ORCID Profile
0000-0003-0022-1009
Current Organisations
University of Melbourne
,
Royal Australasian College of Physicians
,
Royal Children's Hospital Melbourne
,
Murdoch Childrens Research Institute
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Publications
Voiding stimulation methods for collecting urine from young pre-continent children
Publisher: Informa UK Limited
Date: 02-10-2017
Less invasive SARS-CoV-2 testing for children: A comparison of saliva and a novel Anterior Nasal Swab
Publisher: Cold Spring Harbor Laboratory
Date: 23-09-2022
DOI: 10.1101/2022.09.21.22280208
Abstract: Reducing procedural discomfort for children requiring respiratory testing for SARS-CoV-2 is important in supporting testing strategies for case identification. Alternative s ling methods to nose and throat swabs, which can be self-collected, may reduce laboratory-based testing requirements and provide rapid results for clearance to attend school or hospital settings. The aim of this study was to compare preference and diagnostic sensitivity of a novel anterior nasal swab (ANS), and saliva, with a standard combined nose and throat (CTN) swab. The three s les were self-collected by children aged 5-18 years who had COVID-19 or were a household close contact. S les were analysed by reverse transcription polymerase chain reaction (RT-PCR) on the Allplex SARS-CoV-2 Assay. Most children and parents preferred the ANS and saliva swab over the CTN swab for future testing. The ANS was highly sensitive (sensitivity 1.000 (95% Confidence Interval (CI) 0.920, 1.000)) for SARS-CoV-2 detection, compared to saliva (sensitivity 0.886, 95% CI 0.754, 0.962). We conclude the novel ANS is a highly sensitive and more comfortable method for SARS-CoV-2 detection when compared to CTN swab.
Interpretation and management of discordant tuberculin skin test and interferon-gamma release assays results in children
Publisher: Wiley
Date: 02-2019
DOI: 10.1111/JPC.14338
Is cardiorespiratory disease associated with increased susceptibility of SARS‐CoV‐2 in children?
Publisher: Wiley
Date: 02-09-2021
DOI: 10.1002/PPUL.25642
Abstract: There are limited data in pediatric populations evaluating whether chronic cardiorespiratory conditions are associated with increased risk of coronavirus disease 2019 (COVID‐19). We aimed to compare the rates of chronic cardiac and respiratory disease in children testing positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2[+]) compared with those testing negative (SARS‐CoV‐2[−]) at our institution. Prospective cohort with nested case–control study of all children tested by polymerase chain reaction (PCR) for SARS‐CoV‐2 by nasopharyngeal/oropharyngeal s ling between March and October 2020. Children were identified prospectively via laboratory notification with age and sex‐matching of SARS‐CoV‐2[+] to SARS‐CoV‐2[−] (1:2). Clinical data were extracted from the electronic medical record. In total, 179 SARS‐CoV‐2[+] children (44% females, median age 3.5 years, range: 0.1–19.0 years) were matched to 391 SARS‐CoV‐2[−] children (42% female, median age 3.7 years, range: 0.1–18.3 years). The commonest comorbidities showed similar frequencies in the SARS‐CoV‐2[+] and [−] groups: asthma ( n = 9, 5% vs. n = 17, 4.4%, p = 0.71), congenital heart disease ( n = 6, 3.4% vs. n = 7, 1.8%, p = 0.25) and obstructive sleep apnoea ( n = 4, 2.2% vs. n = 10, 2.3%, p = 0.82). In the SARS‐CoV‐2[+] group, the prevalence of symptomatic disease was similar among children with and without cardiorespiratory comorbidities ( n = 12, 75% vs. n = 103, 57%, p = 0.35). A high proportion of children hospitalized with SARS‐CoV‐2 infection had cardiac comorbidities (23.8%). In this single site data set, rates of pre‐existing cardiorespiratory disease were similar in SARS‐CoV‐2[+] and SARS‐CoV‐2[−] children. Rates of symptomatic infection were similar between children with and without cardiorespiratory comorbidity. High rates of comorbid cardiac disease were observed among hospitalized children with COVID‐19 warranting further research to inform vaccine prioritization.
