ORCID Profile
0000-0002-4516-4127
Current Organisations
Telethon Kids Institute
,
University of Sydney
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Publisher: Cold Spring Harbor Laboratory
Date: 02-07-2022
DOI: 10.1101/2022.07.01.22277170
Abstract: Pneumonia remains a leading cause of hospitalization and death among young children worldwide, and the diagnostic challenge of differentiating bacterial from non-bacterial pneumonia is the main driver of antibiotic use for treating pneumonia in children. Causal Bayesian networks (BNs) serve as powerful tools for this problem as they provide clear maps of probabilistic relationships between variables and produce results in an explainable way by incoporating both domain expert knowledge and numerical data. We used domain expert knowledge and data in combination and iteratively, to construct, parameterise and validate a causal BN to predict causative pathogens for childhood pneumonia. Expert knowledge elicitation occurred through a series of group workshops, surveys and one-on-one meetings involving 6-8 experts from erse domain areas. The model performance was evaluated based on both quantitative metrics (area under the receiver-operator curve (AUROC) and log loss) and qualitative expert validation. Sensitivity analyses were conducted to investigate how the target output is influenced by varying key assumptions of particular high degree of uncertainty around data or domain expert knowledge. Designed to apply to a cohort of children with X-ray confirmed pneumonia who presented to a tertiary paediatric hospital in Australia, the resulting BN offers explainable and quantitative predictions on a range of variables of interest, including the diagnosis of bacterial pneumonia, detection of respiratory pathogens in the nasopharynx, and the clinical phenotype of a pneumonia episode. Satisfactory numeric performance has been achieved including an AUROC of 0.8 in predicting the clinical diagnosis of bacterial pneumonia. Three commonly encountered scenarios were presented to demonstrate the potential usefulness of the BN outputs in various clinical pictures. To our knowledge, this is the first causal model developed to help determine the causative pathogen for paediatric pneumonia. It can be utilized to derive recommendations to support more directed and judicious use of antimicrobials for relevant cohorts. The BN needs further validation before it can be clinically implemented. Our model framework and the methodological approach can be adapted beyond our context to broad respiratory infections and geographical and healthcare settings.
Publisher: Wiley
Date: 25-02-2016
DOI: 10.1111/RESP.12741
Abstract: Respiratory infections are a common cause of paediatric morbidity. Clinical outcomes in children hospitalized with single respiratory virus infection are compared with those with two or more viral-viral coinfection. Studies were restricted to those reporting on children aged less than 5 years (PROSPERO CRD#42014009133). Published data to calculate risk ratios (RR) comparing children with single viral infections to coinfection using a random effects model were used. Similar analyses by pathogen pairs and by excluding children with comorbidities were performed. Of 4443 articles reviewed, 19 were included. Overall, no differences in the risk of fever, admission to an intensive care unit (ICU), oxygen use, mechanical ventilation and abnormal radiographs between children with single infection and those with coinfection were found. When analysing only children without comorbidities, the risk of fever (RR = 1.16 to RR = 1.24, 95% confidence intervals (CI) = 1.00-1.55) and ICU admission (RR = 1.08 to RR = 1.31, 95% CI = 0.93-1.83) increased but remained non-significant. Point estimates suggested an increased risk of ICU admission in those coinfected with either respiratory syncytial virus or human metapneumovirus compared with those with single infection but was non-significant. Our findings suggest that coinfection is not associated with increased clinical severity, but further investigations by pathogen pairs are warranted.
Publisher: Public Library of Science (PLoS)
Date: 30-11-2017
Publisher: Swansea University
Date: 18-04-2017
Abstract: ABSTRACTObjectivesAustralia’s Childhood Immunisation Register (ACIR) is one of only a handful of national immunisation registers world-wide. We have, for the first time, linked the ACIR to other health datasets to measure the real-world impact of Australia’s immunisation program. In this study, we aimed to assess the population-based effectiveness of the 3-dose infant pneumococcal vaccination program (due at 2, 4, and 6 months) against invasive pneumococcal disease caused by the 7 vaccine specific serotypes. The 7-valent pneumococcal conjugate vaccine (PCV7) has been available since 2001 and a funded universal program started in 2005 (with a switch to 13-valent PCV in 2011). ApproachVaccination records from ACIR, death records, and invasive pneumococcal disease notifications for 2001-2013 were in idually linked for 1.37 million children born in 2001-2012 in two Australian states (Western Australia and New South Wales). A Cox proportional hazards model (adjusting for sex, Indigenous status and year of birth) was used to estimate the hazard ratio for invasive pneumococcal disease in vaccinated compared to unvaccinated children less than 2 years old. The per cent of disease prevented by vaccination, or vaccine effectiveness, was calculated as (1-adjusted hazard ratio) x 100%. ResultsFrom 2005, vaccination coverage with dose 3 of the pneumococcal vaccine was steady at ~91% in eligible cohorts. Between 2001 and 2013, there were 468 notifications of invasive pneumococcal disease caused by the 7 vaccine specific serotypes during 2.66 million person years of observation only 39 (8.3%) of these cases occurred after the universal program was implemented. Vaccine effectiveness against invasive pneumococcal disease caused by the 7 vaccine specific serotypes for 1, 2 and 3 doses of the pneumococcal vaccine was 68% (95%CI: 44-89%), 93% (81-97%), and 92% (95%CI: 86-93%), respectively. ConclusionThis is the first study to link Australia’s national immunisation register and measure population-based vaccine effectiveness. The study provides robust evidence of the effectiveness of at least 2 doses of pneumococcal vaccine against vaccine serotype specific infection using a 3 dose infant schedule.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.VACCINE.2021.10.013
Abstract: Pertussis hospitalisation is more common among infants born prematurely, who have significant comorbidities, or are Indigenous, but acellular pertussis (aP) vaccine effectiveness (VE) estimates in these sub-groups are lacking. We measured aP VE by Indigenous status, and policy-relevant categories of prematurity and comorbidity, in a population-based Australian cohort. Perinatal, disease notification, hospitalisation, mortality, and vaccination data were linked to birth records in two Australian states (Western Australia and New South Wales) 2001-2012, with follow-up to the end of 2013. Children followed to 18 months of age were stratified by Aboriginality, prematurity (<32 vs 32- 1,300,000 children, 63,867 (4·9%) were Aboriginal, 47,721 (3·6%) had at least one comorbidity and 3,771 first episodes of notified pertussis occurred <18 months of age of these, 1,207 (32.0%) had an associated pertussis-coded hospitalisation. For hospitalised pertussis in Aboriginal and non-Aboriginal children, there was significant protection post dose 1 (VE 51% v 25%), 2 (VE 69% v 74%) and 3 (VE 76% v 80%). For children with co-morbidities, VE for hospitalised pertussis was low and non-significant post dose 1 (0%) and 2 (30%). Post dose 3, VE was significant for hospitalised pertussis (70% 95% CI 29-87) but not for non-hospitalised pertussis (24% 95% CI -49 to 61). For most Aboriginal and non-Aboriginal children, improved timeliness of current infant doses and higher antenatal coverage should further improve protection against pertussis of any severity. For children at highest risk of severe pertussis (born <32 weeks gestation or with significant medical comorbidities), our data suggest that additional measures-such as extra doses of pertussis-containing vaccines and/or vaccines with improved immunogenicity-are needed for protection.
