Suchergebnisse

AbstractAs COVID-19 vaccinations rolled out globally from late 2020, rules and recommendations regarding vaccine use in pregnancy shifted rapidly. Pre-registration COVID-19 vaccine trials excluded those who were pregnant. Initial Australian medical advice did not routinely recommend COVID-19 vaccines in pregnancy, due to limited safety data and little perceived risk of local transmission. Advice from local medical authorities changed throughout 2021, however, with recommendations and priority access during pregnancy. In Western Australia (WA), recommendations became requirements as the State government mandated vaccines for some workers, with brief availability of pregnancy exemptions. Through an examination of 10 in-depth interviews with WA pregnant women, we explore their decision-making and complex emotions regarding COVID-19 vaccinations, and how they balanced mandates, recommendations, and shifting considerations and perceptions of risk. Changing recommendations and rules—and media and popular interpretation and communications of these—led to confusion, including for medical professionals. Expectant parents had to negotiate the risks of COVID-19 disease, potential benefits and risks of vaccination, professional and personal costs of vaccine refusal, and interpret mixed medical advice. Our findings can inform the development and communication of public health policies and medical advice, and contribute to our understanding of bodily autonomy, risk, and decision-making beyond the pandemic.

AbstractAustralian governments have used vaccine mandates to drive high uptake of routine childhood vaccines and adult Coronavirus Disease 2019 (COVID‐19) and influenza vaccines. We sought to understand the attitudes of Western Australian parents regarding mandating COVID‐19 vaccines for children, interviewing 44 parents of children aged up to 18 years between May and December 2021. Transcripts were analysed to ascertain parents' attitudes and sources of reasoning. Over half of the parents supported COVID‐19 vaccine mandates for children, while the rest had opposing, nuanced or indifferent views. Participants invoked community and health‐related reasoning; policy and government‐related reasoning; and concerns based on practical implementation. There was a high degree of consistency in parents' attitudes toward COVID‐19 vaccines and whether they supported mandating them for children, although some who planned to delay vaccination nevertheless supported the idea of mandates. Some participants reported that a mandate would prompt them to vaccinate, but others were willing to accept the consequences of keeping their children unvaccinated, or said that a mandate would not affect them as they would vaccinate regardless. Understanding how parents think and feel about mandating COVID‐19 vaccines with educational exclusions or financial penalties is critical to inform policymakers, who may consider these strategies for future pandemic vaccines.

ABSTRACT
ObjectivesAcute lower respiratory infections (ALRI) such as bronchiolitis, pneumonia and influenza are a common cause of childhood morbidity. The relative importance of individual respiratory viruses associated with these infections may fluctuate in different populations. Knowledge of the aetiology of ALRI is important so that preventive strategies, such as vaccination, may be targeted appropriately. We sought to describe the virus-specific burden of ALRI in children born in Western Australia (WA).
ApproachWe identified a birth cohort of children born in WA from 1996 to 2012. ALRI-coded hospital admissions and routine laboratory data regarding the detection of respiratory viruses pertaining to these children were extracted and linked through the WA Data Linkage Unit. Hospitalisation and laboratory data were restricted to Jan 2000 to Jun 2013 as laboratory data were only available for this period.
Repeat hospital admissions for ALRI within 14 days of each other were collapsed into the same episode of infection. Virus detection was defined as detection via culture, immunofluorescence or molecular methods from a respiratory sample 48 hours pre- or post-hospitalisation. We estimated the proportion of ALRI episodes in children aged up to 17 years with a laboratory test recorded and identified the viruses detected. Using person-time-at-risk as the denominator, we calculated the virus-specific rates of ALRI in 2000-2012 in the birth cohort.
ResultsOf 469,589 children born 1996-2012, 7.0% were admitted to hospital at least once for ALRI between Jan 2000 and Jun 2013. Bronchiolitis and pneumonia were the most common diagnoses, collectively accounting for 73.3% (n=32,815) of all ALRI episodes.
45.4% of ALRI episodes (n=20,323) in children aged 0-17 years linked to a laboratory test record. Of those with a laboratory record, 60.0% tested positive for one or more viruses, most commonly respiratory syncytial virus (RSV; n=7671). Of those with at least 1 virus detected, 4.7% had 2 or more viruses detected, with RSV-adenovirus being the most common viral pair.
Among children aged under 5 years, rates of virus-related ALRI hospitalisation were highest in children aged 1-2 months (37.2 per 1000 child-years), corresponding to the peak in RSV-related hospitalisations (30.6 per 1000 child-years). By contrast, rates of adenovirus-related hospitalisations were highest in children aged 6-11 months (1.7 per 1000 child-years).
ConclusionThis study demonstrates the power of using linked data to assess the virus-specific burden of ALRI in a population of children. Future work will focus on viral-viral coinfection and its impact on clinical outcomes.

