ORCID Profile
0000-0001-9635-8784
Current Organisation
Women's and Children's Hospital
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
Publisher: American Academy of Pediatrics (AAP)
Date: 10-2006
Abstract: OBJECTIVE. The aim of this study was to determine the site, extent, and resolution of tissue involvement when extensive limb swelling occurred in the injected limb for children who received diphtheria-tetanus-acellular pertussis or reduced-antigen content diphtheria-tetanus-acellular pertussis vaccine at 4 to 6 years of age. METHODS. Children who had experienced an injection site reaction at 18 months of age were assigned randomly to receive an intramuscular injection of either reduced-antigen content diphtheria-tetanus-acellular pertussis vaccine or diphtheria-tetanus-acellular pertussis vaccine between 4 and 6 years of age. Children who developed extensive limb swelling were recruited for assessment by clinical examination ultrasound studies of the affected and opposite (control) arms were performed 24 to 48 hours after immunization and 48 to 96 hours later. RESULTS. Twelve children with extensive limb swelling were enrolled in the study. Ultrasound examinations demonstrated swelling of both the subcutaneous and muscle layers of the vaccinated arm. Ultrasound assessment showed that the swelling exceeded the clinical measurements of skin redness and swelling. Subcutaneous and muscle tissues expanded to 281% and 111% of the tissue thicknesses of the control arm, respectively. Repeat ultrasound examinations after 48 to 96 hours showed considerable resolution of muscle swelling, compared with subcutaneous tissue swelling. There was no significant difference in the extent of swelling detected between children who received diphtheria-tetanus-acellular pertussis vaccine and those who received reduced-antigen content diphtheria-tetanus-acellular pertussis vaccine. CONCLUSION. Extensive limb swelling reactions after diphtheria-tetanus-acellular pertussis or reduced-antigen content booster immunizations involved swelling of subcutaneous and muscle tissues with swelling and duration more marked in subcutaneous tissue.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.JINF.2015.11.004
Abstract: Changes in circulating Bordetella pertussis genotypes, including a novel pertussis toxin promoter ptxP3 allele and absence of pertactin (Prn) antigen, have been reported from several countries but limited data on relative severity are available. We compared markers of disease severity in children with B. pertussis infection due to strains of differing genotype. Culture confirmed cases presenting to tertiary paediatric hospitals in three Australian states between 2008 and 2012 were classified as severe if they required a hospital stay greater than seven days, were admitted to intensive care, or if death occurred. Associations between age, vaccination, genotype and severity were assessed. Of 199 pertussis cases, 81 (41%) were <3 months, including 32/39 (82%) of severe cases. The proportion of isolates from these cases that were Prn deficient increased markedly between 2008 and 2012. Of B. pertussis isolates, the proportion considered severe was similar for Prn positive (27/128, 21%) and Prn deficient (12/71, 17%) cases but only 1/22 (4.5%) of non ptxP3 cases were severe versus 38/177 (21.4%) ptxP3 positive. Adjusting for ptxP type, vaccination status and age, disease severity was not significantly associated with Prn status (RRA: 0.95, [0.57-1.56] p = 0.83). In children, we found no relationship between Prn status and markers of severe pertussis. An increased proportion of severe disease in isolates with the ptxP3 allele was observed.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.VACCINE.2014.02.054
Abstract: To assess knowledge of invasive meningococcal disease (IMD) and concern about the disease in the South Australian Community including adolescents, adults, parents and non-parents. This cross-sectional study was conducted by face to face interviews in South Australia in 2012. Participants were scored on their knowledge and concern about IMD. Univariate and multivariate regression analyses were performed with the survey data weighted by age and gender in accordance with 2011 Census data. Of 5200 households randomly selected and stratified by metropolitan or rural location, 3055 participants were interviewed with a response rate of 60.3%. The majority were Australian born (74.2%, n=2267) with 31.8% (n=972) of those interviewed being parents, and 15.9% (n=487) adolescents (15-24 years). Almost a quarter of participants (23.5%, n=717) do not know what meningococcal disease is, with 9.1% (n=278) believing incorrectly that IMD is a viral infection. 