Publisher: Wiley
Date: 12-03-2020
DOI: 10.1111/PPE.12669
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.VACCINE.2019.08.047
Abstract: Two rotavirus vaccines (RV1 and RV5) were included in the publicly funded National Immunisation Program in Australia from July 2007. The programme in Western Australia initially provided RV1 (at ages 2 and 4 months) and then switched to RV5 (at ages 2, 4 and 6 months) from July 2009. This retrospective case-control study was conducted to assess the effectiveness of rotavirus vaccine against laboratory confirmed and notified cases of rotavirus infection among children aged <5 years. Case-subjects were identified as vaccine-eligible children (born from 1 May 2007) who were notified as having rotavirus infection during the period 2009-2011. The control group was vaccine-eligible children notified as having C ylobacter or Salmonella infection during the same period. In idual rotavirus immunisation status was ascertained from a population-based immunisation register. Full-dose and partial-dose vaccine effectiveness (VE) were calculated for both vaccines using the adjusted odds ratio (OR) of vaccination for cases versus controls (VE = (1 - OR)*100%). Overall, 282 cases and 883 controls were included. The adjusted VE for a full course of either rotavirus vaccine was 72% (95% CI: 56-82) and 71% (95% CI: 50-84) for partial vaccination (one dose of RV1 or one/two doses of RV5). The VE for a complete 3-dose course of RV5 was 82% (95% CI: 59-92) and for a full 2-dose course of RV1 was 73% (95% CI: 55-83). RV1 and RV5 were both effective in preventing laboratory confirmed and notified rotavirus infections among children aged <5 years. Even incomplete courses of vaccination conferred good protection.
Publisher: American Chemical Society (ACS)
Date: 04-02-2020
Publisher: Public Library of Science (PLoS)
Date: 07-12-2021
DOI: 10.1371/JOURNAL.PONE.0260388
Abstract: The burden of IgE-mediated food allergy in Australian born children is reported to be among the highest globally. This illness shares risk factors and frequently coexists with asthma, one of the most common noncommunicable diseases of childhood. Findings from a case-control study suggest that compared to immunisation with acellular pertussis vaccine, early priming of infants with whole-cell pertussis vaccine may be associated with a lower risk of subsequent IgE-mediated food allergy. If whole-cell vaccination is protective of food allergy and other atopic diseases, especially if protective against childhood asthma, the population-level effects could justify its preferential recommendation. However, the potential beneficial effects of whole-cell pertussis vaccination for the prevention of atopic diseases at a population-scale are yet to be investigated. Analyses of population-based record linkage data will be undertaken to compare the rates of admissions to hospital for asthma in children aged between 5 and 15 years old, who were born in Western Australia (WA) or New South Wales (NSW) between 1997 and 1999 (329,831) when pertussis immunisation in Australia transitioned from whole-cell to acellular only schedules. In the primary analysis we will estimate hazard ratios and 95% confidence intervals for the time-to-first-event (hospital admissions as above) using Cox proportional hazard models in recipients of a first dose of whole-cell versus acellular pertussis-containing vaccine before 112 days old (~4 months of age). Similarly, we will also fit time-to-recurrent events analyses using Andersen-Gill models, and robust variance estimates to account for potential within-child dependence. Hospitalisations for all-cause anaphylaxis, food anaphylaxis, venom, all-cause urticaria and atopic dermatitis will also be examined in children who received at least one dose of pertussis-containing vaccine by the time of the cohort entry, using analogous statistical methods. Presentations to the emergency departments will be assessed separately using the same statistical approach.
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-025360
Abstract: Studies examining acute respiratory infections (ARIs) in emergency department (EDs), particularly in rural and remote areas, are rare. This study aimed to examine the burden of ARIs among Aboriginal and non-Aboriginal children presenting to Western Australian (WA) EDs from 2002 to 2012. Using a retrospective population-based cohort study linking ED records to birth and perinatal records, we examined presentation rates for metropolitan, rural and remote Aboriginal and non-Aboriginal children from 469 589 births. We used ED diagnosis information to categorise presentations into ARI groups and calculated age-specific rates. Negative binomial regression was used to investigate association between risk factors and frequency of ARI presentation. Overall, 26% of presentations were for ARIs. For Aboriginal children, the highest rates were for those aged months in the Great Southern (1233 per 1000 child-years) and Pilbara regions (1088 per 1000 child-years). Rates for non-Aboriginal children were highest in children months in the Southwest and Kimberley (400 and 375 per 1000 child-years, respectively). Presentation rates for ARI in children from rural and remote WA significantly increased over time in all age groups years. Risk factors for children presenting to ED with ARI were: male, prematurity, caesarean delivery and residence in the Kimberley region and lower socio-economic areas. One in four ED presentations in WA children are for ARIs, representing a significant out-of-hospital burden with some evidence of geographical disparity. Planned linkages with hospital discharge and laboratory detection data will aid in assessing the sensitivity and specificity of ARI diagnoses in ED.