Assessment of the quality of neonatal care in the Solomon Islands
Publisher: Wiley
Date: 14-09-2018
DOI: 10.1111/JPC.13686
Abstract: To identify strengths and obstacles for improving the quality of newborn care in the Solomon Islands. Improving the quality of newborn care is a priority in the Sustainable Development Goals and the Action Plan for Healthy Newborns in the Western Pacific. The neonatal mortality rate in the Solomon Islands, a lower-middle-income country, has improved slower than overall child mortality. In 2013, neonatal mortality (13.2/1000) constituted 44% of under-5 deaths (30.1/1000). A cross-sectional study of newborn care in five provincial hospitals using a World Health Organization assessment tool for hospital quality of care. Twelve months of neonatal records of the National Referral Hospital (NRH) labour ward and nursery were audited. Essential medications and basic equipment were generally available. Challenges included workforce shortages and lack of expertise, high costs, organisation and maintenance of equipment, infection control and high rates of stillbirth. Over 12 months at the NRH labour ward, there were 5412 live births, 65 (1.2%) 'fresh' stillbirths and 96 (1.8%) 'macerated' stillbirths. Over the same period, there were an associated 779 nursery admissions, and the main causes of mortality were complications of prematurity, birth asphyxia, congenital abnormalities and sepsis. Total neonatal mortality at NRH was 16 per 1000 live births, and 77% of deaths occurred in the first 3 days of life. Infrastructure limitations, technical maintenance and equipment organisation were obstacles to newborn care. Greater health-care worker knowledge and skills for early essential newborn care, infection control and management of newborn complications is needed.
Cause‐specific neonatal morbidity and mortality in the Solomon Islands: An assessment of data from four hospitals over a three‐year period
Publisher: Wiley
Date: 10-12-2019
DOI: 10.1111/JPC.14699
Abstract: Data on stillbirths and neonatal morbidity and mortality in low-middle income Pacific Island Nations such as Solomon Islands is limited, partly due to weak health information systems. We describe the perinatal mortality and clinical factors associated with poor newborn outcomes at four hospitals in Solomon Islands. This was a registry based retrospective cohort study at three provincial hospitals and the National Referral Hospital (NRH) from 2014-2016 inclusive. 23 966 labour ward births and 3148 special care nursery (SCN) admissions were reviewed. Overall still birth rate was 29.2/1000 births and the perinatal mortality rate was 35.9/1000 births. PNMR were higher in provincial hospitals (46.2, 44.0 and 34.3/1000) than at NRH (33.3/1000). The commonest reasons for admission to SCN across the hospitals were sepsis, complications of prematurity and birth asphyxia. SCN mortality rates were higher in the 3 provincial hospitals than at NRH (15.9% (95/598) vs. 7.9% (202/2550), P value <0.01). At NRH, the conditions with the highest case fatality rates were birth asphyxia (21.3%), congenital abnormalities (17.7%), and prematurity (15.1%). Up to 11% of neonates did not have a diagnosis recorded. The perinatal mortality rates are high and intrapartum complications, prematurity and sepsis are the main causes of morbidity and mortality for neonates at hospitals in Solomon Islands. Stillbirths account for 81% of perinatal deaths. These results are useful for planning for quality improvement at provincial level. Improved vital registration systems are required to better capture stillbirths and neonatal outcomes.
Chronic use of teething gel causing salicylate toxicity
Publisher: Wiley
Date: 28-02-2018
DOI: 10.1111/JPC.13861
Immune responses to SARS-CoV-2 in children of parents with symptomatic COVID-19
Publisher: Research Square Platform LLC
Date: 28-07-2020
DOI: 10.21203/RS.3.RS-47021/V1
Abstract: Compared to adults, children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have mild or asymptomatic infection, but the underlying immunological differences remain unclear. We describe clinical features, virology, longitudinal cellular and cytokine immune profile, SARS-CoV-2-specific serology and salivary antibody responses in a family of two parents with PCR-confirmed symptomatic SARS-CoV-2 infection and their three children, who were repeatedly SARS-CoV-2 PCR negative. Cellular immune profiles and cytokine responses of all children were similar to their parents at all timepoints. All family members had salivary anti-SARS-CoV-2 antibodies detected, predominantly IgA, that coincided with symptom resolution in 3 of 4 symptomatic members. Plasma from both parents and one child had IgG antibody detected against the S1 protein and virus neutralising activity ranging from just detectable to robust titers. Using a systems serology approach, we show that all family members demonstrated higher levels of SARS-CoV-2-specific antibody features than healthy controls. These data indicate that children can mount an immune response to SARS-CoV-2 without virological evidence of infection. This raises the possibility that despite chronic exposure, immunity in children prevents establishment of SARS-CoV-2 infection. Relying on routine virological and serological testing may therefore not identify exposed children, with implications for epidemiological and clinical studies across the life-span.
