ORCID Profile
0000-0002-2391-4396
Current Organisation
UNSW Sydney
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Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.JINF.2022.10.028
Abstract: Evidence on the effectiveness of influenza vaccine in preventing antibiotic prescriptions for influenza-like illness (ILI) in adults is limited. A primary care-based case-control study was conducted to estimate influenza vaccine effectiveness (VE) against influenza-like illness (ILI) and antibiotic prescribing for ILI in adults aged ≥40 years. Cases were patients diagnosed with ILI from 1 The number of ILI cases varied from 558 in 2018 to 2901 in 2017 and controls from 86618 in 2015 to 136763 in 2017. Over 4 years the pooled estimate of VE was 24% (95%CI, 11% to 34%) against ILI and 15% (95%CI, -3% to 29%) against antibiotic prescription for ILI. Influenza vaccine was effective in reducing ILI with an associated antibiotic prescriptions in patients aged <65 years (VE=23%, 95%CI, 3% to 38%) and if no comorbidities were recorded (VE=22%, 95%CI, 1% to 39%) but not in other subgroups. Influenza vaccine reduced the likelihood of antibiotic prescriptions for ILI in low-risk adults (40-64 years and those without comorbidities).
Publisher: Springer Science and Business Media LLC
Date: 08-05-2019
DOI: 10.1007/S10096-019-03554-7
Abstract: Surveillance of influenza epidemics is a priority for risk assessment and pandemic preparedness, yet representation of their spatiotemporal intensity remains limited. Using the epidemic of influenza type A in 2016 in Australia, we demonstrated a simple but statistically sound adaptive method of mapping epidemic evolution over space and time. Weekly counts of persons with laboratory confirmed influenza type A infections in Australia in 2016 were analysed by official national statistical region. Weekly standardised epidemic intensity was represented by a standard score (z-score) calculated using the standard deviation of below-median counts in the previous 52 weeks. A geographic information system (GIS) was used to present the epidemic progression. There were 79,628 notifications of influenza A infections included. Of these, 79,218 (99.5%) were allocated to a geographical area. The GIS maps indicated areas of elevated epidemic intensity across Australia by week and area that were consistent with the observed start, peak and decline of the epidemic when compared with counts aggregated at the state and territory level. This simple, adaptable approach could improve local level epidemic intelligence in a variety of settings and for other diseases. It may also facilitate increased understanding of geographic epidemic dynamics.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.VACCINE.2019.06.039
Abstract: Although oil-in-water adjuvants improve pandemic influenza vaccine efficacy, AS03 versus MF59 adjuvant comparisons in A(H1N1)pdm09 pandemic vaccines are lacking. We conducted an indirect-comparison meta-analysis extracting published data from randomised controlled trials in literature databases (01/01/2009-09/09/2018), evaluating immunogenicity and safety of AS03- or MF59-adjuvanted vaccines. We conducted comparisons of log-transformed haemagglutination inhibition geometric mean titre ratio (GMTR primary outcome) of different regimens of each adjuvant versus unadjuvanted counterparts. Then via test of subgroup differences, we indirectly compared different AS03 versus MF59 regimens. We identified 22 publications with 10,734 participants. In adults, AS03-adjuvanted vaccines (3.75 µg haemagglutinin) achieved superior GMTR versus unadjuvanted vaccines (all four comparisons) MD = 0.56 (95%CI 0.33 to 0.80, p < 0.001) to 1.18 (95%CI 0.72 to 1.65, p < 0.001). MF59 (full-dose)-adjuvanted vaccines (7.5 µg haemagglutinin) were superior to unadjuvanted vaccines (three of four comparisons) MD = 0.47 (95%CI 0.19 to 0.75, p = 0.001) to 0.80 (95%CI 0.44 to 1.16, p < 0.001). Adult indirect comparisons favoured AS03 over MF59 (six of eight comparisons p < 0.001 to p = 0.088). Paediatric indirect comparisons favoured MF59-adjuvanted vaccines (two of seven comparisons p = 0.011, 0.079). However, unadjuvanted control group seroconversion rate was lower in MF59 than AS03 studies (p < 0.001 to p = 0.097). There was substantial heterogeneity, and adult AS03 studies had lower risk of bias. Despite limited studies, in adults, AS03-adjuvanted vaccines allow antigen sparing versus MF59-adjuvanted and unadjuvanted vaccines, with similar immunogenicity, but higher risk of pain and fatigue (secondary outcomes) than unadjuvanted vaccines. In children, adjuvanted vaccines are also superior, but the better adjuvant is uncertain.
Publisher: Wiley
Date: 13-02-2019
Abstract: Programmes that reduce the time to defibrillation are likely to improve overall survival rates from out-of-hospital cardiac arrests (OHCAs). This research sought to identify human factors common among community responders taking an automated external defibrillator (AED) to a victim of an OHCA that are either barriers or enablers of desired behaviour. A qualitative methodology was used. Community members who had access to an AED and who had been notified of an incident of OHCA near them were approached to participate in the research. Participants completed a written survey and undertook a semi-structured interview. A thematic analysis was undertaken using NVivo software and triangulated against findings from an automated data-mining package, Leximancer. The study found that 100% of people who were notified of the need for an AED responded. Twelve participants subsequently identified during interviews that they held some form of leadership role in their community. First aid training and previous experience of, and competency in managing emergencies were the strongest motivations for their response. Personal risk was not a concern when responding to victims in immediately life-threatening situations. Prospective programmes may be able to be designed to increase the likelihood that community members with AEDs will respond in advance of emergency medical services by targeting common human factors, such as leadership behaviour, training, competency and experience in managing emergencies, leading to better overall survival rates from OHCA.