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-028710
Abstract: Acute respiratory infections (ARIs) are a global cause of childhood morbidity. We compared temporal trends and socioeconomic disparities for ARI hospitalisations in young children across Western Australia, England and Scotland. Retrospective population-based cohort studies using linked birth, death and hospitalisation data. Population birth cohorts spanning 2000–2012 (Western Australia and Scotland) and 2003–2012 (England). ARI hospitalisations in infants ( months) and children (1–4 years) were identified through International Classification of Diseases, 10th edition diagnosis codes. We calculated admission rates per 1000 child-years by diagnosis and jurisdiction-specific socioeconomic deprivation and used negative binomial regression to assess temporal trends. The overall infant ARI admission rate was 44.3/1000 child-years in Western Australia, 40.7/1000 in Scotland and 40.1/1000 in England. Equivalent rates in children aged 1–4 years were 9.0, 7.6 and 7.6. Bronchiolitis was the most common diagnosis. Compared with the least socioeconomically deprived, those most deprived had higher ARI hospitalisation risk (incidence rate ratio 3.9 (95% CI 3.5 to 4.2) for Western Australia 1.9 (1.7 to 2.1) for England 1.3 (1.1 to 1.4) for Scotland. ARI admissions in infants were stable in Western Australia but increased annually in England (5%) and Scotland (3%) after adjusting for non-ARI admissions, sex and deprivation. Admissions for ARI were higher in Western Australia and displayed greater socioeconomic disparities than England and Scotland, where ARI rates are increasing. Prevention programmes focusing on disadvantaged populations in all three countries are likely to translate into real improvements in the burden of ARI in children.
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2018-023263
Abstract: To actively solicit adverse events experienced in the days following immunisation with quadrivalent inactivated influenza vaccine using Australia’s near real-time, participant-based vaccine safety surveillance system, AusVaxSafety. Observational cohort study conducted in 194 sentinel surveillance immunisation sites (primary care, hospital and community-based clinics) across Australia. In iduals aged ≥6 months who received a routine seasonal influenza vaccine at a participating site (n=102 911) and responded to a survey (via short message service or email) sent 3 days after vaccination about adverse events experienced (n=73 892 71.8%). Near real-time and cumulative participant-reported rates of any adverse event, fever or medical attendance experienced within 3 days after vaccination overall, by brand, age, pregnancy status and concomitant vaccine receipt. Participant median age was 57 years (range: 6 months to 102 years) 58.1% (n=42 869) were female and 2.7% (n=2018) were pregnant. Near real-time fast initial response cumulative summation and Bayesian analyses of weekly event rates did not demonstrate a safety signal. Children aged 6 months to 4 years had higher event rates (522/6180 8.4%) compared with older ages participants aged ≥65 years reported fewer events (1695/28 154 6.0%). There were no clinically significant differences in safety between brands, by age group or overall. Cumulative data analysis demonstrated that concomitant vaccination was associated with increased rates of fever (2.1% vs 0.8%) and medical attendance (0.8% vs 0.4%), although all rates were low and did not exceed expected levels. Novel, postmarketing AusVaxSafety surveillance demonstrated comparable and expected safety outcomes for the 2017 quadrivalent inactivated influenza vaccine brands used in Australia. These near real-time, participant-reported data are expected to encourage confidence in vaccine safety and promote uptake.
Publisher: Oxford University Press (OUP)
Date: 23-11-2018
DOI: 10.1093/CID/CIX923
Abstract: Pneumococcal conjugate vaccine (PCV) was included in Australia's National Immunisation Program for all children from 2005. We assessed the impact of PCV on all-cause and pathogen-specific pneumonia hospitalizations in Western Australian (WA) children aged ≤16 years. All hospitalizations with pneumonia-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes occurring in WA-born children (1996-2012) were linked to pathology records. Age-specific incidence rate ratios and temporal trends for all-cause and pathogen-specific pneumonia hospitalizations were calculated before and after PCV introduction. Among 469589 births, there were 15175 pneumonia-related hospitalizations. Hospitalization rates were 6.7 (95% confidence interval, 6.4-6.9) times higher in Aboriginal than in non-Aboriginal children. Following PCV introduction, all-cause pneumonia hospitalizations showed significant declines across all age groups. A pathogen was identified in 2785 of 6693 (41.6%) pneumonia hospitalizations that linked to a pathology record. Respiratory syncytial virus (RSV) was most frequently identified, with RSV-associated pneumonia hospitalization rates of 89.6/100000 child-years in Aboriginal and 26.6/100000 child-years in non-Aboriginal children. The most common bacterial pathogen was Streptococcus pneumoniae in Aboriginal children (32.9/100000 child-years) and Mycoplasma pneumoniae in non-Aboriginal children (8.4/100000 child-years). Viral pneumonia rates declined in all children following PCV introduction, with the greatest declines seen in non-Aboriginal children declines in bacterial pneumonia were observed in non-Aboriginal children. Based on our ecological analyses, PCV seems to have had an impact on hospitalizations for pneumonia, suggesting that the pneumococcus is likely to play a role in both bacterial and viral pneumonia. Respiratory viruses remain an important pathogen in childhood pneumonia. Vaccines targeting respiratory viruses are needed to combat the residual burden of childhood pneumonia.