36.6% (n=1114) had low overall knowledge of IMD. Adolescents (p<0.050), non-Australian born (p<0.001), low educational attainment (p=0.019), low household income (p=0.011), low/medium socio-economic status (p<0.050) or living in a metropolitan area (p=0.006) were more likely to have lower overall knowledge of IMD. Participants who were not parents (p<0.001), male gender (p<0.001), single (p<0.001), highly educated (p=0.022) or had high household income (p=0.015), had lower concern about IMD. Large community knowledge gaps for IMD were observed, particularly amongst adolescents and adults with low educational attainment and low socio-economic status. Improving community knowledge of IMD could help ensure optimal uptake of a new meningococcal vaccine. Our study results can help guide development of community tailored immunisation education programs.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.VACCINE.2016.05.019
Abstract: Adolescents' views, and preferences are often over-looked when public health policies that affect them are designed and implemented. The purpose of this study was to describe young people's views and preferences for determining government funding priorities for adolescent immunization programs. In 2015 we conducted a youth jury in metropolitan Adelaide, South Australia to deliberate on the question "What criteria should we use to decide which vaccines for young people in Australia should receive public funding?" Fifteen youth aged 15-19 years participated in the jury. Jury members were recruited from the general community through a market research company using a stratified s ling technique. The jury's key priorities for determining publically funded vaccines were: Disease severity - whether the vaccine preventable disease (VPD) was life threatening and impacted on quality of life. Transmissibility - VPDs with high/fast transmission and high prevalence. Demonstration of cost-effectiveness, taking into account purchase price, program administration, economic and societal gain. The jury's recommendations for vaccine funding policy were strongly underpinned by the belief that it was critical to ensure that funding was targeted to not only population groups who would be medically at risk from vaccine preventable diseases, but also to socially and economically disadvantaged population groups. A novel recommendation proposed by the jury was that there should be a process for establishing criteria to remove vaccines from publically funded programs as a complement to the process for adding new vaccines. Young people have valuable contributions to make in priority setting for health programs and their views should be incorporated into the framing of health policies that directly affect them.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-07-2020
Publisher: Wiley
Date: 08-08-2016
DOI: 10.1111/IRV.12403
Publisher: Oxford University Press (OUP)
Date: 26-04-2012
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.VACCINE.2015.10.068
Abstract: Pertussis is a highly virulent vaccine preventable disease that remains a global challenge. This study aimed to assess community knowledge of pertussis infection as well as awareness and uptake of adult pertussis booster vaccine. A cross-sectional survey was conducted of randomly selected households in South Australia by Computer Assisted Telephone Interviews in 2011. Survey data were weighted to the age, gender and geographical area profile of the population. From 3124 randomly s led contactable households, 1967 interviews were conducted (participation rate 63%) with in iduals aged 18-93 years, including 608 parents of children aged <18 years. The majority of respondents (97%) had heard of pertussis (whooping cough) and 18% reported that a household member had previously contracted whooping cough infection. Most respondents considered whooping cough to be highly contagious (73%) and severe for infants (89%). Over half (51%) of those surveyed were aware that family members commonly transmit pertussis to infants. Despite high knowledge, pertussis vaccine uptake was low, with only 10% of respondents reporting pertussis vaccination in the previous five years. Whilst 61% of respondents were aware of the availability of an adult pertussis booster vaccine, only 8% (n=154) reported their Family Physician had discussed it with them. If provided free, 77% agreed that they would be more likely to accept a booster pertussis vaccination. Independent predictors of recent pertussis vaccination included higher education, larger household size, perception of greater disease severity for infants and discussion with a Family Physician about pertussis vaccination. Whilst knowledge regarding transmission and severity of Bordetella pertussis was high, uptake of pertussis vaccination for adults is remarkably low amongst the South Australian community. Improved awareness regarding the availability of a booster pertussis vaccine through Family Physicians and/or provision of funded pertussis vaccination for adults has the potential to improve pertussis vaccine coverage.