Characteristics and outcomes of SARS‐CoV‐2 infection in Victorian children at a tertiary paediatric hospital
Publisher: Wiley
Date: 25-10-2021
DOI: 10.1111/JPC.15786
Abstract: Victoria experienced two ‘waves’ of COVID‐19 between March and September 2020 and more cases than any other jurisdiction in Australia. Although world‐wide reports of COVID‐19 reflect that children are less likely to experience severe disease compared with adults, hospitalisations and deaths have been reported. We report testing and outcomes of children with SARS‐CoV‐2 infection presenting to a tertiary paediatric hospital in Melbourne. We conducted a prospective cohort study at The Royal Children's Hospital (RCH), including all children and adolescents (aged 0–18 years) who presented and were tested for SARS‐CoV‐2 over a 6‐month period, between 21 March 2020, up to the 21 September 2020. Detailed epidemiological and clinical data were recorded. A total of 19 708 tests for SARS‐CoV‐2 were performed in 14 419 patients. One hundred and eighty patients tested positive for SARS‐CoV‐2 (1.2%). 110 (61%) were symptomatic, 60 (33%) were asymptomatic and 10 (6%) were pre‐symptomatic. Close contacts of a positive case were associated with a higher risk of a testing positive for SARS‐CoV‐2 (120/2027 (6%) vs. 60/14589 (0.4%), RD 5.5 (95% CI 4.5 to 6.5), P 0.001). Eighteen (10%) SARS‐CoV‐2‐positive patients were admitted to hospital with one patient requiring intensive care. All patients recovered fully with no deaths. In Victorian children presenting to a tertiary hospital, SARS‐CoV‐2 infection caused predominantly mild or asymptomatic infection, with most children not requiring hospitalisation.
Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: An observational cohort study
Publisher: Wiley
Date: 27-04-2012
DOI: 10.1111/J.1440-1754.2012.02449.X
Abstract: The optimal method for diagnostic collection of urine in children is unclear. National Institute of Health and Clinical Excellence recommend specimens taken by clean catch urine (CCU) for identification of urinary tract infection (UTI). We investigated contamination rates for CCU, suprapubic aspiration (SPA), catheter specimen urine (CSU) and bag specimen urine (BSU) collections. Retrospective observational cohort study with review of microbiology data and medical records at a large tertiary children's hospital. We reviewed urine culture growth from consecutive first urine specimens of children aged <2 years, over a 3-month period in 2008. Patient demographics, collection method, location (emergency department, inpatient ward), culture growth, history of UTI, urogenital tract abnormality and antibiotic use were assessed. Contamination rates for collection methods were compared using logistic regression. Urine culture specimens of 599 children (mean age 7.0 months, 54% male) were included. There were 34% CCU, 16% CSU, 14% SPA, 2% BSU and 34% with unknown s le method. Contamination rates were 26% in CCU, 12% in CSU (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.2-0.8) and 1% in SPA (OR 0.03 95% CI 0.0-0.3). Concurrent antibiotics use was associated with a lower contamination rate. Contamination rates were not associated with age, sex, location, history of UTI or urogenital abnormalities. Contamination rates in CCU are much higher than in CSU and SPA s les. Ideally, SPA should be used for microbiological assessment of urine in young children. Collection procedures need to be optimised if CCU is used.
Perspective: 'The forgotten children: National inquiry into children in immigration detention (2014)'
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/JPC.12873
Providing oxygen to children in hospitals: a realist review
Publisher: WHO Press
Date: 21-02-2017
Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS‐CoV‐2 in primary care and children
Publisher: Wiley
Date: 20-07-2021
DOI: 10.5694/MJA2.51188
Health of children who experienced Australian immigration detention
Publisher: Public Library of Science (PLoS)
Date: 09-03-2023
DOI: 10.1371/JOURNAL.PONE.0282798
Abstract: Australian immigration policy resulted in large numbers of children being held in locked detention. We examined the physical and mental health of children and families who experienced immigration detention. Retrospective audit of medical records of children exposed to immigration detention attending the Royal Children’s Hospital Immigrant Health Service, Melbourne, Australia, from January 2012 –December 2021. We extracted data on demographics, detention duration and location, symptoms, physical and mental health diagnoses and care provided. 277 children had directly (n = 239) or indirectly via parents (n = 38) experienced locked detention, including 79 children in families detained on Nauru or Manus Island. Of 239 detained children, 31 were infants born in locked detention. Median duration of locked detention was 12 months (IQR 5–19 months). Children were detained on Nauru/Manus Island (n = 47/239) for a median of 51 (IQR 29–60) months compared to 7 (IQR 4–16) months for those held in Australia/Australian territories (n = 192/239). Overall, 60% (167/277) of children had a nutritional deficiency, and 75% (207/277) had a concern relating to development, including 10% (27/277) with autism spectrum disorder and 9% (26/277) with intellectual disability. 62% (171/277) children had mental health concerns, including anxiety, depression and behavioural disturbances and 54% (150/277) had parents with mental illness. Children and parents detained on Nauru had a significantly higher prevalence of all mental health concerns compared with those held in Australian detention centres. This study provides clinical evidence of adverse impacts of held detention on children’s physical and mental health and wellbeing. Policymakers must recognise the consequences of detention, and avoid detaining children and families.