Publisher: Public Library of Science (PLoS)
Date: 13-03-2023
DOI: 10.1371/JOURNAL.PCBI.1010967
Abstract: Pneumonia remains a leading cause of hospitalization and death among young children worldwide, and the diagnostic challenge of differentiating bacterial from non-bacterial pneumonia is the main driver of antibiotic use for treating pneumonia in children. Causal Bayesian networks (BNs) serve as powerful tools for this problem as they provide clear maps of probabilistic relationships between variables and produce results in an explainable way by incorporating both domain expert knowledge and numerical data. We used domain expert knowledge and data in combination and iteratively, to construct, parameterise and validate a causal BN to predict causative pathogens for childhood pneumonia. Expert knowledge elicitation occurred through a series of group workshops, surveys and one-on-one meetings involving 6-8 experts from erse domain areas. The model performance was evaluated based on both quantitative metrics and qualitative expert validation. Sensitivity analyses were conducted to investigate how the target output is influenced by varying key assumptions of a particularly high degree of uncertainty around data or domain expert knowledge. Designed to apply to a cohort of children with X-ray confirmed pneumonia who presented to a tertiary paediatric hospital in Australia, the resulting BN offers explainable and quantitative predictions on a range of variables of interest, including the diagnosis of bacterial pneumonia, detection of respiratory pathogens in the nasopharynx, and the clinical phenotype of a pneumonia episode. Satisfactory numeric performance has been achieved including an area under the receiver operating characteristic curve of 0.8 in predicting clinically-confirmed bacterial pneumonia with sensitivity 88% and specificity 66% given certain input scenarios (i.e., information that is available and entered into the model) and trade-off preferences (i.e., relative weightings of the consequences of false positive versus false negative predictions). We specifically highlight that a desirable model output threshold for practical use is very dependent upon different input scenarios and trade-off preferences. Three commonly encountered scenarios were presented to demonstrate the potential usefulness of the BN outputs in various clinical pictures. To our knowledge, this is the first causal model developed to help determine the causative pathogen for paediatric pneumonia. We have shown how the method works and how it would help decision making on the use of antibiotics, providing insight into how computational model predictions may be translated to actionable decisions in practice. We discussed key next steps including external validation, adaptation and implementation. Our model framework and the methodological approach can be adapted beyond our context to broad respiratory infections and geographical and healthcare settings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 08-2020
DOI: 10.1016/J.VACCINE.2019.09.091
Abstract: Receiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity. Perinatal, notification, death and immunisation databases were linked for 1.3 million births in 2000-11 from two Australian states (Western Australia and New South Wales), with follow-up data until 2013. Ordinal logistic regression was used to estimate adjusted relative risks (RR) by degree of delay. Separate models were constructed for each vaccine dose and for Aboriginal and non-Aboriginal children. Each dose-specific cohort included at least 49,000 Aboriginal and 1.1 million non-Aboriginal children. Delayed receipt was more common among Aboriginal than non-Aboriginal children (eg for the first dose of DTP [DTP1] 19.4 v 8.1%). Risk factors for delayed vaccination were strongest for DTP1, and delayed receipt of DTP1 was a key driver of subsequent delays every week DTP1 was delayed was associated with a 1.6 to 2-fold increased risk of delayed DTP2 receipt. For DTP1, ≥3 previous pregnancies (the only factor more strongly associated with longer than shorter delays RR ≥5 compared to no previous pregnancies), and children born to mothers <20 years of age (RR ≥2 compared to ≥35 years) were at highest risk of delay. Other independent predictors were prematurity, maternal smoking during pregnancy, and being born in Western Australia (if Aboriginal) or another country in the Oceania region. The sub-populations at risk for delayed vaccination we have identified are likely generalisable to other high-income settings. Measures to improve their dose 1 timeliness, particularly for children with older siblings, are likely to have significant flow-on benefits for timeliness of later doses.
Publisher: Elsevier BV
Date: 12-2022
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 29-10-2015
DOI: 10.2807/1560-7917.ES.2015.20.43.30050
Abstract: Increased febrile reactions in Australian children from one influenza vaccine brand in 2010 diminished confidence in influenza immunisation, highlighting the need for improved vaccine safety surveillance. AusVaxSafety , a national vaccine safety surveillance system collected adverse events in young children for 2015 influenza vaccine brands in real time through parent/carer reports via SMS/email. Weekly cumulative data on 3,340 children demonstrated low rates of fever (4.4%) and medical attendance (1.1%). Fever was more frequent with concomitant vaccination.
Publisher: Oxford University Press (OUP)
Date: 07-02-2020
Abstract: Significant progress has been made towards an effective respiratory syncytial virus (RSV) vaccine. Age-stratified estimates of RSV burden are urgently needed for vaccine implementation. Current estimates are limited to small cohorts or clinical coding data only. We present estimates of laboratory-confirmed RSV across multiple severity levels. We linked laboratory, perinatal, and hospital data of 469 589 children born in Western Australia in 1996–2012. Respiratory syncytial virus tests and detections were classified into community, emergency department (ED), and hospital levels to estimate infection rates. Clinical diagnoses given to children with RSV infection presenting to ED or hospitalized were identified. In 2000–2012, 10% (n = 45 699) of children were tested for RSV and 16% (n = 11 461) of these tested positive. Respiratory syncytial virus was detected in community, ED (both 0.3 per 1000 child-years), and hospital (2.4 per 1000 child-years) settings. Respiratory syncytial virus-confirmed rates were highest among children aged & months (31 per 1000 child-years). At least one third of children with RSV infection presenting to ED were diagnosed as other infection, other respiratory, or other (eg, agranulocytosis). Respiratory syncytial virus is pervasive across multiple severity levels and diagnoses. Vaccines targeting children & months must be prioritized. Given that most children are never tested, estimating the under-ascertainment of RSV infection is imperative.
