sorrell, T %E McCormack, J %X %Z FOR Codes: 110702 %0 Book Section %A Menzies, Robert %A Williams, Katrina %A McIntyre, Peter %T Measuring vaccination coverage in Aboriginal and Torres Strait Islander children. %B Djiadi # 1.1. Revised monograph of the inaugural Indigenous Health Unit Research Day 2004 %D 2005 %C Sydney %I Muru Marri Indigenous Health Unit, UNSW %V %N %P 73-76 %@ 07334 2280 2 %E Jackson Pulver, Lisa %E McDermott, Dennis %X %Z FOR Codes: 111701 %0 Book Section %A Joseph, Telphia-Leanne %A Menzies, Robert %A McIntyre, Peter %T Vaccination of Indigenous adults in the Community Controlled Sector - what is done and what works. %B Djiadi #1.1. Revised monograph of the inaugural Indigenous Health Unit Research Day 2004 %D 2005 %C Sydney %I Muru Marri Indigenous Health Unit, UNSW %V %N %P 69-71 %@ 07334 2280 2 %E Jackson Pulver, Lisa %E McDermott, Dennis %X %Z FOR Codes: 111701 %0 Journal Article %~ Pubmed %A Horby, P %A Macintyre, C R %A McIntyre, P B %A Gilbert, G L %A Staff, M %A Hanlon, M %A Heron, L G %A Cagney, M %A Bennett, C %T A boarding school outbreak of pertussis in adolescents: value of laboratory diagnostic methods. %B Epidemiology and Infection %D 2005 %V 133 %N 2 %P 229-36 %@ 0950-2688 %X Culture for Bordetella pertussis (B. pertussis) is the traditional gold standard for laboratory diagnosis of pertussis but is insensitive, especially later in the course of illness and in vaccinated persons. Interpretation of serology is limited by the lack of an appropriate reference standard. An outbreak of pertussis in a crowded boarding-school dormitory allowed evaluation of laboratory correlates of infection. Questionnaires, serum samples and throat swabs were collected from members of the exposed group. Serum samples from unexposed controls of a similar age group were used for comparison. B. pertussis PCR was performed on throat swabs, and sera were tested for IgA antibodies against whole-cell (WC) B. pertussis antigen and IgG antibodies to pertussis toxin (PT). The Centers for Disease Control and Prevention definition for pertussis was used to define clinical cases. We evaluated the use of a previously published cut-off for PT IgG of 125 EIA units (EU)/ml. Completed questionnaires were obtained from 115 students, of whom 85 (74%) reported coughing symptoms, including 32 (28%) who met the clinical case definition for pertussis. B. pertussis was detected by PCR in 17 (15%) and WC IgA in 22 (19%) students; neither correlated with symptoms, but dormitory of residence strongly predicted PCR status. The mean PT IgG geometric mean concentration, in this situation of high pertussis exposure, correlated with severity of symptoms and was significantly higher in both symptomatic and asymptomatic children exposed during the outbreak (P < 0.001) than in control children. A cut-off for PT IgG of 125 EU/ml was too high in an outbreak situation to be sensitive enough to identify pertussis cases. A case of pertussis in a crowded boarding-school dormitory resulted rapidly in an outbreak. Serology and PCR were useful in identifying the outbreak and commencing disease control measures. The use of serology has mostly been evaluated in community serosurveys, where it is not possible to determine if immunity reflects vaccination, asymptomatic disease or symptomatic disease. This outbreak gave us the opportunity to evaluate the value of serology and PCR in the presence of confirmed exposure to pertussis. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A McIntyre, P B %A Macintyre, C R %A Gilmour, R %A Wang, H %T A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis. %B Archives of Disease in Childhood %D 2005 %V 90 %N 4 %P 391-6 %@ 1468-2044 %X BACKGROUND: Despite an extensive literature, the impact of both adjunctive steroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis is controversial. AIM: To determine the independent contribution of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis in a representative population with good access to medical services. METHODS: Data were obtained from laboratories and hospital records to assemble a population register in Sydney, Australia, 1994-99. Follow up questionnaires were completed by attending physicians. RESULTS: A total of 122 cases of pneumococcal meningitis aged 0-14 years were identified. Almost 50% of 120 children with available records either died (n = 15) or had permanent neurological impairment (n = 39). Early use (before or with parenteral antibiotics) of corticosteroids protected against death or severe morbidity (adjusted OR 0.21, 95% CI 0.05 to 0.77). Delayed diagnosis was associated with increased morbidity in survivors (OR 3.4, 95% CI 1.03 to 11.4) but not with increased mortality. CONCLUSION: In a population with good access to health care and after adjusting for other known prognostic variables, early recognition of pneumococcal meningitis and treatment with adjunctive dexamethasone significantly improves outcomes. These data add to those from randomised controlled trials. Implementation requires development of protocols and guidelines for use in emergency departments. %0 Journal Article %~ Pubmed %A Wood, N %A Menzies, R %A McIntyre, P %T Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease. %B Internal Medicine Journal %D 2005 %V 35 %N 9 %P 530-5 %@ 1444-0903 %X BACKGROUND: Acute epiglottitis due to infection with Haemophilus influenzae type b (Hib) is much less common in children following the introduction of Hib vaccination; however, adult epiglottitis cases have not decreased. In addition, epiglottitis hospitalizations are consistently more numerous than notifications and the reason for this is not clear. AIMS: To more accurately describe the clinical, aetiological and epidemiological features of epiglottitis and to ascertain the accuracy of hospitalization data in an era of widespread Hib vaccination. METHODS: Medical records in 11 public hospitals in three area health services in New South Wales with a principal or stay diagnosis (International Classification of Diseases (ICD)-9-CM or ICD-10-AM code) of acute epiglottitis between July 1990 and June 1992 (prior to Hib vaccination = pre-vaccine era) and July 1998 and June 2000 (widespread Hib vaccination = vaccine era) were reviewed. Case definitions of epiglottitis were applied. RESULTS: One hundred and forty-two records were identified (114 pre-vaccine era and 28 vaccine era). Incorrect coding was more common in vaccine era records (32 vs 7%). Of correctly coded records, adults over 20 years old comprised the majority in the vaccine era (84 vs 17%). Hib bacteraemia was identified in 62% of cases in the pre-vaccine era compared to no cases in the vaccine era, despite equivalent blood cultures being taken between the two eras (84 vs 74%). Streptococcus pneumoniae was the only other organism isolated. Three deaths were recorded (1 child, 2 adults), all in the pre-vaccine era. CONCLUSIONS: Acute epiglottitis hospitalizations in the current Hib vaccine era are predominantly in adults, and rarely are Hib or other causative organisms identified, although microbiological data are often incomplete. The discrepancy between hospitalization and notification data appears to be due to misclassification of hospitalization records. %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Cagney, Michelle %A MacIntyre, C Raina %A McIntyre, Peter %A Torvaldsen, Siranda %A Melot, Vincent %T Cough symptoms in children aged 5-14 years in Sydney, Australia: non-specific cough or unrecognized pertussis? %B Respirology %D 2005 %V 10 %N 3 %P 359-64 %@ 1323-7799 %X OBJECTIVE: The aim of this study was to estimate the community prevalence of coughing symptoms, consistent with surveillance definitions for pertussis, and doctor-diagnosed pertussis in children aged 5-14 years. METHODOLOGY: A telephone survey of a cross-sectional community sample of parents regarding their child's cough symptoms in the previous 12 months was undertaken in a representative Australian urban region. RESULTS: In 2020 interviews, parents reported that 22% of children had a cough lasting 2 weeks or longer in the preceding 12 months, and 14% (283) had additional symptoms meeting the Centers for Disease Control (CDC) case definition for pertussis. A cough meeting the case definition was significantly more commonly reported by parents of children aged 5-9 years (17%; P < 0.001) but reported exposure to diagnosed pertussis in such cases was significantly more common in children aged 10-14 years (4.3%; odds ratio 12.8; P < 0.01). Parents of 90% of children meeting the CDC case definition sought medical advice. A diagnosis of pertussis was reported in only 1.2% of cases, which extrapolates to an annual incidence of doctor-diagnosed pertussis of 347/100,000 (95% confidence interval, 140-714 per 100,000). This contrasts with 29/100,000 notified cases in the same age group, time period and geographic area. CONCLUSION: Cough episodes meeting a clinical case definition for pertussis commonly used in surveillance are reported by a high proportion of carers of school-aged children in Australia. The majority of children who met the CDC and Australian case definitions for pertussis and sought medical attention were not identified as potentially having pertussis, suggesting underdiagnosis of pertussis. Even if less than half of this is true pertussis, the potential impact in terms of transmission of pertussis in the community is likely to be high. The reported incidence of doctor-diagnosed disease estimated from this survey was at least five and up to 20 times the official notification rate. More work needs to be done in raising awareness among medical practitioners of pertussis as a differential diagnosis in older children and adolescents with cough. %0 Journal Article %~ Pubmed %A McIntyre, Peter B %A Kelly, Heath A %A Mulholland, E Kim %T Immunisation at the crossroads: 9th National Immunisation/1st Asia-Pacific Vaccine Preventable Diseases Conference. %B Medical Journal of Australia %D 2005 %V 182 %N 1 %P 15-6 %@ 0025-729X %X %0 Journal Article %~ Pubmed %A Macartney, K K %A Beutels, P %A McIntyre, P %A Burgess, M A %T Varicella vaccination in Australia. %B Journal of Paediatrics and Child Health %D 2005 %V 41 %N 11 %P 544-52 %@ 1034-4810 %X Varicella zoster virus (VZV) causes both chickenpox and herpes zoster and is responsible for a significant disease burden, including hospitalizations and deaths, in Australian children and adults. Varicella vaccine has been available in Australia for 5 years; however, from November 2005, it will