Influenza vaccine administration in a paediatric intensive care unit
Publisher: Wiley
Date: 24-06-2022
DOI: 10.1111/JPC.16083
Abstract: We describe the clinical profile of children and outcomes of influenza immunisation for patients in a paediatric intensive care unit (PICU). Over two influenza seasons: 19/04/2018 to 07/08/2018 and 02/05/2019 to 10/10/2019, an immunisation nurse and PICU nurse coordinator met weekly and identified patients to receive the influenza vaccine. An inpatient list of PICU patients was screened for eligible patients: greater than 6 months of age, did not have imminent procedures (e.g. surgery) or were not critically unwell, as determined by the treating team, to receive the influenza vaccine. Patients were excluded if they had undergone surgery in the previous 24 hours or were being treated palliatively. Sixty patients in PICU were identified, with 43% (26/60) receiving the vaccine while in PICU and 17% (10/60) once discharged from PICU to the general ward environment. The majority of patients immunised were in PICU due to cardiac surgery/cardiology or general medical conditions, such as cerebral palsy or RSV bronchiolitis. There were no reported adverse events following immunisation. We have demonstrated the suitability and acceptability of children in the PICU receiving the seasonal influenza vaccine and tailored interventions to follow‐up once discharged from PICU to optimise protection.
Innate cell profiles during the acute and convalescent phase of SARS-CoV-2 infection in children.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2021
DOI: 10.1038/S41467-021-21414-X
Abstract: Children have mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed disease (COVID-19) compared to adults and the immunological mechanisms underlying this difference remain unclear. Here, we report acute and convalescent innate immune responses in 48 children and 70 adults infected with, or exposed to, SARS-CoV-2. We find clinically mild SARS-CoV-2 infection in children is characterised by reduced circulating subsets of monocytes (classical, intermediate, non-classical), dendritic cells and natural killer cells during the acute phase. In contrast, SARS-CoV-2-infected adults show reduced proportions of non-classical monocytes only. We also observe increased proportions of CD63+ activated neutrophils during the acute phase to SARS-CoV-2 in infected children. Children and adults exposed to SARS-CoV-2 but negative on PCR testing display increased proportions of low-density neutrophils that we observe up to 7 weeks post exposure. This study characterises the innate immune response during SARS-CoV-2 infection and household exposure in children.
Increased platelet activation in SARS‐CoV‐2 infected non‐hospitalised children and adults, and their household contacts
Publisher: Wiley
Date: 07-06-2021
DOI: 10.1111/BJH.17629
Virology and immune dynamics reveal high household transmission of ancestral SARS-CoV-2 strain
Publisher: Wiley
Date: 07-2022
DOI: 10.1111/PAI.13824
Abstract: Household studies are crucial for understanding the transmission of SARS‐CoV‐2 infection, which may be underestimated from PCR testing of respiratory s les alone. We aim to combine the assessment of household mitigation measures nasopharyngeal, saliva, and stool PCR testing along with mucosal and systemic SARS‐CoV‐2–specific antibodies, to comprehensively characterize SARS‐CoV‐2 infection and transmission in households. Between March and September 2020, we obtained s les from 92 participants in 26 households in Melbourne, Australia, in a 4‐week period following the onset of infection with ancestral SARS‐CoV‐2 variants. The secondary attack rate was 36% (24/66) when using nasopharyngeal swab (NPS) PCR positivity alone. However, when respiratory and nonrespiratory s les were combined with antibody responses in blood and saliva, the secondary attack rate was 76% (50/66). SARS‐CoV‐2 viral load of the index case and household isolation measures were key factors that determine secondary transmission. In 27% (7/26) of households, all family members tested positive by NPS for SARS‐CoV‐2 and were characterized by lower respiratory Ct values than low transmission families (Median 22.62 vs. 32.91 IQR 17.06–28.67 vs. 30.37–34.24). High transmission families were associated with enhanced plasma antibody responses to multiple SARS‐CoV‐2 antigens and the presence of neutralizing antibodies. Three distinguishing saliva SARS‐CoV‐2 antibody features were identified according to age (IgA1 to Spike 1, IgA1 to nucleocapsid protein (NP)), suggesting that adults and children generate distinct mucosal antibody responses during the acute phase of infection. Utilizing respiratory and nonrespiratory PCR testing, along with the measurement of SARS‐CoV‐2–specific local and systemic antibodies, provides a more accurate assessment of infection within households and highlights some of the immunological differences in response between children and adults.