Publisher: Cold Spring Harbor Laboratory
Date: 03-07-2021
DOI: 10.1101/2021.06.29.21259668
Abstract: There is limited empiric evidence on the coverage of pneumococcal conjugate vaccines (PCV) required to generate substantial indirect protection. We investigate the association between population PCV coverage and indirect protection against invasive pneumococcal disease (IPD) and pneumonia hospitalisations among under-vaccinated Australian children. Birth and vaccination records, IPD notifications and hospitalisations were in idually linked for children aged five years, born between 2001 and 2012 in two Australian states (New South Wales and Western Australia 1.37 million children). Using Poisson regression models, we examined the association between PCV coverage, in small geographical units, and the incidence of (1) 7-valent PCV (PCV7)-type IPD, (2) all-cause pneumonia and (3) pneumococcal and lobar pneumonia hospitalisation in under-vaccinated children. Under-vaccinated children received two doses of PCV at 12 months of age and no doses at ≥ 12 months of age. Potential confounding variables were selected for adjustment a priori with the assistance of a directed acyclic graph. The main limitations of this study include the potential for differential loss to follow-up, geographical misclassification of children (based on addressed at birth only) and unmeasured confounders. There were strong inverse associations between PCV coverage and the incidence of PCV7-type IPD (adjusted incidence rate ratio [aIRR] 0.967, 95% CI 0.958-0.975, p-value .001), and pneumonia hospitalisations (all-cause pneumonia: aIRR 0.991 95% CI 0.990-0.994, p-value .001) among under-vaccinated children. Subgroup analyses for children four months old, urban, rural and Indigenous populations showed similar trends, although effects were smaller for rural and Indigenous populations. Fifty-percent coverage of PCV7 among children five years of age prevented up to 72.5% (95% CI 51.6-84.4) of PCV7-type IPD among under-vaccinated children, while 90% coverage prevented 95.2% (95% CI 89.4-97.8). In this study we observed substantial indirect protection at low PCV coverage, challenging assumptions high vaccine coverage is required. Pneumococcal conjugate vaccines (PCVs) reduce the burden of pneumococcal disease in vaccinated and unvaccinated populations through both direct and indirect (herd) effects. The indirect effects comprise a substantial component of overall vaccine impact, contributing to the cost-effectiveness of the vaccine but little is known about what factors contribute to herd protection, including vaccination coverage. In this study, we examined association between PCV coverage and indirect effects within in erse populations within Australia Using a large dataset of 1.3 million children from two states in Australia, we quantified the relationship between PCV coverage within small geographical units and indirect protection against pneumococcal disease. We also performed similar analyses for infants too young to be fully vaccinated, urban, rural and Indigenous populations. There were strong inverse relationships between PCV coverage and the incidence of severe invasive disease due to vaccine types and pneumonia hospitalisations among under-vaccinated children i.e. higher coverage were associated with greater reductions in disease due to indirect effects. We also found substantial indirect effects at relatively low levels of PCV coverage. We estimated that 50% and 90% coverage of 7-valent PCV (PCV7) among children under five years of age prevented almost three-quarters (72.5%, 95% CI 51.6-84.4) and almost all (95.2%, 95% CI 89.4-97.8) of PCV7-type severe invasive disease, respectively. For pneumonia, we estimated that 50% and 90% coverage was sufficient to prevent one-third (33.3%, 95% CI 27.3-38.8) and about half (51.7%, 95% CI 43.7-58.6) of all-cause pneumonia hospitalisations among under-vaccinated children. These trends were similar for children less than four months old, urban, rural and Indigenous populations, although these effects were smaller for rural and Indigenous populations. There was also a trend towards decreasing incidence of PCV13-type IPD among under-vaccinated children as PCV13 coverage increased. Our results challenge existing assumptions that high PCV coverage is required to achieve substantial indirect protection. Understanding the determinants of indirect effects are particularly urgent as countries that have controlled vaccine-type pneumococcal disease consider using reducing the number of PCV doses (from three to two). Reduced dose schedules have the potential to significantly lower program costs while maintaining vaccine impact, providing indirect protection is achieved and preserved.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.EPIDEM.2016.05.001
Abstract: Respiratory syncytial virus (RSV) causes respiratory illness in young children and is most commonly associated with bronchiolitis. RSV typically occurs as annual or biennial winter epidemics in temperate regions, with less pronounced seasonality in the tropics. We sought to characterise and compare the seasonality of RSV and bronchiolitis in temperate and tropical Western Australia. We examined over 13 years of RSV laboratory identifications and bronchiolitis hospitalisations in children, using an extensive linked dataset from Western Australia. We applied mathematical time series analyses to identify the dominant seasonal cycle, and changes in epidemic size and timing over this period. Both the RSV and bronchiolitis data showed clear winter epidemic peaks in July or August in the southern Western Australia regions, but less identifiable seasonality in the northern regions. Use of complex demodulation proved very effective at comparing disease epidemics. The timing of RSV and bronchiolitis epidemics coincided well, but the size of the epidemics differed, with more consistent peak sizes for bronchiolitis than for RSV. Our results show that bronchiolitis hospitalisations are a reasonable proxy for the timing of RSV detections, but may not fully capture the magnitude of RSV epidemics.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.YEBEH.2021.108482
Abstract: To determine the proportion of first status epilepticus (SE) cases that are vaccine-proximate (VP-) and compare clinical outcomes to non-vaccine-proximate (NVP-) cases. Birth records for 1,440,807 Australian children born in 1998-2012, were probabilistically linked to hospitalizations, deaths, and vaccination history available to 2013. First SE coded hospitalizations were categorized as VP-SE or NVP-SE clinical severity and post-SE vaccination coverage were compared. SE rates were calculated. Of 867 first SE cases (7.9 per 100,000 person-years), 31 (3.6%) were VP-SE 16 followed dose-1 measles vaccine (1.2 SE per 100,000 doses). Compared with NVP-SE, VP-SE cases were younger (1.0 vs 2.6 years, P < 0.0001) and had longer hospitalizations (4 vs 3 days, P = 0.005). There was no difference in the proportion of VP-SE cases with a coinfection diagnosis compared to NVP-SE (25.8% vs 19.9%, P = 0.42). Controlling for age and history of hospitalization for a neurological condition, intensive care unit (ICU) admission had a stronger association with coinfection (aOR 2.52 (95%CI 1.78-3.57)) than having VP-SE (aOR 1.41 (0.66-3.01)). Groups had similar SE recurrence rates at 12-months (12.9% VP vs 16.9% NVP, P = 0.56) and reduced vaccine uptake following initial SE (from 93.5% to 56.3%). Proportionally few first SE cases were VP-SE, with higher ICU admission rates mostly explained by younger age and higher coinfection rates. Vaccination plans are needed to improve vaccine uptake following SE.