be funded for use in all susceptible children at 18 months and 10-13 years of age under the National Immunisation Program. Experience with universal varicella vaccination of children in the USA over the last 10 years has shown that the vaccine is safe and highly effective in reducing varicella-related disease. This review summarizes the epidemiology of VZV-related disease in Australia, the use of varicella vaccine and the international experience with vaccine efficacy and safety. The potential impact of varicella vaccination on the incidence of herpes zoster is also discussed. %Z FOR Codes: 111716 110309 %0 Journal Article %~ Pubmed %A McIntyre, Peter %T Should dexamethasone be part of routine therapy of bacterial meningitis in industrialised countries? %B Advances in Experimental Medicine and Biology %D 2005 %V 568 %N %P 189-97 %@ 0065-2598 %X Two issues are clear from the data available regarding the current place of dexamethasone in routine management of suspected bacterial meningitis in industrialised countries. First, there is now good evidence of benefit from adjunctive dexamethasone therapy which is not confined to Hib meningitis, but in the case of pneumococcal meningitis probably requires that dexamethasone is given with or before, rather than after, parenteral antibiotics. In meningococcal meningitis, statistically significant benefit has not been demonstrated for any outcome, even in meta-analyses, but the point estimate is in the direction of benefit and failure to demonstrate an effect is more likely to be due to limited power from low event rates rather than no benefit; certainly there is no evidence of a detrimental effect. Most culture-negative cases of presumptive bacterial meningitis outside the neonatal period are likely to be due to one of the above 3 organisms. In the neonatal period or in some settings in developing countries, the spectrum of organisms is very different and extrapolation of these findings cannot be assumed. Second, the suggestion that dexamethasone is not applicable to certain subgroups in industrialised countries (such as cases not treated with cefuroxime, or some other sub-optimal therapy, or cases treated with vancomycin) (5) or that benefit only applies to hearing loss or Hib cases, either do not stand up to scrutiny or are not answerable from available data. What does this mean for clinical practice? The results of randomised controlled trials may not readily translate to clinical practice, particularly with respect to early commencement of steroids. The Sydney data show that in a representative developed country population with good access to services, after controlling for other prognostic variables, early corticosteroid therapy is associated with improved outcome. These data also show that deferred lumbar puncture is frequent and so criteria requiring presumptive identification of an organism are not practical to guide dexamethasone use, indeed those patients in whom lumbar puncture is deferred are more likely to have severe disease. This experience is an important addition to the findings from clinical trials of dexamethasone in pneumococcal meningitis in industrialised countries (5,6) as it demonstrates that adjunctive steroid therapy is beneficial in a 'real world' situation. In addition, the prospect of clinical trials in children, already limited by small case numbers, will be further reduced when the use of the conjugate pneumococcal vaccines is widespread. In Canada, a trend to decreasing use of corticosteroids was noted between 1991 and 1999, probably reflecting conflicting evidence. (16). Unless clear protocols are in place, the commencement of steroids before or with antibiotics will be difficult to implement in emergency situations, as illustrated by the data from Sydney. %0 Journal Article %~ Pubmed %A Andrews, Ross M %A Skull, Susan A %A Byrnes, Graham B %A Campbell, Donald A %A Turner, Joy L %A McIntyre, Peter B %A Kelly, Heath A %T Influenza and pneumococcal vaccine coverage among a random sample of hospitalised persons aged 65 years or more, Victoria. %B Communicable Diseases Intelligence Quarterly Report %D 2005 %V 29 %N 3 %P 283-8 %@ 0725-3141 %X This study was undertaken to assess the uptake of influenza and pneumococcal vaccination based on provider records of the hospitalised elderly, a group at high risk of influenza and pneumococcal disease. The study used a random sample of 3,204 admissions at two Victorian teaching hospitals for patients, aged 65 years or more who were discharged between 1 April 2000 and 31 March 2002. Information on whether the patient had received an influenza vaccination within the year prior to admission or pneumococcal vaccination within the previous five years was ascertained from the patient's nominated medical practitioner/vaccine provider. Vaccination records were obtained from providers for 82 per cent (2,804/2,934) of eligible subjects. Influenza vaccine coverage was 70.9 per cent (95% CI 68.9-72.9), pneumococcal coverage was 52.6 per cent (95% CI 50.4-54.8) and 46.6 per cent (95% CI 44.4-48.8) had received both vaccines. Coverage for each vaccine increased seven per cent over the two study years. For pneumococcal vaccination, there was a marked increase in 1998 coinciding with the introduction of Victoria's publicly funded program. Influenza and pneumococcal vaccine coverage in eligible hospitalised adults was similar to, but did not exceed, estimates in the general elderly population. Pneumococcal vaccination coverage reflected the availability of vaccine through Victoria's publicly funded program. A nationally funded pneumococcal vaccination program for the elderly, as announced recently, should improve coverage. However, these data highlight the need for greater awareness of pneumococcal vaccine among practitioners and for systematic recording of vaccination status, as many of these subjects will soon become eligible for revaccination. %0 Journal Article %~ Pubmed %A Wood, Nicholas %A Backhouse, Josephine %A Gidding, Heather F %A Gilbert, Gwendolyn L %A Lum, Gary %A McIntyre, Peter B %T Estimates of chronic hepatitis B virus infection in the Northern Territory. %B Communicable Diseases Intelligence Quarterly Report %D 2005 %V 29 %N 3 %P 289-90 %@ 0725-3141 %X %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Isaacs, David %A McIntyre, Peter %T Influenza vaccines in healthy children. %B Lancet %D 2005 %V 365 %N 9477 %P 2086; author reply 2087 %@ 1474-547X %X %0 Journal Article %~ Isi %A Macartney, K. K. %A Beutels, P. %A McIntyre, P. %A Burgess, M. A. %T Varicella vaccination in Australia. %B Journal of Paediatrics and Child Health %D 2005 %C Australia %I Blackwell Publishing Asia %V 41 %N 11 %P 544-552 %@ 1034-4810 %X %0 Journal Article %~ Pubmed %A Macartney, Kristine %A Mcintyre, Peter %T Universal varicella vaccination. Comment. %B Medical Journal of Australia %D 2005 %V 183 %N 5 %P 278-9 %@ 0025-729X %X %Z FOR Codes: 110309 %0 Journal Article %~ Pubmed %A Burgess, Margaret A %A McIntyre, Peter B %T Vaccines: the new Australian best-practice schedule. %B Medical Journal of Australia %D 2004 %V 180 %N 10 %P 494-6 %@ 0025-729X %X %0 Journal Article %~ Pubmed %A Lawrence, Glenda %A Boyd, Ian %A McIntyre, Peter %A Isaacs, David %T Surveillance of adverse events following immunisation: Australia 2002 to 2003. %B Communicable Diseases Intelligence Quarterly Report %D 2004 %V 28 %N 3 %P 324-38 %@ 0725-3141 %X Reports of suspected adverse events following immunisation (AEFI) are reviewed by the Adverse Drug Reactions Advisory Committee and collated in a central database. We analysed AEFI records for vaccines administered during October 2002 to December 2003, and assessed AEFI reporting trends for 2000 to 2003. AEFI reporting rates were calculated using denominator data from the Australian Childhood Immunisation Register and the annual national influenza vaccination coverage survey. A total of 1,744 AEFI records were analysed for October 2002 to December 2003. The majority described non-serious events; 9 per cent (n=149) described AEFIs defined as 'serious'. Four deaths were reported but none were causally related to immunisation. Dose-based AEFI reporting rates were 2.1 per 100,000 doses of influenza vaccine for adults aged 40 years or over and 19.8 per 100,000 doses of scheduled vaccines for children aged <7 years. The most frequently reported individual AEFI was injection site reaction in children after a fourth or fifth dose of an acellular pertussis-containing vaccine (54 and 98 reports per 100,000 doses respectively). The most frequently suspected vaccine was meningococcal C conjugate vaccine (34% of reports-mostly injection site reactions, gastrointestinal symptoms and headaches). The average annual reporting rate was 7.0 per 100,000 population, the highest to date. The increase in the AEFI reporting rate was due to a greater number of children becoming eligible to receive a fourth or fifth consecutive dose of acellular pertussis vaccine and the introduction of the meningococcal C vaccination program in January 2003 for those aged 1-19 years. The low reporting rate of serious AEFIs demonstrates the high level of safety of vaccines in Australia. %0 Journal Article %A Menzies, R %A McIntyre, Peter %A Beard, E %T Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people %B Communicable Diseases Intelligence %D 2004 %C Canberra, Australia %I Australian Government %V 28 Suppl. 