The QuickWee trial: protocol for a randomised controlled trial of gentle suprapubic cutaneous stimulation to hasten non-invasive urine collection from infants
Publisher: BMJ
Date: 08-2016
Virology and immune dynamics reveal high household transmission of ancestral SARS-CoV-2 strain
Publisher: Authorea, Inc.
Date: 21-04-2022
DOI: 10.22541/AU.165053425.54585615/V1
Abstract: Background Household studies are crucial for understanding the transmission of SARS-CoV-2 infection, which may be underestimated from PCR testing of respiratory s les alone. We aim to combine assessment of household mitigation measures nasopharyngeal, saliva and stool PCR testing along with mucosal and systemic SARS-CoV-2 specific antibodies, to comprehensively characterise SARS-CoV-2 infection and transmission in households. Methods Between March and September 2020, we obtained s les from 92 participants in 26 households in Melbourne, Australia, in a 4-week period following onset of infection with ancestral SARS-CoV-2 variants. Results The secondary attack rate was 36% (24/66) when using nasopharyngeal swab (NPS) PCR positivity alone. However, when respiratory and non-respiratory s les were combined with antibody responses in blood and saliva, the secondary attack rate was 76% (50/66). SARS-CoV-2 viral load of the index case and household isolation measures were key factors that determine secondary transmission. In 27% (7/26) of households, all family members tested positive by NPS for SARS-CoV-2 and were characterised by lower respiratory Ct-values than low transmission families (Median 22.62 vs 32.91 IQR 17.06 to 28.67 vs 30.37 to 34.24). High transmission families were associated with enhanced plasma antibody responses to multiple SARS-CoV-2 antigens and the presence of neutralising antibodies. Three distinguishing saliva SARS-CoV-2 antibody features were identified according to age (IgA1 to Spike 1, IgA1 to nucleocapsid protein (NP), suggesting that adults and children generate distinct mucosal antibody responses during the acute phase of infection. Conclusion Utilising respiratory and non-respiratory PCR testing, along with measurement of SARS-CoV-2 specific local and systemic antibodies, provides a more accurate assessment of infection within households and highlights some of the immunological differences in response between children and adults.
Immune responses to SARS-CoV-2 in three children of parents with symptomatic COVID-19
Publisher: Springer Science and Business Media LLC
Date: 11-11-2020
DOI: 10.1038/S41467-020-19545-8
Abstract: Compared to adults, children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have predominantly mild or asymptomatic infections, but the underlying immunological differences remain unclear. Here, we describe clinical features, virology, longitudinal cellular, and cytokine immune profile, SARS-CoV-2-specific serology and salivary antibody responses in a family of two parents with PCR-confirmed symptomatic SARS-CoV-2 infection and their three children, who tested repeatedly SARS-CoV-2 PCR negative. Cellular immune profiles and cytokine responses of all children are similar to their parents at all timepoints. All family members have salivary anti-SARS-CoV-2 antibodies detected, predominantly IgA, that coincide with symptom resolution in 3 of 4 symptomatic members. Plasma from both parents and one child have IgG antibody against the S1 protein and virus-neutralizing activity detected. Using a systems serology approach, we demonstrate higher levels of SARS-CoV-2-specific antibody features of these family members compared to healthy controls. These data indicate that children can mount an immune response to SARS-CoV-2 without virological confirmation of infection, raising the possibility that immunity in children can prevent the establishment of SARS-CoV-2 infection. Relying on routine virological and serological testing may not identify exposed children, with implications for epidemiological and clinical studies across the life-span.
Clean catch urine collection: Time taken and diagnostic implication. A prospective observational study
Publisher: Wiley
Date: 15-06-2017
DOI: 10.1111/JPC.13595
Abstract: Clean catch urine (CCU) collection is commonly used in pre-continent children. CCU can be time-consuming and specimens may be contaminated. Our aim was to determine the time taken for CCU attempts and to describe the success of this method in diagnosing or excluding urinary tract infection. Prospective observational study of CCU in pre-continent children aged 2-48 months in the emergency department. Time taken until urine collection, 'successful' (voided and caught), 'missed' (voided not caught) or the procedure 'stopped', were recorded and urine culture results analysed. Two hundred and seventeen children (131 (60%) male) were enrolled. There were a total of 247 attempts at CCU. For the first attempt, the median collecting time was 30.5 min (interquartile range (IQR) 11-66). Outcome was 'successful' in 64% (95% confidence intervals (CI) 58-70%), 'missed' in 16% (95% CI 11-20%) and 'stopped' in 20% (95% CI 15-26%). Median time if 'successful' was 25 min (IQR 7-46.5), 'missed' 27 min (IQR 11.6-59) and 71 min (IQR 42.5-93) when 'stopped'. One hundred and sixty children had successful CCU collection, 129 were sent for culture. Fifty of 129 (39%) cultures were contaminated. If all urine specimens caught were sent for culture, the estimated yield of an uncontaminated urine specimen was 45%. Contamination was not related to time taken for CCU. CCU is time-consuming, frequently unsuccessful and contaminated, resulting in a low overall diagnostic yield. Clinicians could expect a 45% chance of obtaining a definitive urine s le from this method overall.