Publisher: Public Library of Science (PLoS)
Date: 23-04-2019
Publisher: Wiley
Date: 30-10-2017
DOI: 10.1111/IRV.12508
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.VACCINE.2019.08.013
Abstract: Rotavirus vaccines (RV), included in Australia's National Immunisation Program from mid-July 2007, are unique in strict time limits for administration. Here, we report on timeliness of RV uptake, compare cumulative RV coverage to age 12 months with DTPa, and assess factors associated with receipt of RV among Aboriginal and non-Aboriginal children. Birth records for 681,456 children born in two Australian states in 2007-2012 were probabilistically linked to national immunisation records. We assessed on-time coverage (defined as receipt of vaccine dose between 4 days prior to scheduled date and the recommended upper limit) for RV and compared this to diphtheria-tetanus-pertussis (DTPa) vaccine. Logistic regression modelling was used to assess independent determinants of receipt of RV. Compared to non-Aboriginal infants, on-time RV coverage was lower for all doses among Aboriginal infants. Post the upper age limit of RV dose2, DTPa dose2 coverage increased by 9-16% to ≥90%, whereas RV coverage remained around 77% (Aboriginal) and 85% (non-Aboriginal). Compared to first-born children, the adjusted odds of receiving ≥1 RV dose if born to a mother with ≥3 previous births was 0.30 (95%CI: 0.27-0.34) among Aboriginal, and 0.53 (95%CI: 0.51-0.55) among non-Aboriginal children. Prematurity (<33 weeks), low birthweight (<1500 g), maternal age <20 years, maternal smoking during pregnancy and living in a disadvantaged area were independently associated with decreased vaccine uptake. Aboriginal children are at greater risk of rotavirus disease than non-Aboriginal children and delayed vaccine receipt is substantially higher. Although specific programs targeting groups at risk of delayed vaccination might improve RV coverage, relaxation of upper age restrictions is most readily implementable, and its overall risk-benefit should be evaluated.
Publisher: Swansea University
Date: 18-09-2017
Abstract: 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.
Publisher: American Medical Association (AMA)
Date: 05-05-2020
Publisher: Public Library of Science (PLoS)
Date: 03-08-2021
DOI: 10.1371/JOURNAL.PMED.1003733
Abstract: There is limited empiric evidence on the coverage of pneumococcal conjugate vaccines (PCVs) required to generate substantial indirect protection. We investigate the association between population PCV coverage and indirect protection against invasive pneumococcal disease (IPD) and pneumonia hospitalisations among undervaccinated Australian children. Birth and vaccination records, IPD notifications, and hospitalisations were in idually linked for children aged years, born between 2001 and 2012 in 2 Australian states (New South Wales and Western Australia 1.37 million children). Using Poisson regression models, we examined the association between PCV coverage, in small geographical units, and the incidence of (1) 7-valent PCV (PCV7)-type IPD (2) all-cause pneumonia and (3) pneumococcal and lobar pneumonia hospitalisation in undervaccinated children. Undervaccinated children received doses of PCV at months of age and no doses at ≥12 months of age. Potential confounding variables were selected for adjustment a priori with the assistance of a directed acyclic graph. There were strong inverse associations between PCV coverage and the incidence of PCV7-type IPD (adjusted incidence rate ratio [aIRR] 0.967, 95% confidence interval [CI] 0.958 to 0.975, p -value 0.001), and pneumonia hospitalisations (all-cause pneumonia: aIRR 0.991 95% CI 0.990 to 0.994, p -value 0.001) among undervaccinated children. Subgroup analyses for children months old, urban, rural, and Indigenous populations showed similar trends, although effects were smaller for rural and Indigenous populations. Approximately 50% coverage of PCV7 among children years of age was estimated to prevent up to 72.5% (95% CI 51.6 to 84.4) of PCV7-type IPD among undervaccinated children, while 90% coverage was estimated to prevent 95.2% (95% CI 89.4 to 97.8). The main limitations of this study include the potential for differential loss to follow-up, geographical misclassification of children (based on residential address at birth only), and unmeasured confounders. In this study, we observed substantial indirect protection at lower levels of PCV coverage than previously described—challenging assumptions that high levels of PCV coverage (i.e., greater than 90%) are required. Understanding the association between PCV coverage and indirect protection is a priority since the control of vaccine-type pneumococcal disease is a prerequisite for reducing the number of PCV doses (from 3 to 2). Reduced dose schedules have the potential to substantially reduce program costs while maintaining vaccine impact.
Publisher: Japan Epidemiological Association
Date: 05-08-2021
Publisher: Springer Science and Business Media LLC
Date: 22-10-2020
DOI: 10.1186/S12887-020-02390-5
Abstract: The monoclonal antibody, palivizumab is licensed for use in high-risk infants to prevent severe illness caused by respiratory syncytial virus (RSV). The level of its use and compliance with current jurisdictional guidelines which were amended in 2010, is unknown. We determined the level of palivizumab use in a cohort of high-risk infants in Western Australia. Using probabilistically linked administrative data, we conducted a birth cohort study within tertiary neonatal intensive care units (NICUs) born between 2002 and 2013. We described palivizumab use by patient characteristics, eligibility criteria according to guidelines over the period of study and identified predictors of its use. Of 24,329 infants admitted to tertiary NICUs, 271 (1.1%) were dispensed 744 palivizumab doses with 62.5% being dispensed to infants born 2010–2013. The median number of doses received was 2. A total of 2679 infants met at least one of three criteria for palivizumab (criteria 1: gestational age at birth 28 weeks and chronic lung disease criteria 2: gestational age 28 weeks and Aboriginal criteria 3: congenital heart disease not otherwise in criteria 1 or 2). The extent of palivizumab use differed across the 3 groups. Of 803 infants meeting criteria 1, 21.8% received at least 1 dose of palivizumab 52.8% from 2010 onwards. From 174 infants meeting criteria 2, 14.4% received at least 1 dose 43.1% from 2010 onwards and from 1804 births meeting criteria 3, only 3.7% received at least 1 dose 5.4% from year of birth 2010 onwards). In adjusted analyses, being born after 2010, being extreme preterm, chronic lung disease, congenital lung disease and being born in autumn or winter were independent predictors of palivizumab use. In this high-risk setting and notwithstanding the limitations of our data sources, the level of compliance of palivizumab use against current guidelines was low. Most doses were dispensed to infants meeting at least one high-risk criterion. Evidence of incomplete dosing is an important finding in light of recent developments of single dose monoclonal antibodies offering longer protection.