1 %N %P S1-S45 %@ 0725-3141 %X %Z FOR Codes: 111701 %0 Journal Article %~ Pubmed %A Hull, Brynley P %A McIntyre, Peter B %T What do we know about 7vPCV coverage in Aboriginal and Torres Strait Islander children? %B Communicable Diseases Intelligence Quarterly Report %D 2004 %V 28 %N 2 %P 238-43 %@ 0725-3141 %X In 2001, a publicly funded pneumococcal conjugate vaccine (7vPCV) program commenced for Aboriginal and Torres Strait Islander children aged under two years. At present, there is very little knowledge about the uptake of 7vPCV vaccine amongst Aboriginal and Torres Strait Islander children. This study examined the rollout and use of 7vPCV vaccine in Australia and estimated immunisation coverage for Indigenous children at the age of 12 months for 7vPCV vaccine. To calculate 7vPCV coverage we chose four consecutive 3-month birth cohorts born between 1 October 2001 and 30 September 2002. The immunisation status of children in each birth cohort was assessed at 12 months for the third dose of 7vPCV vaccine. The largest absolute number of 7vPCV doses was given in Queensland, the Northern Territory and New South Wales. As the 7vPCV program matured, a progressively higher proportion of total doses was administered to children under the age of 12 months consistent with the introduction of the program. For all jurisdictions except the Northern Territory and Western Australia, where it has remained reasonably constant, estimated coverage increased over the most recent birth cohorts but was still less than 50 per cent for all states except the Northern Territory, Queensland, and Western Australia. This study provides the first national measure of 7vPCV immunisation coverage among Indigenous children in Australia. With the likely improvement over time in the recording of 7vPCV vaccinations and Indigenous status on the Australian Childhood Immunisation Register, the validity of coverage estimates is likely to increase. %0 Journal Article %A McIntyre, Peter %A Wood, N %T Does universal hepatitis B vaccination at birth have a negative impact on breastfeeding? %B Australian Midwifery: Journal of the Australian College of Midwives %D 2004 %C Australia %I Australian College of Midwives %V 14 %N %P 4-5 %@ 1448-8272 %X %Z FOR Codes: 111402 %0 Journal Article %~ Pubmed %A Poynten, M %A McIntyre, P B %A Mooi, F R %A Heuvelman, K J %A Gilbert, G L %T Temporal trends in circulating Bordetella pertussis strains in Australia. %B Epidemiology and Infection %D 2004 %V 132 %N 2 %P 185-93 %@ 0950-2688 %X Australia experienced a resurgence of pertussis in the 1990s despite improved vaccine coverage. Although much of the increase was attributable to increased detection of cases in older persons with waning immunity by serology, vaccine changes or alterations in circulating Bordetella pertussis strains may also have contributed. We determined the frequency of variants of B. pertussis pertactin (prn), and pertussis toxin subunit 1 (ptxS1) genes, restriction fragment length polymorphism (RFLP) types and fimbrial serotypes prevalent in Australia prior to, and during the 1990s. Ampoules of the whole-cell vaccine in use prior to 1999 and 84 B. pertussis isolates stored between 1967 and 1998 by laboratories around Australia were analysed. One pertactin allele, Prn3, not detected before 1985, was found in 24 out of 57 (42%) isolates between 1989 and 1998 (P<0.0001). PtxS1A was found in all isolates. IS1002 type 29, found in 17 out of 31 (55%) isolates tested, was the predominant RFLP type. The only difference in fimbrial serotype distribution between the time-periods was an increase in serotype 3 (P=0.054). The whole-cell vaccine contained only the alleles prn1 and ptxS1A. Antigenic shift in B. pertussis may have contributed to the re-emergence of pertussis in Australia. Monitoring these trends will be important as acellular vaccines are introduced and changes are made to pertussis vaccine schedules. %0 Journal Article %~ Pubmed %A Andrews, Ross M %A Counahan, Megan L %A Hogg, Geoff G %A McIntyre, Peter B %T Effectiveness of a publicly funded pneumococcal vaccination program against invasive pneumococcal disease among the elderly in Victoria, Australia. %B Vaccine %D 2004 %V 23 %N 2 %P 132-8 %@ 0264-410X %X Within Australia, Victoria is the only jurisdiction where the 23-valent polysaccharide pneumococcal vaccine (23vPPV) has been publicly funded for the elderly (aged > or = 65 years). We compared age-specific rates of invasive pneumococcal disease (IPD) for periods before and after implementation of the program, and data from a comparable Australian population that does not have a funded program. Vaccine effectiveness (VE) was estimated using the screening and indirect cohort methods. Compared to the pre-program period, there was a 36% reduction in the reported rates of IPD among persons aged > or = 65 years. Adjusted for under-reporting in the referent rate, the decrease was equivalent to an annual reduction of 112 cases and an estimated 14 deaths among persons > or = 65 years. VE was 71% (95% CI 54-82) using the screening method and 79% (95% CI -14 to 96) by the indirect cohort method. Both point estimates were consistent with the VE expected among persons aged > or = 65 years, although the small number of isolates meant the indirect cohort method was inconclusive at the lower 95% confidence limit. Consideration should be given to publicly funding pneumococcal vaccine for this age group in other settings. %0 Journal Article %~ Pubmed %A Lawrence, Glenda L %A Hull, Brynley P %A MacIntyre, C Raina %A McIntyre, Peter B %T Reasons for incomplete immunisation among Australian children. A national survey of parents. %B Australian Family Physician %D 2004 %V 33 %N 7 %P 568-71 %@ 0300-8495 %X BACKGROUND: Incomplete immunisation among Australian children may be due to parents disagreeing with immunisation rather than medical contraindications or access issues. SETTING AND METHODS: The parents of 1338 children recorded on the ACIR as incompletely immunised were telephoned and interviewed. RESULTS: Of the 462 parents who confirmed their child was incompletely immunised, 270 (58%) disagreed with or were concerned about immunisation; 190 (70%) of these were concerned about vaccine side effects. The disagreeing 270 parents were significantly more likely to be highly educated and have a child with no vaccinations recorded on the ACIR. No vaccinations were recorded on the ACIR for 81% of children of both these parents, and of parents registered as conscientious objectors to immunisation. Together these two groups accounts for 2.5-3.0% of the annual birth cohort. DISCUSSION: In order to achieve the 95% immunisation rates necessary for disease control, tailored approaches to promote immunisation among parents are required. %0 Book Section %A McIntyre, Peter %T Meningitis %B Evidence-based pediatrics and child health - second edition %D 2004 %C London %I BMJ Books %V %N %P 285-291 %@ 0-7279-1746-3 %E Moyer, Virginia %E Elliott, Elizabeth %E Gilbert, Ruth %E Klassen, Terry %E Logan, Stuart %E Mellis, Craig %E Henderson-Smart, David %E Williams, Katrina %X %0 Journal Article %~ Pubmed %A Butler, James R G %A McIntyre, Peter %A MacIntyre, C Raina %A Gilmour, Robin %A Howarth, Ann L %A Sander, Beate %T The cost-effectiveness of pneumococcal conjugate vaccination in Australia. %B Vaccine %D 2004 %V 22 %N 9-10 %P 1138-49 %@ 0264-410X %X Background: Pneumococcal conjugate vaccine, 7 valent (PCV7) is the most costly vaccine yet considered for publicly funded programs. In mid 2001, Australia funded PCV7 for high-risk groups only (indigenous children and children with certain underlying medical conditions). World wide, non-industry-funded studies and studies using cost-utility measures are sparse. We undertook an independent economic analysis of PCV7 compared with no vaccination in the non high-risk Australian childhood population using cost-utility and cost-effectiveness measures. Methods: The incidence of invasive pneumococcal disease (IPD), non-bacteraemic pneumonia and otitis media was estimated using representative urban Australian data, or by extrapolation from comparable industrialised countries. A decision-analytic model was developed for a hypothetical birth cohort using the age-specific vaccine coverage from the Californian randomised controlled trial of PCV7. Health outcomes were measured by life-years saved and deaths and disability-adjusted life-years (DALYs) averted. In line with government guidelines, only direct costs were considered in 1997-1998 Australian dollars. Results: For a birth cohort of 250,000, the gross cost of vaccination is $ 78.6 million. Subtracting treatment cost savings, the net cost (discounted) is $ 61.7 million. In undiscounted terms, vaccination prevents 13.7 deaths, 11.2 (82%) from IPD and the remainder from non-bacteraemic pneumonia. The discounted cost per death avoided is $ 5.0 million, per life-year saved $ 230,130 and per DALY averted $ 121,100, giving a break-even vaccine price of $ 15.40 per dose. These estimates are most sensitive to the unit cost per dose of vaccine, estimates of incidence and vaccine efficacy against non-bacteraemic pneumonia and the discount rate. The cost per DALY reduced to $ 81,000 with a discount rate of 3% rather than 5% and to $ 90,000 with the most favourable assumptions concerning pneumonia reduction. Discussion: With a vaccine price of $ 90 per dose, mid-range estimates of impact against non-bacteraemic pneumonia, and discount rate of 5%, a PCV7 program for infants not at high risk of IPD is at the upper limit of cost per DALY previously approved under Australian pharmaceutical funding guidelines. The impact of PCV7 against non-bacteraemic pneumonia is poorly defined, but its importance to cost-effectiveness in resource rich and resource poor settings warrants further studies or analysis to give greater precision to this outcome. %0 Journal Article %~ Pubmed %A Hethcote, Herbert W %A Horby, Peter %A McIntyre, Peter %T Using computer simulations to compare pertussis vaccination strategies in Australia. %B Vaccine %D 2004 %V 22 %N 17-18 %P 2181-91 %@ 0264-410X %X High levels of notified pertussis in adolescents and adults, persisting severe disease (hospitalization and deaths) in infants despite high childhood immunization coverage, together with the availability of adult-formulated pertussis vaccines, have made alternate strategies for vaccine control of pertussis an important issue in Australia. An age-structured computer simulation model was used to compare the likely effects of adopting different vaccination strategies in Australia on pertussis transmission by age group over a 50 year time period. Epidemiological parameters and vaccination coverage in Australia were estimated from previous pertussis modeling studies and existing data. In the simulations, replacing the pertussis booster at 18 months with a booster dose for adolescents at an age between 12 and 17 years, assuming 80% coverage, led to decreases in pertussis cases of 30% in children of ages 0-23 months (who have the highest complication rates) and of 25% in adolescents, but an increase of 15% in cases in 2-4-year-old children. The simulations did not suggest any shift of pertussis cases into the adult child-bearing years. Varying parameter values in the simulations in a series of sensitivity analyses showed the model predictions to be robust over a plausible range. The results of these simulations suggest that the recent change in the Australian pertussis vaccination schedule, replacing the 18 month dose with a pertussis booster in 15-17-year-old adolescents, is very likely to reduce overall pertussis incidence in Australia without