The use of dried blood spots for the serological evaluation of SARS-CoV-2 antibodies
Publisher: Oxford University Press (OUP)
Date: 22-02-2021
Abstract: To determine if dried blood spot specimens (DBS) can reliably detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, we compared the SARS-CoV-2 IgG antibody response in paired serum and eluates from DBS specimens. A total of 95 paired DBS and serum s les were collected from 74 participants (aged 1–63 years) as part of a household cohort study in Melbourne, Australia. SARS-CoV-2 IgG antibodies specific for the receptor-binding domain (RBD) and S1 proteins between serum and eluates from DBS specimens were compared using an FDA-approved ELISA method. Among the 74 participants, 42% (31/74) were children and the rest were adults. A total of 16 children and 13 adults were SARS-CoV-2 positive by polymerase chain reaction. The IgG seropositivity rate was similar between serum and DBS specimens (18.9% (18/95) versus 16.8% (16/95)), respectively. Similar RBD and S1-specific IgG levels were detected between serum and DBS specimens. Serum IgG levels strongly correlated with DBS IgG levels (r = 0.99, P & 0.0001) for both SARS-CoV-2 proteins. Furthermore, antibodies remained stable in DBS specimens for & months. DBS specimens can be reliably used as an alternative to serum s les for SARS-CoV-2 antibody measurement. The use of DBS specimens would facilitate serosurveillance efforts particularly in hard-to-reach populations and inform public health responses including COVID-19 vaccination strategies.
COVID ‐19 in children: I. Epidemiology, prevention and indirect impacts
Publisher: Wiley
Date: 13-10-2021
DOI: 10.1111/JPC.15791
Abstract: Children globally have been profoundly impacted by the coronavirus disease 2019 (COVID‐19) pandemic. This review explores the direct and indirect public health impacts of COVID‐19 on children. We discuss in detail the transmission dynamics, vaccination strategies and, importantly, the ‘shadow pandemic’, encompassing underappreciated indirect impacts of the pandemic on children. The indirect effects of COVID‐19 will have a long‐term impact beyond the immediate pandemic period. These include the mental health and wellbeing risks, disruption to family income and attendant stressors including increased family violence, delayed medical attention and the critical issue of prolonged loss of face‐to‐face learning in a normal school environment. Amplification of existing inequities and creation of new disadvantage are likely additional sequelae, with children from vulnerable families disproportionately affected. We emphasise the responsibility of paediatricians to advocate on behalf of this vulnerable group to ensure the longer‐term effects of COVID‐19 public health responses on the health and wellbeing of children are fully considered.
Parent-Reported Child and Parent Quality of Life during COVID-19 Testing at an Australian Paediatric Hospital Outpatient Clinic: A Cross-Sectional Study
Publisher: MDPI AG
Date: 15-09-2023
‘I think we've had a health screen’: New offshore screening, new refugee health guidelines, new Syrian and Iraqi cohorts: Recommendations, reality, results and review
Publisher: Wiley
Date: 09-08-2019
DOI: 10.1111/JPC.14142
Abstract: To examine refugee health assessments in Syrian and Iraqi children in the context of changes to offshore immigration screening, updated Australian refugee health guidelines and the primary care refugee health model in Victoria. This is a retrospective audit of Syrian and Iraqi children aged 0-17 years attending a specialist immigrant health service from January 2015 to September 2017. We saw 128 children (7 months-16 years, 64.8% male). Prior to arrival, 58.9% of children had experienced trauma, and 67.9% had missed at least 1 year of school. Almost all children (93.3%) were linked with a regular general practitioner in Australia, and 23.6% children were linked with a refugee health nurse offshore health records were infrequently available. Of school-aged children, 25% were not enrolled in school 3 months after arrival. Only 2 of 113 (1.8%) children had completed a recommended refugee health assessment, and 55.1% had commenced appropriate catch-up vaccination in primary care. After screening completion, the most prevalent conditions were low vitamin D (63.6%) growth/nutrition (24.2%), neurological/metabolic (16.4%), learning/behaviour (15.6%) and mental health (12.5%) concerns latent tuberculosis infection (11.8%) and developmental delay (10.2%). Sixteen children required surgery after arrival, and six children had life-threatening medical conditions on arrival - only one had an offshore critical alert care for the other five children resulted in 133 unanticipated hospital admission days. There are substantial challenges with the current primary care screening model in Victoria. Disability, developmental and mental health concerns were prominent in this cohort, and many children had delays in education access, compounding prior disadvantage.