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.JPEDS.2019.06.058
Abstract: To measure the real-world effectiveness of palivizumab immunoprophylaxis against respiratory syncytial virus (RSV)-confirmed infection before age 2 years in a population-cohort of high-risk infants. Palivizumab is funded for high-risk infants in Western Australia. We used probabilistically linked administrative data encompassing RSV laboratory-confirmed infections, hospital admissions, and palivizumab dispensing records for a cohort of 24 329 high-risk infants admitted to neonatal intensive care units, born 2002-2013 with follow-up to 2015. We used a traditional cohort method with Cox proportional hazards regression and a self-controlled case series analysis to assess effectiveness of palivizumab in reducing RSV-confirmed infection by number of doses. From the cohort of 24 329 infants, 271 (1.1%) received at least 1 dose of palivizumab and 1506 (6.2%) had at least 1 RSV-confirmed infection before age 2 years. Using the traditional cohort approach, we found no protective association of palivizumab receipt with RSV detection (adjusted hazard ratio = 0.99 [95% CI 0.5, 1.9] for 1 dose). However, using a self-controlled case series to eliminate confounding by indication, a protective association was seen with a 74% lower RSV incidence (relative incidence = 0.26 95% CI 0.11, 0.67) following any dose of palivizumab compared with control (nonexposed) periods. After accounting for confounding by indication through a self-controlled analysis, palivizumab appeared effective for reducing virologically confirmed RSV in this high-risk cohort.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.VACCINE.2018.03.058
Abstract: Most studies use indirect cohort or case-control methods to estimate vaccine effectiveness (VE) of 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) against invasive pneumococcal disease (IPD). Neither method can measure the benefit vaccination programs afford the unvaccinated and many studies were unable to estimate dose-specific VE. We linked Australia's national immunisation register with health data from two states to calculate IPD incidence by vaccination status and VE for a 3 + 0 PCV schedule (doses at 2, 4, 6 months, no booster) among a cohort of 1.4 million births. Births records for 2001-2012 were probabilistically linked to IPD notifications, hospitalisations, deaths, and vaccination history (available until December 2013). IPD rates in vaccinated and unvaccinated children 90% coverage in the first year of a universal 3 + 0 PCV program provided high population-level protection, predominantly attributable to strong herd effects. The size of the cohort enabled calculation of robust dose-specific VE estimates for important population sub-groups relevant to vaccination policies internationally.
Publisher: Springer Science and Business Media LLC
Date: 17-06-2017
Publisher: Wiley
Date: 09-2019
DOI: 10.1111/PPE.12573
Abstract: 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 hospitalisation in WA children, focussing on Aboriginal children aged <17 years. We conducted a retrospective population-based cohort study with linked perinatal and hospitalisation 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 first hospitalisation with skin infection. To identify specific risk factors for early-onset infection, we further restricted the cohort to infants aged <1 year. Overall, 5439 (17.4%) Aboriginal and 6750 (1.5%) non-Aboriginal children were hospitalised at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalisation rate (63.2 per 1000 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 hospitalisations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy, and low birthweight. We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalisations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalisations. Our evidence not only 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 in iduals/families on maternal smoking during pregnancy and skin hygiene for families.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
Publisher: Oxford University Press (OUP)
Date: 30-05-2022
Abstract: Children with chronic medical conditions are at higher risk of invasive pneumococcal disease (IPD), but little is known about the effectiveness of the primary course of pneumococcal conjugate vaccine (PCV) in these children. A cohort born in 2001–2004 from two Australian states and identified as medically at-risk (MAR) of IPD either using ICD-coded hospitalizations (with conditions of interest identified by 6 months of age) or linked perinatal data (for prematurity) were followed to age 5 years for notified IPD by serotype. We categorized fully vaccinated children as either receiving PCV dose 3 by & months of age or ≥1 PCV dose at ≥12 months of age. Cox proportional hazard modeling was used to estimate hazard ratios (HRs), adjusted for confounders, and vaccine effectiveness (VE) was estimated as (1-HR) × 100. A total of 9220 children with MAR conditions had 53 episodes of IPD (43 vaccine-type) 4457 (48.3%) were unvaccinated and 4246 (46.1%) were fully vaccinated, with 1371 (32.3%) receiving dose 3 by 12 months and 2875 (67.7%) having ≥1 dose at ≥12 months. Estimated VE in fully vaccinated children was 85.9% (95% CI: 33.9–97.0) against vaccine-type IPD and 71.5% (95% CI: 26.6–88.9) against all-cause IPD. This is the first population-based study evaluating the effectiveness of PCV in children with MAR conditions using record linkage. Our study provides evidence that the VE for vaccine-type and all-cause IPD in MAR children in Australia is high and not statistically different from previously reported estimates for the general population. This method can be replicated in other countries to evaluate VE in MAR children.