increasing the cost of the current vaccine program. %0 Journal Article %~ Pubmed %A Brotherton, Julia %A McIntyre, Peter %A Puech, Michele %A Wang, Han %A Gidding, Heather %A Hull, Brynley %A Lawrence, Glenda %A MacIntyre, Raina %A Wood, Nicholas %A Armstrong, Donna %T Vaccine preventable diseases and vaccination coverage in Australia 2001 to 2002. %B Communicable Diseases Intelligence Quarterly Report %D 2004 %V 28 Suppl 2 %N %P vii-S116 %@ 0725-3141 %X %0 Journal Article %~ Pubmed %A Scuffham, P A %A McIntyre, P B %T Pertussis vaccination strategies for neonates--an exploratory cost-effectiveness analysis. %B Vaccine %D 2004 %V 22 %N 21-22 %P 2953-64 %@ 0264-410X %X Hospitalisation and death from pertussis in highly immunised populations largely occurs before the first vaccination at 2 months. A Markov model was constructed to estimate the costs and health consequences of three strategies to reduce pertussis over the first 6 months of an infant's life. Earlier vaccination (at either birth or 1 month in addition to current practice) or vaccination of the parents soon after birth was compared with the current practice of vaccination at 2, 4 and 6 months. The model was populated using data on the incidence and costs from Australia. Disability-adjusted life-years (DALYs) were used as the primary outcome measure. The cost to the Australian public health system was chosen as the economic perspective, and Monte-Carlo simulations were used to accommodate uncertainties in the variables. Vaccination at birth was estimated to cost (S.D.) an additional A$33.21 (A$1.60) per infant and to reduce cases, deaths and DALYs by 45%. Vaccination at 1 month was estimated to cost an additional A$43.24 (A$8.98) per infant and to reduce morbidity by approximately 25%. Parental vaccination at birth was the most expensive alternative, costing an additional A$73.38 (A$4.98) per infant and reducing pertussis morbidity by 38%. The costs per DALY averted were A$330,175 (A$15,461) A$735,994 (A$147,679) and A$787,504 (A$48,075) for the birth, 1 month and parental vaccination strategies, respectively. Changing the estimated factor by which hospitalisations and deaths are under-reported, and the efficacy of early vaccination, had large effects on results. Parental vaccination at birth was most cost-effective where protection persisted for subsequent children. The birth vaccination strategy appears to offer the greatest potential benefit for one-child families, but the efficacy at birth (and 1 month) needs to be established. %0 Journal Article %~ Pubmed %A McIntyre, Peter %T Vaccines for other neonatal infections: vaccination strategies for the prevention of neonatal pertussis. %B Expert review of vaccines %D 2004 %V 3 %N 4 %P 375-8 %@ 1476-0584 %X Current progress in the use of vaccines against a range of infectious agents, both bacterial (pertussis, pneumococcus and group B streptococcus) and mycobacterial (bacille Calmette-Gu?rin), to prevent neonatal infection are reviewed by Professors Gilbert, Britton and McIntyre and Dr Peter Richmond. %0 Journal Article %~ Pubmed %A Hull, Brynley P %A McIntyre, Peter B %A Couzos, Sophia %T Evaluation of immunisation coverage for aboriginal and Torres Strait Islander children using the Australian Childhood Immunisation Register. %B Australian and New Zealand Journal of Public Health %D 2004 %V 28 %N 1 %P 47-52 %@ 1326-0200 %X OBJECTIVE: To estimate immunisation coverage for routinely administered vaccines among children using receipt of a particular Hib vaccine (PRP-OMP) as a proxy for Indigenous status. METHODS: Until May 2000, PRP-OMP was provided only for Indigenous children in all jurisdictions except the Northern Territory. In three one-year ACIR-derived birth cohorts, any child recorded on the ACIR as receiving one or more doses of PRP-OMP as the only Hib vaccine was presumed to be Aboriginal and Torres Strait Islander. Using this proxy, estimated numbers of Indigenous children were compared with Australian Bureau of Statistics estimates, and immunisation status for recommended vaccines was estimated at 12 and 24 months by jurisdiction and remoteness compared with children who received other Hib vaccines (presumed non-Indigenous). RESULTS: The numbers of Aboriginal and Torres Strait Islander children estimated using this 'proxy method' are approximately 42% of those estimated by the ABS. Immunisation coverage (among proxy Indigenous children) at 12 months (72-76%) and 24 months (64-73%) was considerably lower than others (90-94% and 81-88%, respectively). These children had significantly lower coverage when living in accessible areas than remote areas. CONCLUSIONS AND IMPLICATIONS: These data provide the first national measure of immunisation status and are likely to be a valid measure among those identified. Aboriginal and Torres Strait Islander immunisation coverage is 17% lower with the biggest gaps in urban areas, indicating the need for better quality data informing appropriate interventions. %0 Journal Article %~ Pubmed %A Leask, Julie %A Williams, Alison %A McIntyre, Peter %A O'Dea, Deirdre %T Are general practice registrars prepared for immunisation? A cross sectional survey. %B Australian Family Physician %D 2004 %V 33 %N 8 %P 665-7 %@ 0300-8495 %X OBJECTIVE: To describe undergraduate formal training on immunisation as remembered by general practice registrars and its perceived helpfulness. SETTING AND METHODS: Self completed questionnaire by all general practice registrars in advanced general practice terms (second 6 months of general practice) in New South Wales during 2002. RESULTS: Formal undergraduate training in immunisation was reported by 68% (84/123) of respondents. The 20% who remembered formal practical training were significantly more likely to rate it as helpful (OR: 1.7 p<0.05). Only 33% recalled a practical session offered by one university during an undergraduate paediatrics rotation. The most frequent training request was for practical experience, and the most commonly used print resource was the Australian Immunisation Handbook. DISCUSSION: General practice registrar access to a training session on practical immunisation techniques and childhood immunisation before commencing the basic general practice term might be helpful. Registrars should automatically receive a copy of the Australian Immunisation Handbook which might address perceived education needs. %0 Journal Article %~ Pubmed %A Menzies, Robert %A McIntyre, Peter %A Beard, Frank %T Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 1999 to 2002. %B Communicable Diseases Intelligence Quarterly Report %D 2004 %V 28 %N 2 %P 127-59 %@ 0725-3141 %X This report complements the Vaccine Preventable Diseases and Vaccination Coverage reports produced biannually since 2000 by the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases in association with the Australian Institute of Health and Welfare. It integrates the available sources of routinely collected data relevant to the current status of vaccine preventable diseases and vaccine coverage in Aboriginal and Torres Strait Islander people in Australia. It aims to better inform Indigenous communities, Indigenous health care providers and planners of immunisation services of the current status and future needs for vaccine prevention in Indigenous people. The data presented here demonstrate that vaccination programs have had a significant impact on the health of Aboriginal and Torres Strait Islander people. Several areas are highlighted for further development of vaccination policy recommendations, in particular high rates of preventable hepatitis A and B, influenza and pneumococcal disease. Areas where more research is needed include means to more accurately monitor vaccination status, the applicability of meningococcal serogroup B vaccines when available, and effective ways of increasing vaccination coverage and timeliness of vaccination. Such issues need to be considered and implemented in full cooperation with Aboriginal and Torres Strait Islander people. %0 Journal Article %~ Pubmed %A Brotherton, Julia M L %A McIntyre, Peter B %T Planning for human papillomavirus vaccines in Australia; report of a research group meeting. %B Communicable Diseases Intelligence Quarterly Report %D 2004 %V 28 %N 2 %P 249-54 %@ 0725-3141 %X %0 Journal Article %A McIntyre, Peter %A Wood, N %T What's new in childhood immunisation? %B Medicine Today %D 2004 %C Australia %I Medicine Today Pty. Ltd %V 5 %N %P 68-77 %@ 1443-430X %X %Z FOR Codes: 111704 %0 Journal Article %~ Pubmed %A van de Beek, Diederik %A de Gans, Jan %A McIntyre, Peter %A Prasad, Kameshwar %T Steroids in adults with acute bacterial meningitis: a systematic review. %B The Lancet infectious diseases %D 2004 %V 4 %N 3 %P 139-43 %@ 1473-3099 %X Bacterial meningitis is uncommon but causes significant mortality and morbidity, despite optimum antibiotic therapy. A clinical trial in 301 patients showed a beneficial effect of adjunctive steroid treatment in adults with acute community-acquired pneumococcal meningitis, but data on other organisms or adverse events are sparse. This led us to do a quantitative systematic review of adjunctive steroid therapy in adults with acute bacterial meningitis. Five trials involving 623 patients were included (pneumococcal meningitis=234, meningococcal meningitis=232, others=127, unknown=30). Overall, treatment with steroids was associated with a significant reduction in mortality (relative risk 0.6, 95% CI 0.4-0.8, p=0.002) and in neurological sequelae (0.6, 0.4-1, p=0.05), and with a reduction of case-fatality in pneumococcal meningitis of 21% (0.5, 0.3-0.8, p=0.001). In meningococcal meningitis, mortality (0.9, 0.3-2.1) and neurological sequelae (0.5, 0.1-1.7) were both reduced, but not significantly. Adverse events, recorded in 391 cases, were equally divided between the treatment and placebo groups (1, 0.5-2), with gastrointestinal bleeding in 1% of steroid-treated and 4% of other patients. Since treatment with steroids reduces both mortality and neurological sequelae in adults with bacterial meningitis, without detectable adverse effects, routine steroid therapy with the first dose of antibiotics is justified in most adult patients in whom acute community-acquired bacterial meningitis is suspected. %0 Journal Article %~ Pubmed %A McIntyre, Peter B %A Turnbull, Fiona M %A Egan, Anne-Marie %A Burgess, Margaret A %A Wolter, Joanne M %A Schuerman, Lode M %T High levels of antibody in adults three years after vaccination with a reduced antigen content diphtheria-tetanus-acellular