IntroductionSeveral countries have developed national immunisation registers, but only the Nordic countrieshave linked their registers to other health data in order to comprehensively evaluate the 'real world'effectiveness of vaccines. Nordic countries can link datasets deterministically using the nationalperson identifier, but most countries, including Australia, don't have such an identifier to enablethis type of linkage.
ObjectivesTo describe the process for assembling a linked study cohort that will enable the conduct ofpopulation-based studies related to immunisation and immunisation policy.
MethodsNational death and immunisation databases along with state health data (notifications of vaccinepreventable diseases, perinatal data, hospital admissions and emergency department presentations)up until December 2013 were probabilistically linked (using demographic details) for children bornbetween 1996 and 2012 in two states: Western Australia and New South Wales (42% of Australia'spopulation, combined).
ResultsAfter exclusions there were 1.95 million children in the study cohort (live born children withboth a birth and perinatal record which represents 97.5% of all live births in the state perinataldata collections - our source population) and 18.0 million person years of follow up (mean: 9.2years per child). The characteristics of children in the cohort were generally similar to those onlyincluded in state perinatal databases and outcome measures were in keeping with expected figuresfrom unlinked data sources. However, the lack of a dynamic national population register meantimmigrants could not be included.
ConclusionsWe have been able to develop a similarly comprehensive system to the Nordic countries based onprobabilistic linkage methods. Our experience should provide encouragement to other countrieswith national immunisation registers looking to establish similar systems.

BACKGROUND: Hospitalisation with skin infection in Western Australian (WA) Aboriginal children is common, with the highest rates in infants and children from remote WA. We aimed to quantify infant, maternal, and sociodemographic risk factors for skin infection hospitalization in WA children, focusing on Aboriginal children aged <17 years. METHODS: We conducted a retrospective population-based cohort study with linked perinatal and hospitalization data on WA-born children (1996–2012), of whom 31,348 (6.7%) were Aboriginal. We used Cox regression to calculate adjusted hazard ratios and associated population attributable fractions (PAFs) for perinatal factors attributed to the first hospitalization with skin infection. To identify specific risk factors for early-onset infection, we further restricted the cohort to infants aged <1 year. RESULTS: Overall, 5,439 (17.4%) Aboriginal and 6,750 (1.5%) non-Aboriginal children were hospitalized at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalization rate (63.2/1,000 child-years). The strongest risk factors in Aboriginal children aged <17 years were socio-economic disadvantage, very remote location at birth and multi-parity (≥3 previous pregnancies) accounting for 24%, 23% and 15% of skin infection hospitalizations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy and low birthweight. CONCLUSION: We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalizations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalizations. Our evidence supports existing calls for substantial government investment in addressing underlying social and environmental barriers to healthy skin in WA Aboriginal children but also identifies potential areas to target health promotion messaging at individuals/families on maternal smoking during pregnancy and skin hygiene for ...

INTRODUCTION: Pregnant women and infants are at risk of severe influenza and pertussis infection. Inactivated influenza vaccine (IIV) and diphtheria-tetanus-acellular pertussis vaccine (dTpa) are recommended during pregnancy to protect both mothers and infants. In Australia, uptake is not routinely monitored but coverage appears sub-optimal. Evidence on the safety of combined antenatal IIV and dTpa is fragmented or deficient, and there remain knowledge gaps of population-level vaccine effectiveness. We aim to establish a large, population-based, multi-jurisdictional cohort of mother-infant pairs to measure the uptake, safety and effectiveness of antenatal IIV and dTpa vaccines in three Australian jurisdictions. This is a first step toward assessing the impact of antenatal vaccination programmes in Australia, which can then inform government policy with respect to future strategies in national vaccination programmes. METHODS AND ANALYSIS: 'Links2HealthierBubs' is an observational, population-based, retrospective cohort study established through probabilistic record linkage of administrative health data. The cohort includes births between 2012 and 2017 (~607 605 mother-infant pairs) in jurisdictions with population-level antenatal vaccination and health outcome data (Western Australia, Queensland and the Northern Territory). Perinatal data will be the reference frame to identify the cohort. Jurisdictional vaccination registers will identify antenatal vaccination status and the gestational timing of vaccination. Information on maternal, fetal and child health outcomes will be obtained from hospitalisation and emergency department records, notifiable diseases databases, developmental anomalies databases, birth and mortality registers. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Western Australian Department of Health, Curtin University, the Menzies School of Health Research, the Royal Brisbane and Women's Hospital, and the West Australian Aboriginal Health Ethics Committees. Research findings ...

INTRODUCTION: Pneumococcal conjugate vaccines (PCVs) prevent disease through both direct protection of vaccinated individuals and indirect protection of unvaccinated individuals by reducing nasopharyngeal (NP) carriage and transmission of vaccine-type (VT) pneumococci. While the indirect effects of PCV vaccination are well described, the PCV coverage required to achieve the indirect effects is unknown. We will investigate the relationship between PCV coverage and VT carriage among undervaccinated children using hospital-based NP pneumococcal carriage surveillance at three sites in Asia and the Pacific. METHODS AND ANALYSIS: We are recruiting cases, defined as children aged 2-59 months admitted to participating hospitals with acute respiratory infection in Lao People's Democratic Republic, Mongolia and Papua New Guinea. Thirteen-valent PCV status is obtained from written records. NP swabs are collected according to standard methods, screened using lytA qPCR and serotyped by microarray. Village-level vaccination coverage, for the resident communities of the recruited cases, is determined using administrative data or community survey. Our analysis will investigate the relationship between VT carriage among undervaccinated cases (indirect effects) and vaccine coverage using generalised estimating equations. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the relevant ethics committees at participating sites. The results are intended for publication in open-access peer-reviewed journals and will demonstrate methods suitable for low- and middle-income countries to monitor vaccine impact and inform vaccine policy makers about the PCV coverage required to achieve indirect protection.