COVID-19-associated croup severity in Australian children
Publisher: BMJ
Date: 22-05-2023
COVID ‐19 in children. II : Pathogenesis, disease spectrum and management
Publisher: Wiley
Date: 25-10-2021
DOI: 10.1111/JPC.15811
Abstract: The global disruption of the COVID‐19 pandemic has impacted the life of every child either directly or indirectly. This review explores the pathophysiology, immune response, clinical presentation and treatment of COVID‐19 in children, summarising the most up‐to‐date data including recent developments regarding variants of concern. The acute infection with SARS‐CoV‐2 is generally mild in children, whilst the post‐infectious manifestations, including paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS) and ‘long COVID’ in children, are more complex. Given that most research on COVID‐19 has focused on adult cohorts and that clinical manifestations, treatment availability and impacts differ markedly in children, research that specifically examines COVID‐19 in children needs to be prioritised.
Healthcare worker knowledge and skills following coaching in WHO early essential newborn care program in the Solomon Islands: a prospective multi-site cohort study
Publisher: Springer Science and Business Media LLC
Date: 07-02-2020
DOI: 10.1186/S12884-020-2739-Z
Abstract: Newborn mortality in Oceania declined slower than other regions in the past 25 years. The World Health Organization (WHO) introduced the Early Essential Newborn Care program (EENC) in 2015 in Solomon Islands, a Small Island Developing State, to address high newborn mortality. We explored knowledge and skills retention among healthcare workers following EENC coaching. Between March 2015 and December 2017, healthcare workers in five hospitals were assessed: pre- and post-clinical coaching and at a later evaluation. Standardised written and clinical skills assessments for breathing and non-breathing baby scenarios were used. Additionally, written surveys were completed during evaluation for feedback on the EENC experience. Fifty-three healthcare workers were included in the evaluation. Median time between initial coaching and evaluation was 21 months (IQR 18–26). Median written score increased from 44% at baseline to 89% post-coaching ( p 0.001), and was 61% at evaluation ( p 0.001). Skills assessment score was 20% at baseline and 95% post-coaching in the Breathing Baby scenario ( p 0.001). In the Non-Breathing Baby scenario, score was 63% at baseline and 86% post-coaching ( p 0.001). At evaluation, median score in the Breathing Baby scenario was 82% a reduction of 13% from post-coaching ( p 0.001) and 72% for the Non-Breathing Baby, a reduction of 14% post-coaching ( p 0.001). Nurse aides had least reduction in evaluation scores of − 2% for the Breathing Baby and midwives − 10% for the Non-Breathing Baby respectively from post-coaching to evaluation. EENC coaching resulted in immediate improvements in knowledge and skills but declined over time. Healthcare workers who used the skills in regular practice had higher scores. Complementary quality improvement strategies are needed to sustain resuscitation skills following training over time. Australia New Zealand Trial Registry, Retrospective Registration (12/2/2019), registration number ACTRN12619000201178 .
Quick-Wee: a novel non-invasive urine collection method
Publisher: BMJ
Date: 26-08-2016
DOI: 10.1136/EMERMED-2016-206000
Abstract: Clean catch urine (CCU) collection in precontinent children is often time-consuming, with associated collection failure. We hypothesise that stimulating cutaneous reflexes hastens voiding for CCU. 40 children aged 1-24 months in the ED. Standard CCU was augmented with gentle suprapubic cutaneous stimulation using saline-soaked gauze (Quick-Wee method). 12/40 (30%) children voided within 5 min for successful CCU. Parental and clinician satisfaction was high. Quick-Wee appears to be a simple method to speed CCU in young children.