pertussis vaccine. %B Vaccine %D 2004 %V 23 %N 3 %P 380-5 %@ 0264-410X %X There is increasing interest in prevention of pertussis in adults by vaccination, but little is known about the duration of the antibody response to pertussis, diphtheria or tetanus in reduced antigen content vaccines formulated for adult use. Follow-up of a clinical trial including 550 adults comparing responses to reduced antigen content diphtheria-tetanus-acellular pertussis (dTpa) vaccine, or a licensed Td vaccine, provided the opportunity to evaluate this. Blood samples were collected at 0, 1, 12, 24 and 36 months following vaccination; of the original cohort of 550, 387 subjects (dTpa group N=310, Td+pa group N=77) were tested at month 36. Following a decrease in antibody levels against all vaccine antigens between one and 24 months following vaccination, levels stabilized during the third year, remaining higher at 36 months than pre-vaccination for all vaccine antigens. In particular, more than 90% of subjects remained seropositive for pertussis toxin and pertactin antibodies at 36 months after vaccination, suggesting ongoing protection against pertussis. Adult-formulated dTpa vaccines could replace Td for routine booster vaccination of older individuals. %0 Journal Article %~ Pubmed %A Elliott, Elizabeth %A McIntyre, Peter %A Ridley, Greta %A Morris, Anne %A Massie, John %A McEniery, Julie %A Knight, Geoff %T National study of infants hospitalized with pertussis in the acellular vaccine era. %B The Pediatric Infectious Disease Journal %D 2004 %V 23 %N 3 %P 246-52 %@ 0891-3668 %X BACKGROUND: In Australia in 1999 acellular pertussis vaccine (DTPa) replaced locally manufactured whole cell vaccine given at 2, 4 and 6 months of age with coverage of about 95% by 12 months of age. Few data are available on pertussis hospitalizations or sources of infection in countries exclusively using DTPa. METHODS: In 2001 national active monthly surveillance of infant hospitalizations for pertussis was conducted through the Australian Pediatric Surveillance Unit, which surveys all child health specialists monthly. A standard questionnaire was completed for notified cases. RESULTS: There were 140 infants reported (median age at diagnosis, 8 weeks). The rate of hospitalization in indigenous infants was significantly higher than in nonindigenous infants (P < 0.01). Of 97 (69%) infants who had not been vaccinated for pertussis, 63 (65%) were <8 weeks old (before the first scheduled dose of DTPa vaccine). Of 76 infants age > or =8 weeks, only 28 (37%) were appropriately immunized for age. Of 68 coughing contacts whose ages were known, 46 (68%) were adults, usually one of the infant's parents. Of 32 child contacts 16 (50%) were siblings. Four infants <6 weeks old died. CONCLUSION: Despite universal vaccination with DTPa in Australia, pertussis remains an important cause of hospitalization, morbidity and death in infants, most of whom were too young to be vaccinated or had missed vaccinations. The most common source of infection was a parent. Strategies to improve pertussis control in countries with high DTPa coverage could include adult-formulated booster pertussis vaccines for adolescents and recent parents and/or accelerated pertussis vaccine schedules for infants. %0 Journal Article %~ Pubmed %A Belshe, Robert B %A Newman, Frances K %A Tsai, Theodore F %A Karron, Ruth A %A Reisinger, Keith %A Roberton, Don %A Marshall, Helen %A Schwartz, Richard %A King, James %A Henderson, Frederick W %A Rodriguez, William %A Severs, Joseph M %A Wright, Peter F %A Keyserling, Harry %A Weinberg, Geoffrey A %A Bromberg, Kenneth %A Loh, Richard %A Sly, Peter %A McIntyre, Peter %A Ziegler, John B %A Hackell, Jill %A Deatly, Anne %A Georgiu, Alice %A Paschalis, Maribel %A Wu, Shin-Lu %A Tatem, Joanne M %A Murphy, Brian %A Anderson, Edwin %T Phase 2 evaluation of parainfluenza type 3 cold passage mutant 45 live attenuated vaccine in healthy children 6-18 months old. %B The Journal of Infectious Diseases %D 2004 %V 189 %N 3 %P 462-70 %@ 0022-1899 %X A phase 2 evaluation of live attenuated parainfluenza type 3 (PIV3)-cold passage mutant 45 (cp45) vaccine was conducted in 380 children 6-18 months old; 226 children (59%) were seronegative for PIV3. Of the 226 seronegative children, 114 received PIV3-cp45 vaccine, and 112 received placebo. No significant difference in the occurrence of adverse events (i.e., runny nose, cough, or temperature > or =38 degrees C) was noted during the 14 days after vaccination. There was no difference between groups in the occurrence of acute otitis media or serous otitis media. Paired serum samples were available for 109 of the seronegative vaccine recipients and for 110 of the seronegative placebo recipients; 84% of seronegative vaccine recipients developed a > or =4-fold increase in antibody titers. The geometric mean antibody titer after vaccination was 1 : 25 in the vaccine group and <1 : 4 in the placebo group. PIV3-cp45 vaccine was safe and immunogenic in seronegative children and should be evaluated for efficacy in a phase 3 field trial. %0 Journal Article %~ Pubmed %A Lawrence, Glenda L %A MacIntyre, C Raina %A Hull, Brynley P %A McIntyre, Peter B %T Effectiveness of the linkage of child care and maternity payments to childhood immunisation. %B Vaccine %D 2004 %V 22 %N 17-18 %P 2345-50 %@ 0264-410X %X In 1998, Australia enacted comprehensive national legislation making receipt of the maternity immunisation allowance (MIA) and the child care benefit (CCB) conditional on evidence of age-appropriate immunisation. We assessed the impact of this policy on immunisation status using a nationally representative population-based case-control study of 589 fully immunised controls and 190 incompletely immunised cases, aged 28-31 months. Immunisation status was significantly associated with parent awareness of the MIA (adjusted odds ratio (aOR) = 3.34, 95% CI = 2.28 - 4.91) and CCB (aOR = 2.08, 95% CI = 1.30 - 3.34). Only 31% of the 219 control parents who were receiving the CCB reported that they could continue to afford child care without the assistance of the CCB. The use of legislated financial immunisation incentives for parents appears to be widely accepted among Australian parents and to have had an impact on immunisation uptake. The policy may serve as a model for other comparable countries. %0 Journal Article %~ Pubmed %A McIntyre, Peter %T Lessons from surveillance; solving the pertussis puzzle. %B NSW Public Health Bulletin %D 2003 %V 14 %N 4-5 %P 69-71 %@ 1034-7674 %X %Z FOR Codes: 111704 %0 Journal Article %~ Pubmed %A Lawrence, Glenda %A Menzies, Robert %A Burgess, Margaret %A McIntyre, Peter %A Wood, Nicholas %A Boyd, Ian %A Purcell, Patrick %A Isaacs, David %T Surveillance of adverse events following immunisation: Australia, 2000-2002. %B Communicable Diseases Intelligence Quarterly Report %D 2003 %V 27 %N 3 %P 307-23 %@ 0725-3141 %X The Adverse Drug Reactions Advisory Committee (ADRAC) database collates notifications of adverse events following immunisation (AEFI) from across Australia. The data were analysed for vaccines received between 1 January 2000 and 30 September 2002. Dose-based AEFI reporting rates were calculated using denominator data from the Australian Childhood Immunisation Register and annual national influenza vaccination coverage surveys. The majority of the 2,409 AEFI records analysed described non-serious events, principally injection site reactions; 10.5 per cent (n = 253) described AEFIs with outcomes defined as 'serious'. Ten deaths were recorded but only one, following yellow fever vaccine, was causally related to immunisation. The average annual population-based reporting rate was 4.5 per 100,000 population. Vaccine dose-based AEFI reporting rates were 2.2 per 100,000 doses of influenza vaccine for adults aged 40 years and over and 14.6 per 100,000 doses of all scheduled vaccines for children aged less than 7 years. The most frequently reported type of adverse event was injection site reaction following receipt of an acellular pertussis-containing vaccine, particularly among children in the age groups scheduled to receive their fourth or fifth doses of the vaccine (overall reporting rate 67 per 100,000 doses). The data highlight the safety of vaccines in Australia, and illustrate both the utility of available immunisation coverage data to estimate dose-based AEFI reporting rates and the value of the ADRAC database as a surveillance tool for monitoring AEFIs nationally. %0 Journal Article %~ Pubmed %A Leask, Julie %A McIntyre, Peter %T Public opponents of vaccination: a case study. %B Vaccine %D 2003 %V 21 %N 32 %P 4700-3 %@ 0264-410X %X Opposition to mass childhood vaccination is a world-wide phenomenon, particularly in industrialised countries. Unfounded claims about vaccination are perpetuated by parental lobby groups and individual spokespeople, some of whom have a medical or scientific background. This article focuses on one such spokesperson who has achieved particular notoriety. Dr. Viera Scheibner is a retired micropalaeontologist, without any formal training in health-related sciences, who tours the world claiming that vaccines are ineffective and dangerous and lead to a host of ills such as cancer and asthma. Professionals in public health or the clinical arena are from time to time called upon to publicly respond to her, or similar, claims disseminated during tours of Europe, North America or Australasia and in books and articles. Health professionals have expressed at how such spokespersons misrepresent the evidence on vaccine safety, resulting in the potential to undermine public confidence in immunisation. Media coverage, or proposed coverage, particularly of her more extreme claims, often makes health professionals engaged in immunisation feel obliged to respond. This paper describes Viera Scheibner's approach, which follows a repetitious path and is representative of that taken by other public opponents of immunisation. We conclude by suggesting how health professionals might respond in the public arena. %Z FOR Codes: 110701 %0 Journal Article %A van de Beck, D %A deGans, J %A McIntyre, P %A Prasad, K %T Corticosteoids in acute bacterial meningitis %B Cochrane Library Systematic Reviews %D 2003 %C WEB %I John Wiley and Sons %V 4, 2003 %N %P 1-26 %@ 1464-780X %X %0 Journal Article %~ Pubmed %A Hull, Brynley P %A Lawrence, Glenda L %A MacIntyre, C Raina %A McIntyre, Peter B %T Estimating immunisation coverage: is the 'third dose assumption' still valid? %B Communicable Diseases Intelligence