Publisher: JMIR Publications Inc.
Date: 23-07-2019
DOI: 10.2196/11780
Publisher: Oxford University Press (OUP)
Date: 08-04-2022
Abstract: Vaccination against influenza may reduce antibiotic use, but data are limited and imprecise. We conducted a case-control study using deidentified data from a large national primary care database to evaluate antibiotic prescribing changes following influenza vaccination in children 1-4 years old attending primary care in the Australian 2018 and 2019 influenza seasons. Cases were prescribed β-lactam or macrolide antibiotics during the influenza season and controls were not. Influenza vaccination was documented in the medical records. Adjusted odds ratios for antibiotic prescribing according to influenza vaccination status were estimated using generalized estimating equations, controlling for age, asthma diagnosis, other vaccinations, practice visit frequency, and attendance week. In 2018, 11 282 cases and 32 020 controls were eligible, and in 2019, 12 705 cases and 36 858 controls. Antibiotic prescriptions were less likely in vaccinated participants in 2018 (aOR, 0.65 95% CI, 0.62-0.69) and 2019 (aOR, 0.78 95% CI, 0.73-0.82) and did not vary by age, the number of GP visits, or prior prescribing of antibiotics. In the subgroup of children vaccinated in the preceding season, influenza vaccination was not associated with a reduction in antibiotic use (2018—aOR, 1.12 95% CI, 0.90-1.39 2019—aOR, 1.30 95% CI, 1.16-1.46). From our estimates, potentially 100 000 antibiotic prescriptions could be avoided annually in Australia if all children in this age range were vaccinated. Influenza vaccination may substantially reduce antibiotic prescribing among young children. This effect should be considered in the overall assessment of the costs and benefits of childhood influenza vaccination programs.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.IJID.2022.06.022
Abstract: Little is known about global variation in early epidemic growth rates and effective reproduction numbers (R Country influenza detection time series from September 2017 through January 2019 were obtained from an international database. Type A and B epidemics by country were selected on the basis of R Time series were included for 119 of 169 available countries. There were 100 countries with influenza A and 79 with B epidemics. Median R The R
Publisher: Elsevier BV
Date: 09-2023
Publisher: Wiley
Date: 24-05-2017
Abstract: Influenza outbreaks cause overcrowding in EDs. We aimed to quantify the impact of influenza on the National Emergency Access Targets and premature patient departure in New South Wales, Australia. This was a retrospective observational study of 11 million presentations to 115 hospitals during 2010-2014, using routinely collected administrative records. A time series generalised additive regression model was used to assess the correlation between weekly influenza activity and the weekly proportion of patients leaving the ED in >4 h and the proportion that departed before commencing or completing treatment ('did not wait'), after controlling for background winter and holiday effects. During 2011-2014, peak annual circulating influenza was associated with the peak weekly proportion of presentations that left in >4 h. The maximum estimated absolute weekly change in that proportion was 3.88 (95% confidence interval 3.02-4.74) percentage points in 2014. For presentations that did not wait, influenza circulation was associated with statistically significant increases in all years, with a maximum weekly value of 2.68 (95% confidence interval 2.31-3.06) percentage points in 2012. Circulating influenza was associated with sustained increases and peaks in delayed patient throughput and premature patient departures. Influenza surveillance information may assist with development of health system and hospital workforce planning and bed management activities.
Publisher: JMIR Publications Inc.
Date: 02-08-2018
Abstract: nfluenza causes serious illness requiring annual health system surge capacity, yet annual seasonal variation makes it difficult to forecast and plan for the severity of an upcoming season. Research shows that hospital and health system stakeholders indicated a preference of forecasting tools that are easy to use and understand, to assist with surge capacity planning for influenza. his study aimed to develop a simple risk prediction tool, Flucast, to predict the severity of an emerging influenza season. tudy data were obtained from the National Notifiable Diseases Surveillance System and Australian Influenza Surveillance Reports, Department of Health, Australia. We tested Flucast using retrospective seasonal data for eleven Australian influenza seasons. We compared five different models, using parameters known early in the season and which may be associated with the severity of the season. To calibrate the tool, the resulting estimates of seasonal severity were validated against independent reports of influenza-attributable morbidity and mortality. A model with highest predictive accuracy against retrospective seasonal activity was chosen as a best fit model to develop the Flucast tool. The tool was prospectively tested against the emerging 2018 influenza season. he Flucast tool predicted the severity of all retrospectively studied years correctly for influenza seasonal activity in Australia. For 2018, the tool provided a reliable early prediction of severe seasonal influenza with the use of real-time data. The tool meets stakeholder preferences for simplicity and ease of use to assist with surge capacity planning. he Flucast tool may be useful to inform future health system influenza preparedness planning, surge capacity and intervention programs in real time and can be adapted for different settings and geographic locations. A
Publisher: Wiley
Date: 13-03-2020
Publisher: Elsevier BV
Date: 09-2020
No related grants have been discovered for David Muscatello.