Publisher: MDPI AG
Date: 29-04-2022
Abstract: Obesity can increase the severity of influenza infection. Data are limited regarding immune responses to influenza vaccination in obese children. We aimed to investigate the impact of obesity on quadrivalent influenza vaccine responses in children. Children with obesity (body mass index (BMI) ≥ 95th percentile for age and gender) and children without obesity (BMI 95th percentile) were enrolled in the study. Blood s les were collected before, 1, and 6 months after influenza vaccination, to measure antibody responses by haemagglutination inhibition (HI) assay. Vaccine immunogenicity outcomes were compared between children with and without obesity. Forty-four children (mean age 13.3 ± 2.1 years, 18 males and 14 with obesity) completed the 6-month study. More than 90% of the participants with and without obesity had seroprotective antibody titres (HI ≥ 40) at both 1 and 6 months following vaccination for each of the four influenza strains (A/H3N2, A/H1N1, B/(Victoria) and B/(Yamagata)). Influenza-specific geometric mean titres at baseline, 1, and 6 months post-vaccination were similar between children with and without obesity for all influenza vaccine strains. Children with and without obesity have robust, sustained antibody responses over 6 months to the quadrivalent influenza vaccine.
Publisher: Oxford University Press (OUP)
Date: 03-09-2019
Abstract: This national, sentinel prospective study aimed to identify children with severe hospitalized varicella, despite availability of universal 1-dose vaccination since 2005, and determine associations between virus genotypes and disease severity. Children with varicella or zoster from 5 Paediatric Active Enhanced Disease Surveillance hospitals were enrolled. Lesions were swabbed for genotyping. Associations with disease severity were analyzed using multiple regression. From 2007 to 2015, 327 children with confirmed varicella (n = 238) or zoster (n = 89) were enrolled. Two hundred three (62%) were immunocompetent children including 5 of 8 children who required intensive care unit management. Eighteen percent (36 of 203) of immunocompetent children had been previously vaccinated. Vaccinated children aged >18 months were less likely to have severe disease (9% 5 of 56) than unvaccinated children (21% 21 of 100 P = .05). Three of 126 children who had virus genotyping (2 immunocompromised) had varicella (n = 2) or zoster (n = 2) due to the Oka/vaccine strain. European origin clades predominated and were independently associated with more severe disease (odds ratio = 3.2 95% confidence interval, 1.1- 9.5 P = .04). Severe hospitalized varicella still occurs with a 1-dose varicella program, although predominantly in unvaccinated children. Most 1-dose vaccine recipients were protected against severe disease. Viral genotyping in complex hospitalized cases is important to assist in monitoring disease due to Oka-vaccine strain.
Publisher: Oxford University Press (OUP)
Date: 19-11-2021
DOI: 10.1093/CID/CIAA1733
Abstract: Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, leads to significant morbidity and mortality worldwide. This review aimed to establish the effectiveness of meningococcal vaccines at preventing IMD and N. meningitidis pharyngeal carriage. A search within PubMed, Embase, Scopus, and unpublished studies up to 1 February 2020 was conducted. After removal of duplicates, 8565 studies were screened and 27 studies included. Protection was provided by meningococcal C vaccines for group C IMD (odds ratio [OR], 0.13 [95% confidence interval {CI}, .07–.23]), outer membrane vesicle (OMV) vaccines against group B IMD (OR, 0.35 [95% CI, .25–.48]), and meningococcal A, C, W, Y (MenACWY) vaccines against group ACWY IMD (OR, 0.31 [95% CI, .20–.49]). A single time series analysis found a reduction following an infant 4CMenB program (incidence rate ratio, 0.25 [95% CI, .19–.36]). Multivalent MenACWY vaccines did not reduce carriage (relative risk [RR], 0.88 [95% CI, .66–1.18]), unlike monovalent C vaccines (RR, 0.50 [95% CI, .26–.97]). 4CMenB vaccine had no effect on group B carriage (RR, 1.12 [95% CI, .90–1.40]). There was also no reduction in group B carriage following MenB-FHbp vaccination (RR, 0.98 [95% CI, .53–1.79]). Meningococcal conjugate C, ACWY, and OMV vaccines are effective at reducing IMD. A small number of studies demonstrate that monovalent C conjugate vaccines reduce pharyngeal N. meningitidis carriage. There is no evidence of carriage reduction for multivalent MenACWY, OMV, or recombinant MenB vaccines, which has implications for immunization strategies. CRD42018082085 (PROSPERO).