Quarterly Report %D 2003 %V 27 %N 3 %P 357-61 %@ 0725-3141 %X Immunisation coverage is calculated from Australian Childhood Immunisation Register (ACIR) data using the 'third dose assumption'. This assumes that if the third in a series of vaccine doses has been recorded on the ACIR, the previous two doses have been received, whether or not they are recorded. The objectives of this study were to validate the 'third dose assumption', and measure the impact of the assumption on immunisation coverage estimates at 12 months of age. A sample of children born in 1999 and assessed as fully immunised at 12 months of age by applying the 'third dose assumption' were selected from the ACIR. Parents were interviewed by telephone to obtain information about vaccinations not recorded on the ACIR. Based on the survey results, the impact of the 'third-dose assumption' on national coverage estimates at 12 months of age was estimated. Of 219 surveyed children assessed as up-to-date at 12 months of age only by applying the 'third dose assumption', 212 (96.8%) met study criteria of 'definite' immunisation for all unrecorded first and second vaccine doses. Of the remaining seven, six believed all doses had been received, while one confirmed that one dose had been missed. The 'third dose assumption' overestimated coverage by 0.2 per cent, based on criteria for 'definite' immunisation. If the assumption were not used, immunisation coverage at 12 months of age in Australia would have been underestimated by 7 per cent. The 'third dose assumption' is valid and important to use in calculating immunisation coverage from the ACIR. Although ACIR reporting and coverage levels continue to improve, under-reporting of vaccine doses due at two and four months of age persists. The 'third dose assumption' may be applicable to comparable immunisation registries in other countries. %0 Journal Article %~ Pubmed %A Bonacruz-Kazzi, G %A McIntyre, P %A Hanlon, M %A Menzies, R %T Diagnostic testing and discharge coding for whooping cough in a children's hospital. %B Journal of Paediatrics and Child Health %D 2003 %V 39 %N 8 %P 586-90 %@ 1034-4810 %X OBJECTIVE: To evaluate the diagnostic pathways for whooping cough in a large urban paediatric hospital to inform assessment of the relative merits of notification and hospitalization data for measuring pertussis disease burden in Australian children. METHODS: All laboratory requests for Bordetella pertussis (BP) culture or serology between 30 June 1997 and 30 June 1999 were reviewed and cross-checked against discharge diagnoses with International Classification of Disease (ICD) codes A37.0, 033.0 (whooping cough due to BP) or 37.9, 033.9 (whooping cough due to unspecified organisms). Culture-positive (CP) cases were defined as a positive culture or polymerase chain reaction for BP. Culture-negative (CN) cases either fulfilled the current Australian clinical case definition (>/=14 days of cough with one or more of paroxysms, whoop, post-tussive vomiting), or had a cough illness with either positive BP serology or documented contact with an individual coughing for >14 days. In infants <6-months-old, a coughing illness with apnoea and negative investigations for other causes was also accepted. Culture positive and CN cases were cross-referenced with notification data. RESULTS: During the study period, laboratory tests for BP were performed in 677 children, of whom 230 were hospitalized and 71 (31%) had an eligible ICD code at discharge; 29 were CP, 40 CN, and two (3%) were misclassified. A further 14 CP children were not admitted. Although 61 hospitalized cases (88%) fulfilled notification criteria, including 32 (80%) of CN cases, only 26 (90%) of CP and eight (20%) of CN cases were notified. CONCLUSIONS: Notifications substantially under-enumerate hospitalized infant cases, especially those without positive laboratory tests. Hospital discharge data add significantly to surveillance for pertussis, particularly in infancy where most severe cases occur. %Z FOR Codes: 111704 111403 %0 Journal Article %~ Pubmed %A McIntyre, Peter %A Gilmour, Robin %A Watson, Michael %T Differences in the epidemiology of invasive pneumococcal disease, metropolitan NSW, 1997-2001. %B NSW Public Health Bulletin %D 2003 %V 14 %N 4-5 %P 85-9 %@ 1034-7674 %X %Z FOR Codes: 111799 %0 Journal Article %~ Pubmed %A Lawrence, Glenda L %A MacIntyre, C Raina %A Hull, Brynley P %A McIntyre, Peter B %T Measles vaccination coverage among five-year-old children: implications for disease elimination in Australia. %B Australian and New Zealand Journal of Public Health %D 2003 %V 27 %N 4 %P 413-8 %@ 1326-0200 %X OBJECTIVES: To (i) assess under-reporting of measles-mumps-rubella (MMR) vaccinations to the Australian Childhood Immunisation Register (ACIR); (ii) estimate MMR coverage among five-year-old children and the proportion immune to measles infection; (iii) identify factors related to non-uptake of MMR vaccination. METHODS: We analysed ACIR data for a birth cohort of approximately 64,000 children aged five years. The parents of a sample of 506 children with no ACIR record for the second MMR vaccination (MMR2), due at four years of age, were interviewed by telephone to assess under-reporting to the ACIR and reasons for non-uptake of MMR vaccination. RESULTS: Parents reported that 22% (n = 111) of the surveyed 506 children had received MMR2 before their fifth birthday, and 42% (n = 214) by approximately 5.5 years of age. After correcting for this level of under-reporting to the ACIR, MMR2 coverage for the entire cohort at five years of age was 52.9% (95% CI 52.3-53.4), and increased to 84.1% (95% CI 83.4-84.8) by approximately 5.5 years of age. This was 4.3% and 8.2%, respectively, higher than ACIR coverage estimates at the two ages. Based on the corrected MMR coverage estimates, 93% of the cohort was immune to measles due to vaccination. The most common parent-reported reason for incomplete vaccination was lack of knowledge about the MMR vaccination schedule. CONCLUSIONS: Measles elimination in Australia will require continued effort in vaccination coverage and timeliness among pre-school children. School-entry requirements are important for MMR2 uptake. Strategies are needed to improve reporting to the ACIR for more accurate measurement of coverage. %0 Journal Article %~ Pubmed %A McIntyre, Peter %A Williams, Alison %A Leask, Julie %T Refusal of parents to vaccinate: dereliction of duty or legitimate personal choice? %B Medical Journal of Australia %D 2003 %V 178 %N 4 %P 150-1 %@ 0025-729X %X %Z FOR Codes: 111704 %0 Journal Article %A Hull, BP %A Lawrence, GL %A MacIntyre, CR %A McIntyre, P %T Is low immunisation coverage in inner urban areas of Australia due to low uptake or poor notification? %B Australian Family Physician %D 2003 %C Australia %I Royal Australian College of General Practitioners %V 32(12) %N %P 1041-1043 %@ 0300-8495 %X %0 Journal Article %~ Pubmed %A Hull, Brynley P %A Lawrence, Glenda L %A MacIntyre, C Raina %A McIntyre, Peter B %T Immunisation coverage in Australia corrected for under-reporting to the Australian Childhood Immunisation Register. %B Australian and New Zealand Journal of Public Health %D 2003 %V 27 %N 5 %P 533-8 %@ 1326-0200 %X OBJECTIVE: To assess the level of under-reporting to the Australian Childhood Immunisation Register (ACIR) and the resulting underestimation of national immunisation coverage using ACIR data, and to correct national immunisation estimates for under-reporting. METHODS: A national population-based telephone survey was conducted in May-July 2001 of two random samples of children born in 1998 and 1999 who were recorded on the ACIR as incompletely immunised at either 12 months or 24 months of age. Parents were asked whether and when their child had received the vaccinations required to qualify as fully immunised. Survey data were then used to correct ACIR-derived coverage estimates at 12 and 24 months of age. RESULTS: Of 640 surveyed children in the 12-month group, 258 (40%) met the study definition of 'definitely immunised'. This adjusted the ACIR coverage estimate upwards by 2.7% to 94% (95% CI 93.6-94.1). Of 698 surveyed children in the 24-month group, 387 (55%) met the study definition of 'definitely immunised' at the second birthday. Adjusted coverage for doses due by 24 months was 89.8% (95% CI 89.6-90.1), 5% higher than recorded on the ACIR. CONCLUSIONS: Immunisation coverage in Australia for all scheduled vaccines due by 12 months of age is 94% and for all vaccines due by two years of age is almost 90%. The ACIR underestimates coverage by up to 5%. As the ACIR database relies on provider notification, published estimates of immunisation coverage are unlikely to rise significantly above current levels, unless mechanisms are put in place to further improve notification to the ACIR. %0 Journal Article %~ Pubmed %A MacIntyre, C R %A McIntyre, P B %A Cagney, M %T Community-based estimates of incidence and risk factors for childhood pneumonia in Western Sydney. %B Epidemiology and Infection %D 2003 %V 131 %N 3 %P 1091-6 %@ 0950-2688 %X The aim was to estimate the community incidence and risk factors for all-cause pneumonia in children in Western Sydney, Australia. A cross-sectional randomized computer-assisted telephone interview was conducted in July 2000, in Western Sydney. Parents of 2020 children aged between 5 and 14 years were interviewed about their child's respiratory health since birth. No verification of reported diagnosis was available. Logistic regression analysis was used to determine risk factors for pneumonia. A lifetime diagnosis of pneumonia was reported in 137/2020 (68%) children, giving an estimated incidence in the study sample of 7.6/1000 person-years. Radiological confirmation was reported in 85% (117/137). Hospitalization was reported in 41% (56/137) and antibiotic therapy in 93% (127/137) of cases. Using logistic regression modelling, statistically significant associations with pneumonia were a reported history of either asthma, bronchitis or other lung problems and health problems affecting other systems. In most cases, the diagnosis of asthma preceded the diagnosis of pneumonia. The community incidence of all causes of pneumonia is not well enumerated, either in adults or in children. This study provides community-based incidence data. The incidence of hospitalization for pneumonia in this study is comparable to estimates from studies in comparable populations, suggesting that retrospective parental report for memorable events is likely to be valid. We