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-031851
Abstract: To determine how soon after commencement of the seasonal influenza vaccination programme, the AusVaxSafety active vaccine safety surveillance system, currently in use across Australia, would have detected a safety signal had it been operating in 2010 when there was an unprecedented number of febrile seizures in young children associated with one specific influenza vaccine brand, Fluvax (CSL Biotherapies). Simulation study. Western Australian vaccine influenza coverage and adverse event surveillance data. Simulated solicited responses from caregivers who would have received an SMS survey about adverse events experienced following seasonal influenza vaccination of their children aged 6 months to years. None. We estimated a % probability of a safety signal being detected by AusVaxSafety based on solicited reports for either fever or medical attendance at or before the week ending 28 March 2010, 3 weeks after the start of vaccine distribution. Suspension of the national paediatric influenza vaccination programme as a result of the passive adverse events surveillance operating at the time did not occur until 23 April 2010. Active vaccine safety surveillance leading to rapid detection of a safety signal would likely have resulted in earlier suspension of Fluvax from the vaccination programme, prevention of many febrile convulsions and maintenance of public confidence in influenza vaccination for young children.
Publisher: Elsevier BV
Date: 2023
Publisher: Public Library of Science (PLoS)
Date: 19-11-2020
DOI: 10.1371/JOURNAL.PMED.1003429
Abstract: The proportion of births via cesarean section (CS) varies worldwide and in many countries exceeds WHO-recommended rates. Long-term health outcomes for children born by CS are poorly understood, but limited data suggest that CS is associated with increased infection-related hospitalisation. We investigated the relationship between mode of birth and childhood infection-related hospitalisation in high-income countries with varying CS rates. We conducted a multicountry population-based cohort study of all recorded singleton live births from January 1, 1996 to December 31, 2015 using record-linked birth and hospitalisation data from Denmark, Scotland, England, and Australia (New South Wales and Western Australia). Birth years within the date range varied by site, but data were available from at least 2001 to 2010 for each site. Mode of birth was categorised as vaginal or CS (emergency/elective). Infection-related hospitalisations (overall and by clinical type) occurring after the birth-related discharge date were identified in children until 5 years of age by primary/secondary International Classification of Diseases , 10th Revision (ICD-10) diagnosis codes. Analysis used Cox regression models, adjusting for maternal factors, birth parameters, and socioeconomic status, with results pooled using meta-analysis. In total, 7,174,787 live recorded births were included. Of these, 1,681,966 (23%, range by jurisdiction 17%–29%) were by CS, of which 727,755 (43%, range 38%–57%) were elective. A total of 1,502,537 offspring (21%) had at least 1 infection-related hospitalisation. Compared to vaginally born children, risk of infection was greater among CS-born children (hazard ratio (HR) from random effects model, HR 1.10, 95% confidence interval (CI) 1.09–1.12, p 0.001). The risk was higher following both elective (HR 1.13, 95% CI 1.12–1.13, p 0.001) and emergency CS (HR 1.09, 95% CI 1.06–1.12, p 0.001). Increased risks persisted to 5 years and were highest for respiratory, gastrointestinal, and viral infections. Findings were comparable in prespecified subanalyses of children born to mothers at low obstetric risk and unchanged in sensitivity analyses. Limitations include site-specific and longitudinal variations in clinical practice and in the definition and availability of some data. Data on postnatal factors were not available. In this study, we observed a consistent association between birth by CS and infection-related hospitalisation in early childhood. Notwithstanding the limitations of observational data, the associations may reflect differences in early microbial exposure by mode of birth, which should be investigated by mechanistic studies. If our findings are confirmed, they could inform efforts to reduce elective CS rates that are not clinically indicated.
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.VACCINE.2018.05.084
Abstract: Reported infant vaccination coverage at age 12 months in Australia is >90%. On-time coverage of the 2-4-6 month schedule and coverage in specific populations is rarely reported. We conducted a population-based cohort study of 1.9 million Australian births, 1996-2012, combining in idual birth and perinatal records with immunisation records through probabilistic linkage. We assessed on-time coverage across 13 demographic and perinatal characteristics of diphtheria-tetanus-pertussis vaccines (DTP) defined as vaccination 14 days prior to the scheduled due date, to 30 days afterwards. On-time DTP vaccination coverage in non-Aboriginal infants was 88.1% for the 2-month dose, 82.0% for 4-month dose, and 76.7% for 6-month dose 3-dose coverage was 91.3% when assessed at 12 months. On-time DTP coverage for Aboriginal infants was 77.0%, 66.5%, and 61.0% for the 2-4-6 month dose 3-dose coverage at 12 months was 79.3%. Appreciable differences in on-time coverage were observed across population subgroups. On-time coverage in non-Aboriginal infants born to mothers with ≥3 previous pregnancies was 62.5% for the 6-month dose (47.9% for Aboriginal infants) up to 23.5 percentage points lower than for first-borns. Infants born to mothers who smoked during pregnancy had coverage 8.7-10.3 percentage points lower than infants born to non-smoking mothers for the 4- and 6-month dose. A linear relationship was apparent between increasing socio-economic disadvantage and decreasing on-time coverage. On-time coverage of the 2-4-6 month schedule is only 50-60% across specific population subgroups representing a significant avoidable public health risk. Aboriginal infants, multiparous mothers, and those who are socio-economically disadvantaged are key groups most likely to benefit from targeted programs addressing vaccine timeliness.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.VACCINE.2017.09.043
Abstract: Respiratory syncytial virus (RSV) is a major cause of respiratory morbidity and one of the main causes of hospitalisation in young children. While there is currently no licensed vaccine for RSV, a vaccine candidate for pregnant women is undergoing phase 3 trials. We developed a compartmental age-structured model for RSV transmission, validated using linked laboratory-confirmed RSV hospitalisation records for metropolitan Western Australia. We adapted the model to incorporate a maternal RSV vaccine, and estimated the expected reduction in RSV hospitalisations arising from such a program. The introduction of a vaccine was estimated to reduce RSV hospitalisations in Western Australia by 6-37% for 0-2month old children, and 30-46% for 3-5month old children, for a range of vaccine effectiveness levels. Our model shows that, provided a vaccine is demonstrated to extend protection against RSV disease beyond the first three months of life, a policy using a maternal RSV vaccine could be effective in reducing RSV hospitalisations in children up to six months of age, meeting the objective of a maternal vaccine in delaying an infant's first RSV infection to an age at which severe disease is less likely.
No related grants have been discovered for Parveen Fathima.