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.VACCINE.2011.04.109
Abstract: Rotavirus vaccine for infants was introduced into the National Immunisation Program in Australia in July 2007. To determine the impact of rotavirus vaccination on gastroenteritis hospitalisations amongst children less than six years of age in South Australia, we conducted a retrospective analysis of hospital admissions over two time periods: 1 May 2005-30 April 2007 (prior to rotavirus vaccination introduction) and 1 May 2008-30 April 2010 (post rotavirus vaccination introduction). The introduction of rotavirus vaccination has been associated with a marked reduction in hospital admissions for serious rotavirus gastroenteritis (RVGE) and all-cause gastroenteritis (ACGE). Following the introduction of rotavirus vaccination in South Australia, there was an 83% reduction in RVGE coded admissions (955 vs 165) and a 48% reduction in ACGE coded admissions (4153 vs 2142) for children aged less than six years. Children less than two years demonstrated the greatest reduction (90%) in RVGE admissions and ACGE admissions (57%). Age-specific RVGE hospitalisation rates decreased from 933/100,000 prior to rotavirus vaccine introduction to 88/100,000 for children less than two years of age. In addition, for gastroenteritis hospitalisations for children aged five years at time of admission (unvaccinated cohort) there was a reduction in the number of RVGE cases (24 vs 4), a reduction in age-specific RVGE hospitalisation rates (65/100,000 vs 11/100,000) and a significant reduction in the proportion of overall gastroenteritis cases which were rotavirus positive (11.5% vs 3.5%), suggesting a positive impact on both unvaccinated and vaccinated children less than six years of age in South Australia.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.VACCINE.2013.11.042
Abstract: A new meningococcal serogroup B (Men B) vaccine has been licensed in the European Union (EU) and Australia. This study aimed to assess community and parental attitudes to introduction of new Men B vaccines and identify facilitators and barriers to vaccine implementation. Cross-sectional survey including face-to-face interviews with adolescents, parents and adults from randomly selected households in South Australia in 2012. Survey data were weighted to the age, gender and geographical area profile of the population. 3055 interviews were conducted with in iduals aged 15-97 years, including 966 parents. Participation rate was 66.4%. 82.5% (95% CI 79.7-85.4) of parents (797/966) wanted their child to receive the Men B vaccine, with 12.2% (9.7-14.7) (118/966) unsure. Main parental concerns included potential side effects (41.3% (26.7-46.0)) and adequate vaccine testing (11.7% (9.4-14.1)). Potential for an extra injection at an immunisation visit resulted in 15.7% (12.8-18.5) of parents (n=152/966) less likely to have their child immunised. Potential redness/swelling at the injection site or mild/moderate fever resulted in only 8.5% (6.3-10.7) and 10.8% (8.5-13.2) of parents, respectively, less likely to have their child immunised. Children being up to date with vaccinations and recommendation from family physician were the strongest independent predictors of parents agreeing their children should be immunised with Men B vaccine (OR=6.58 p=0.006 and OR=4.15 p<0.001, respectively). Only 16.4% (14.9-17.9) of adults (501/3055) stated that they would not want to receive a Men B vaccine, with family physician recommendation the strongest independent predictor of acceptance (OR=3.81 p<0.001). There is strong community support for introduction of Men B vaccines, with parental willingness to have children immunised, impacted more by number of injections than potential for adverse events such as local reactions or fever.