found a relationship between pneumonia and childhood respiratory diseases such as asthma, which has implications for targeted vaccination strategies. %0 Journal Article %~ Pubmed %A MacIntyre, C R %A Burgess, M A %A Hull, B %A McIntyre, P B %T Hepatitis A vaccination options for Australia. %B Journal of Paediatrics and Child Health %D 2003 %V 39 %N 2 %P 83-7 %@ 1034-4810 %X The epidemiology of hepatitis A is changing, with an increasing proportion of the population becoming susceptible to infection. The burden of hepatitis A is comparable to that of other vaccine-preventable diseases for which new vaccines are available. Options for vaccination include selective programmes for high-risk groups, which could involve screening prior to vaccination, or universal programmes for infants and/or adolescents. Selective programmes have been shown to be highly cost-effective if well implemented, but there is evidence that they might be poorly implemented. If a universal vaccination programme were considered for Australia, an infant programme, with doses at 18 months and 2 years, possibly with an additional adolescent programme, would be the recommended option. Universal hepatitis A vaccination for infants and/or adolescents is of comparable cost-effectiveness compared with other preventive strategies, but needs to be considered in the context of competing vaccination options. %0 Journal Article %~ Pubmed %A Torvaldsen, Siranda %A Simpson, Judy M %A McIntyre, Peter B %T Effectiveness of pertussis vaccination in New South Wales, Australia, 1996-1998. %B European journal of epidemiology %D 2003 %V 18 %N 1 %P 63-9 %@ 0393-2990 %X Pertussis notifications have increased over the past decade in Australia and other industrialised countries. This study estimates the effectiveness of pertussis vaccination in one Australian State (New South Wales, NSW) among children aged less than 14 years, during a period when an Australian whole-cell pertussis vaccine was in routine use. Cases notified with pertussis between 1996 and 1998 and pertussis vaccine coverage estimates from the Australian Childhood Immunisation Register were used. Vaccine effectiveness (VE) was calculated using the screening method, with adjustment for age group, year of disease onset and area of residence. VE was highest (91%) in the youngest age group (8-23 months) and lowest (78%) in the oldest age group (9-13 years). Pertussis vaccination is highly effective at preventing pertussis in NSW children, as measured by notified cases. Ongoing monitoring will be important to evaluate VE following Australia's change to an acellular vaccine based program. %Z FOR Codes: 110701 %0 Book Section %A McIntyre, P %T Pneumococcal disease %B The health of Indigenous Australians %D 2003 %C VIC %I Oxford University Press %V %N %P 384-396 %@ 0 19 551220 0 %X %0 Journal Article %~ Pubmed %A Torvaldsen, Siranda %A McIntyre, Peter B %T Effect of the preschool pertussis booster on national notifications of disease in Australia. %B The Pediatric Infectious Disease Journal %D 2003 %V 22 %N 11 %P 956-9 %@ 0891-3668 %X BACKGROUND: Australia introduced a fifth dose of pertussis vaccine at 4 to 5 years of age in 1994, the first country to do so for some 40 years. We report trends in national pertussis notifications from 1993 to 2001. METHODS: Notified pertussis cases were analyzed by age and year of disease onset. RESULTS: Before the fifth dose was introduced, notification rates were higher among 5- to 9-year-olds than 10- to 14-year-olds (76 per 100 000 population vs.65 per 100 000). As more 5- to 9-year-olds became eligible for the fifth dose, their notification rates as a group and by year of age progressively fell to below those of 10- to 14-year-olds, consistent with a vaccine effect. Comparison of notification rates for the epidemic years of 1997 and 2001 shows that 5- to 10-year-olds (eligible for fifth dose) had lower notification rates in 2001 (61 per 100 000) than 5- to 10-year-olds in 1997 (196 per 100 000). This contrasts with children who were not eligible for the fifth dose (12- to 14-year-olds), who had higher notification rates in 2001 (223 per 100 000) than 12- to 14-year-olds in 1997 (160 per 100 000). CONCLUSIONS: The pattern of age-specific notification rates provides strong evidence that the fifth dose reduced the incidence of pertussis in older children. It will be important to track the impact of the fifth dose on adolescent pertussis notifications to assess the duration of vaccine-acquired immunity. %Z FOR Codes: 110309 111704 %0 Journal Article %~ Pubmed %A Menzies, Rob %A Wang, Han %A McIntyre, Peter %T Has pertussis increased in NSW over the past decade? An evaluation using hospitalisation and mortality data versus notifications 1988-2002. %B NSW Public Health Bulletin %D 2003 %V 14 %N 4-5 %P 71-6 %@ 1034-7674 %X %Z FOR Codes: 111799 %0 Journal Article %~ Pubmed %A Hull, Brynley %A McIntyre, Peter %T Mapping immunisation coverage and conscientious objectors to immunisation in NSW. %B NSW Public Health Bulletin %D 2003 %V 14 %N 1-2 %P 8-12 %@ 1034-7674 %X %Z FOR Codes: 111799 111799 %0 Journal Article %A Roche, P %A McIntyre, Peter %A Spencer, J %T Pneumococcal disease in Australia: current status and future challenges. %B Communicable Diseases Intelligence %D 2003 %C Canberra, Australia %I Australian Government %V 27 %N %P 79-84 %@ 0725-3141 %X %Z FOR Codes: 111706 %0 Journal Article %~ Pubmed %A Hull, Brynley P %A Lawrence, Glenda L %A MacIntyre, C Raina %A McIntyre, Peter B %T Is low immunisation coverage in inner urban areas of Australia due to low uptake or poor notification? %B Australian Family Physician %D 2003 %V 32 %N 12 %P 1041-3 %@ 0300-8495 %X INTRODUCTION: The Australian Childhood Immunisation Register (ACIR) consistently reveals pockets of lower immunisation coverage in inner urban areas. We investigated whether low uptake or poor notification of immunisation is the main reason for this difference. METHODS: We estimated under reporting by telephone surveying the parents of 640 children recorded as incompletely immunised on the ACIR at 12 months of age. Immunisation status was based on parental report of written records and/or date of receipt. RESULTS: Of the 97 children living in inner urban areas (defined by postcode and population density), 55 (57%) were shown to be 'definitely immunised'. One hundred and thirty-four (53%) of the 253 children in other urban areas were shown to be 'definitely immunised'. Both these groups were significantly more likely to be 'definitely immunised' than the 104 (36%) of 290 children in areas outside capital cities (p < 0.0001). DISCUSSION: Apparent lower immunisation uptake in inner urban areas of Australia may be attributable to reporting error. %0 Journal Article %~ Pubmed %A Horby, Peter %A Gilmour, Robin %A Wang, Han %A McIntyre, Peter %T Progress towards eliminating Hib in Australia: an evaluation of Haemophilus influenzae type b prevention in Australia, 1 July 1993 to 30 June 2000. %B Communicable Diseases Intelligence Quarterly Report %D 2003 %V 27 %N 3 %P 324-41 %@ 0725-3141 %X The status of Haemophilus influenzae (Hib) disease and its prevention by vaccination was reviewed for the period 1997 to 2000. This forms the background to a change in national vaccine policy, from the use of two Hib vaccines to the use of PRP-OMP only throughout Australia from May 2000. Notifications of Hib in the 7-year period between 1993 and 2000 declined by 87 per cent among children 0-4 years of age; adjustment for likely under-reporting increase this to a 95 per cent reduction. Among age groups not included in the immunisation program, there was also a substantial decline in notified cases. Overall, a minimum 430 cases and 13 deaths were prevented by Hib immunisation annually in Australia. Enhanced Hib surveillance recorded 532 cases over seven years, with 353 in unvaccinated persons, 74 fulfilling criteria for true vaccine failure and 75 partially immunised. Of unvaccinated cases, 60 and 182 were eligible for routine and catch-up immunisation respectively. Although the overall incidence for 0-4 years of age declined from 15 to 1.2 cases per 100,000 population, the proportion of cases under six months of age increased from 11 per cent to 23 per cent. Overall vaccine effectiveness, estimated using data from the last five years of the program, was 83 per cent (95% CI 71-91%), increasing to 90 per cent (95% CI 83-94%) when adjusted for under-reporting to the Australian Childhood Immunisation Register. Among Aboriginal and Torres Strait Islander people, the incidence of invasive Hib disease fell from 4.6 cases per 100,000 population to 0.7 cases per 100,000 population but the proportion of cases now occurring among Aboriginal or Torres Strait Islander people increased significantly, from 7 to 15 per cent. The Hib immunisation program in Australia has been highly successful. Nevertheless, experience in Australia and elsewhere indicates that continued careful monitoring of Hib disease, with high quality laboratory surveillance, remains important. %Z FOR Codes: 110309 %0 Journal Article %~ Pubmed %A Torvaldsen, Siranda %A McIntyre, Peter %T Do variations in pertussis notifications reflect incidence or surveillance practices? A comparison of infant notification rates and hospitalisation data in NSW. %B NSW Public Health Bulletin %D 2003 %V 14 %N 4-5 %P 81-4 %@ 1034-7674 %X %Z FOR Codes: 111799 %0 Conference Proceedings %A Morris, AMS %A Elliott, EJ %A McIntyre, PB %A Massie, J %A Ridley, G %A McEniery, J %A Knight, G %T Hospitalised pertussis in infancy %B Journal Of Paediatrics And Child Health %D 2002 %C Brisbane Australia %I Blackwell Publishing Asia, 54 University St,P O Box 378, Carlton, Australia, 3053 %V 38 %N %P A2-A2 %@ 1034-4810 %X %0 Journal Article %A Nolan, T %A McIntyre, PB %A Roberton, D %A Descamps, D %T Reactogenicity and immunogenicity of a live attenuated tetravalent measles - mumps - rubella-varicella (MMRV) vaccine %B Vaccine %D 2002 %C The Boulevard,Langford Lane,Kidlington, Oxford, England, Ox5 1Gb %I Elsevier Sci Ltd %V 21 %N %P 281-289 %@ 0264-410X %X %0 Journal Article %~ Pubmed %A MacIntyre, C R %A Gay, N J %A Gidding, H F %A Hull, B P %A Gilbert, G L %A McIntyre, P B %T A mathematical model to measure the impact of the Measles Control Campaign on the potential for measles transmission in Australia. %B International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases %D 2002 %V 6 %N 4 %P 277-82 %@ 1201-9712 %X BACKGROUND: The aims of this study were to determine the impact of the Australian Measles