Systems serology detects functionally distinct coronavirus antibody features in children and elderly
Publisher: Springer Science and Business Media LLC
Date: 04-2021
DOI: 10.1038/S41467-021-22236-7
Abstract: The hallmarks of COVID-19 are higher pathogenicity and mortality in the elderly compared to children. Examining baseline SARS-CoV-2 cross-reactive immunological responses, induced by circulating human coronaviruses (hCoVs), is needed to understand such ergent clinical outcomes. Here we show analysis of coronavirus antibody responses of pre-pandemic healthy children ( n = 89), adults ( n = 98), elderly ( n = 57), and COVID-19 patients ( n = 50) by systems serology. Moderate levels of cross-reactive, but non-neutralizing, SARS-CoV-2 antibodies are detected in pre-pandemic healthy in iduals. SARS-CoV-2 antigen-specific Fcγ receptor binding accurately distinguishes COVID-19 patients from healthy in iduals, suggesting that SARS-CoV-2 infection induces qualitative changes to antibody Fc, enhancing Fcγ receptor engagement. Higher cross-reactive SARS-CoV-2 IgA and IgG are observed in healthy elderly, while healthy children display elevated SARS-CoV-2 IgM, suggesting that children have fewer hCoV exposures, resulting in less-experienced but more polyreactive humoral immunity. Age-dependent analysis of COVID-19 patients, confirms elevated class-switched antibodies in elderly, while children have stronger Fc responses which we demonstrate are functionally different. These insights will inform COVID-19 vaccination strategies, improved serological diagnostics and therapeutics.
SARS‐CoV
‐2 testing and outcomes in the first 30 days after the first case of
COVID
‐19 at an Australian children's hospital
Publisher: Wiley
Date: 23-06-2020
The characteristics of SARS‐CoV‐2‐positive children who presented to Australian hospitals during 2020: a PREDICT network study
Publisher: AMPCo
Date: 13-08-2021
DOI: 10.5694/MJA2.51207
Evidence to Support Oxygen Guidelines for Children with Emergency Signs in Developing Countries: A Systematic Review and Physiological and Mechanistic Analysis
Publisher: Oxford University Press (OUP)
Date: 02-2017
Abstract: There are currently no evidence-based oxygen saturation targets for treating children with life-threatening conditions. We reviewed evidence of SpO2 targets for oxygen therapy in children with emergency signs as per WHO Emergency Triage Assessment and Treatment guidelines. We systematically searched for physiological data and international guidelines that would inform a safe approach. Our findings suggest that in children with acute lung disease who do not require resuscitation, a threshold SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery. Although there is no empirical evidence regarding oxygen saturation to target in children with emergency signs from developing countries, a SpO2 of ≥ 94% during resuscitation may help compensate for common situations of reduced oxygen delivery. In children who do not require resuscitation or are stable post resuscitation with only lung disease, a lower limit of SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery and save resources.
Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial
Publisher: BMJ
Date: 07-04-2017
DOI: 10.1136/BMJ.J1341
Stick with the nose…Saliva rapid antigen testing is not a viable method for testing children under 5 years old.
Publisher: Wiley
Date: 18-11-2022
DOI: 10.1111/JPC.16277
Abstract: Respiratory testing with rapid antigen tests (RATs) in children under 5 years of age may be uncomfortable and presents specific challenges to testing due to compliance and procedural distress. The aim of this study was to investigate sensitivity and feasibility of self-collected nasal and saliva RAT tests compared with a combined nose and throat (CTN) swab PCR in children under 5. Children aged between 1 month and 5 years, with confirmed COVID-19 or who were a household contact within 7 days were included. A saliva RAT, nasal RAT and CTN swab were collected by the parent. SARS-CoV-2 cycle threshold (Ct) values for CTN tested by PCR were compared with saliva and nasal RAT results. Parent preference for method of s le was recorded. Forty-one children were recruited with median age of 1.5 (interquartile range 0.7-4.0) years. Only 22/41 (54%) of parents were able to successfully collect a saliva RAT from their child. Sensitivity of the nasal RAT and saliva RAT was 0.889 (95% confidence interval (CI) 0.739-0.969) and 0.158 (95% CI 0.034-0.396), respectively. Upper limit of nasal RAT detection by CTN Ct value was higher than saliva (36.05 vs. 27.29). While saliva RAT was rated most comfortable, nasal RAT was rated the preferred specimen by parents for future testing, due to saliva collection difficulties and time taken. Rapid antigen testing with nasal RAT is a more feasible and sensitive method for SARS-CoV-2 detection in young children compared with saliva RAT.
Seroprevalence of SARS‐CoV ‐2 antibodies in health‐care workers at a tertiary paediatric hospital
Publisher: Wiley
Date: 07-2021
DOI: 10.1111/JPC.15585
COVID
‐19 in health‐care workers: Testing and outcomes at a Victorian tertiary children's hospital
Publisher: Wiley
Date: 09-2020
DOI: 10.1111/JPC.15143
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No related grants have been discovered for Shidan Tosif.