Control Campaign (MCC) on the transmission dynamics of measles by calculating the reproductive number (R) before and after the MCC, and to predict measles control in Australia in the future. METHODS: A national serosurvey was conducted before and after the MCC. Sera were tested for anti-measles IgG using enzyme immunoassay (EIA). A mathematical model, using serosurvey results and vaccine coverage estimates, was used to calculate the change in R after the MCC. RESULTS: The values of R calculated before and after the MCC were 0.90 and 0.57. At vaccine coverage levels indicated by the Australian Childhood Immunisation Register (ACIR), the value of R will exceed 1 (the epidemic threshold) in 2007-2008 nationally, and sooner in some regions of Australia. Coverage of at least 84% with two doses of MMR is required to sustain measles control. CONCLUSIONS: The Australian MCC had a significant impact on the transmission dynamics of measles. However, current vaccine coverage levels may result in indigenous measles transmission by 2007. Sustained efforts are required to improve coverage with two doses of MMR and to ensure elimination of indigenous measles transmission. %0 Journal Article %A McMaster, P %A McIntyre, PB %A Gilmour, R %A Gilbert, GL %A Kakakios, A %A Mellis, CM %T The emergence of resistant pneumococcal meningitis - implications for empiric therapy %B Archives Of Disease In Childhood %D 2002 %C British Med Assoc House,Tavistock Square, London, England, Wc1H 9Jr %I British Med Journal Publ Group %V 86 %N %P 207-211 %@ 0003-9888 %X %0 Journal Article %A Turnbull, FM %A McIntyre, PB %A Achat, HM %A Wang, H %A Stapledon, R %A Gold, M %A Burgess, MA %T National study of adverse reactions after vaccination with Bacille Calmette-Guerin %B Clinical Infectious Diseases %D 2002 %C 1427 E 60Th St, Chicago, Il, 60637-2954 %I Univ Chicago Press %V 34 %N %P 447-453 %@ 1058-4838 %X %0 Journal Article %~ Pubmed %A Torvaldsen, Siranda %A McIntyre, Peter B %T Observational methods in epidemiologic assessment of vaccine effectiveness. %B Communicable Diseases Intelligence Quarterly Report %D 2002 %V 26 %N 3 %P 451-7 %@ 0725-3141 %X Observational methods are important in the measurement of vaccine effectiveness (VE) as experimental designs cannot be used for measurement of vaccines already on the vaccination schedule. Furthermore, efficacy measured in clinical trials under ideal conditions may differ to effectiveness in the field under non-ideal conditions and in different populations. In addition to post-licensure surveillance, observational VE studies are particularly important when disease incidence does not predictably decrease with increased vaccine coverage, when high proportions of vaccine failure among reported cases suggest a problem with the vaccine or when issues arise that were not predicted in pre-licensure evaluations. Commonly used study types for evaluating VE include cohort studies, household contact studies, case-control studies, the screening method and case-cohort studies. There are many potential biases in all observational VE studies which should be considered in the study design and analysis stage. Of the five observational study types reviewed, cohort studies undertaken during an outbreak investigation offer the simplest means of VE estimation and is the preferred study design where the situation permits. Where this is not possible the screening method is the most economical and rapid method. It is essential that the effectiveness of all vaccination programs be evaluated. As new vaccines are introduced to the schedule, booster doses are added and the timing of doses changed, the role of observational methods in the evaluation of VE will become even more important. To date, few observational VE studies have been undertaken in Australia, suggesting the under-utilisation of these methods. %0 Journal Article %A Torvaldsen, S %A Hull, BP %A McIntyre, PB %T Using the Australian Childhood Immunisation Register to track the transition from whole-cell to aceullular pertussis vaccines %B Communicable Disease Intelligence %D 2002 %C Canberra ACT %I Department of Health and Ageing %V 26 (4) %N %P 581-583 %@ 0725-3141 %X %0 Journal Article %A Jones, CA %A Isaacs, D %A McIntyre, PB %A Cunningham, AL %A Garland, S %T Neonatal herpes simplex virus infection %B Ninth Annual Report %D 2002 %C Sydney %I Australian Paediatric Surveillance Unit %V 9 %N %P 31-32 %@ 1443-3524 %X %0 Book %A Hull, BP %A Lawrence, GL %A McIntyre, PB %A MacIntyre, R %T Immunisation Coverage: Australia 2001 %B %D 2002 %C Canberra %I Department of Communications, Information, Technology and the ArtsHealth and Ageing %V %N %P %@ 0-642-82023-6 %X %0 Journal Article %~ Pubmed %A Turnbull, F M %A Burgess, M A %A McIntyre, P B %A Lambert, S B %A Gilbert, G L %A Gidding, H F %A Escott, R G %A Achat, H M %A Hull, B P %A Wang, H %A Sam, G A %A Mead, C L %T The Australian Measles Control Campaign, 1998. %B Bulletin of the World Health Organization %D 2001 %V 79 %N 9 %P 882-8 %@ 0042-9686 %X The 1998 Australian Measles Control Campaign had as its aim improved immunization coverage among children aged 1-12 years and, in the longer term, prevention of measles epidemics. The campaign included mass school-based measles-mumps-rubella vaccination of children aged 5-12 years and a catch-up programme for preschool children. More than 1.33 million children aged 5-12 years were vaccinated at school: serological monitoring showed that 94% of such children were protected after the campaign, whereas only 84% had been protected previously. Among preschool children aged 1-3.5 years the corresponding levels of protection were 89% and 82%. During the six months following the campaign there was a marked reduction in the number of measles cases among children in targeted age groups. %0 Journal Article %~ Pubmed %A Gilbert, G L %A Escott, R G %A Gidding, H F %A Turnbull, F M %A Heath, T C %A McIntyre, P B %A Burgess, M A %T Impact of the Australian Measles Control Campaign on immunity to measles and rubella. %B Epidemiology and Infection %D 2001 %V 127 %N 2 %P 297-303 %@ 0950-2688 %X To evaluate the impact of the 1998 Australian Measles Control Campaign on immunity to measles and rubella, 4400 opportunistically-collected sera, submitted to diagnostic laboratories across Australia from subjects aged 1-49 years, and 3000 from subjects aged 1-18 years, were tested before and after the campaign, respectively. The proportion of individuals aged 1-18 years who were immune to measles rose from 85% before, to 90% after, the campaign (P < 0.001). The greatest increase was in preschool (7%, P < 0.001) and primary school (10%, P < 0.001) children, who were actively targeted by the campaign. Rubella immunity in 1-18 year-olds rose from 83% to 91% (P < 0.0001), again with significant increases in preschool (4%, P = 0.002) and primary school (16%, P < 0.001) children. 94% of individuals aged 19-49 years were immune to rubella. These serosurveys confirm other evidence of the effectiveness of the Australian Measles Control Campaign and demonstrate the value of serosurveillance using opportunistically collected sera. %0 Journal Article %~ Pubmed %A MacIntyre, C R %A McIntyre, P B %T MMR, autism and inflammatory bowel disease: responding to patient concerns using an evidence-based framework. %B Medical Journal of Australia %D 2001 %V 175 %N 3 %P 127-8 %@ 0025-729X %X %0 Journal Article %A Hanlon, MG %A Nambiar, R %A Kakakios, A %A McIntyre, PB %A Land, MV %A Devine, PL %T Pertussis antibody levels in infants immunized with an acellular pertussis component vaccine, measured using whole-call pertussis ELISA %B Immunology and Cell Biology %D 2000 %C %I Blackwell Science Asia Pty Ltd %V 78 %N %P 254-258 %@ 0818-9641 %X %0 Journal Article %A Lister, S %A McIntyre, PB %A Menzies, R %T The epidemiology of respiratory syncytial virus infections in NSW children, 1992-1997 %B NSW Public Health Bulletin %D 2000 %C %I Public Health Division of NSW Health %V 11 %N %P 119-123 %@ 1034-7674 %X %0 Book Section %A McIntyre, PB %T Meningitis %B Evidence Based Pediatrics and Child Health %D 2000 %C %I BMJ Books %V %N %P 197-205 %@ 0-7279-1424-3 %X %0 Journal Article %A Thomas, PF %A McIntyre, PB %A Jalaludin, BB %T Survey of pertussis morbidity in adults in western Sydney %B Medical Journal of Australia %D 2000 %C %I Australian Medical Association %V 173 %N %P 74-76 %@ 0025-729X %X %0 Journal Article %A Hull, B %A McIntyre, PB %T A re-evaluation of immunisation coverage estimates from the Australian Childhood Immunisation Register %B Communicable Diseases Intelligence %D 2000 %C %I Department of Health and Family Services %V 24 (6) %N %P 161-164 %@ 0725-3141 %X %0 Journal Article %A McIntyre, PB %A Gidding, HF %A Gilbert, GL %T Measles in an era of measles control %B Medical Journal of Australia %D 2000 %C %I Australasian Medical Publishing Co Ltd %V 172 %N %P 103-104 %@ 0025-729X %X %0 Journal Article %A McIntyre, PB %A Gilmour, R %A Gilbert, GL %A Kakakios, A %A Mellis, C %T Epidemiology of invasive pneumococcal disease in urban New South Wales, 1997-1999 %B Medical Journal of Australia %D 2000 %C %I Australian Medical Association %V 173 %N %P 2-6 %@ 0025-729X %X %0 Journal Article %A McIntyre, PB %A Amin, J %A Gidding, H %A Hull, B %A Torvaldsen, S %A Tucker, A %A Turnbull, FM %A Burgess, MA %T Vaccine preventable diseases and vaccination coverage in Australia, 1993-1998 %B Communicable Diseases Intelligence %D 2000 %C %I Dept of Health and Family Services: National Center for Disease Control %V 24 %N %P 276-277 %@ 0725-3141 %X %0 Journal Article %A Guthridge, S %A McIntyre, PB %A Isaacs, D %A Hanlon, MG %A Patel, C %T Differing serologic responses to an Haemophilus influenzae type b polysaccharide-Neisseria meningitidis outer membrane protein conjugate (PRP-OMPC) vaccine in Australian Aboriginal and Caucasian infants - implications for disease epidemiology %B Vaccine %D 2000 %C %I Elsevier Science Ltd %V 18 %N %P 2584-2591 %@ 0264-410X %X %0 Journal Article %A McIntyre, PB %A Nolan, TM %T Conjugate pneumococcal vaccines for non-indigenous children in Australia %B Medical Journal of Australia %D 2000 %C %I Australian Medical Association %V 173 %N %P S54-S57 %@ 0025-729X %X %0 Journal Article %A Hull, B %A McIntyre, PB %T Immunisation coverage reporting through the Australian Childhood Immunisation Register - an evaluation of the third-dose assumption %B Australian and New Zealand Journal of Public Health %D 2000 %C %I Public Health Association of Australia Inc %V 24 (1) %N %P 17-21 %@ 1326-0200 %X