Publisher: Informa UK Limited
Date: 15-04-2015
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.VACCINE.2013.03.037
Abstract: Globally, recommendations differ on the ideal angle of needle insertion to ensure vaccinate deposition in muscle for optimal safety and immunogenicity. This study aimed to compare the level of vaccinate deposition during vaccination, using two different needle angles (60° and 90°), in young children, adolescents and adults. In this randomized cross-over study, two doses of a licensed hepatitis vaccine, were administered to study participants, at a 60° or 90° angle using a fixed template. Ultrasonography was performed with a Philips iu22 ultrasound system. Real time clips and hard copies of images were recorded showing the injection and level of deposition of the vaccinate. Reactogenicity at the site of administration was assessed by participants arents. Nineteen participants were enrolled including children, adolescents and adults. Of the total 38 injections performed, 29 (76%) were confirmed by ultrasound as intramuscular (IM), 3 (8%) as not IM, and 6 (16%) unknown. For vaccinations visualised and administered at 60°, 87% (13/15) were intramuscular vs 94.1% (16/17) for those administered at 90°. A body mass index (BMI)≤25 was associated with a higher likelihood of IM injection compared to BMI>25 (p=0.038). There were no differences in reactogenicity for either 60° or 90° angle of administration. For the majority of vaccinees, a 60-90° angle of vaccine administration is appropriate for IM deposition of vaccinate. The likelihood of intramuscular deposition is reduced for in iduals with a BMI>25. The increasing rates of obesity globally highlight the importance of tailoring vaccination procedures accordingly.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.VACCINE.2015.11.075
Abstract: Meningococcal B (MenB) vaccines have been licensed in many countries with private purchase the only option until recently, when a funded programme was introduced in the UK. The aim of this study was to explore adolescent arental values for a variety of salient vaccine attributes (cost, effectiveness, side effect profile) to assess preferences and willingness-to-pay (WTP) for a MenB vaccine. A national cross-sectional population study was conducted in Australia using Discrete Choice Experiment methodology to assess adolescent arent/adult preferences for attributes related to MenB vaccine. 2003 adults and 502 adolescents completed the survey in 2013. The majority of participants were willing to be vaccinated with MenB vaccine with vaccination opt-out chosen by 11.9% of adolescents and parents, and 18.2% of non-parent adults. A mixed logit regression model examining adolescent/adult preferences indicated consistent findings the higher the effectiveness, the longer the duration of protection, the less chance of adverse events and the lower the cost, the more likely respondents were to agree to vaccination. For an ideal MenB vaccine, including the most favoured level of each attribute summed together (90% effectiveness, 10 year duration, 1 injection, no adverse events) adolescents would pay AU$251.60 and parents AU$295.10. Adolescents and parents would pay AU$90.70 or AU$127.20 for 90% vaccine effectiveness vs AU$18.50 or AU$16.70 for 70% effectiveness and would want to be financially compensated for 50% effectiveness pay AU$63.30 or AU$76.40 for 10 years protection and pay AU$48.50 or AU$49.20 for no vaccine related adverse events. A slight fever post vaccination was a preferred choice with parents and adolescents willing to pay AU$9.60 or AU$12.30 for this attribute. Vaccine effectiveness, adverse events and duration of immunity are important drivers for parental and adolescent decisions about WTP for MenB vaccine and should be included in discussions on the benefits, risks and cost.
Publisher: Public Library of Science (PLoS)
Date: 14-06-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Cambridge University Press (CUP)
Date: 17-05-2012
DOI: 10.1017/S095026881200091X
Abstract: To assess the impact of Bordetella pertussis infections in South Australia during an epidemic and determine vulnerable populations, data from notification reports for pertussis cases occurring between July 2008 and December 2009 were reviewed to determine the distribution of disease according to specific risk factors and examine associations with hospitalizations. Although the majority (66%) of the 6230 notifications for pertussis occurred in adults aged years, the highest notification and hospitalization rate occurred in infants aged year. For these infants, factors associated with hospitalization included being aged months [relative risk (RR) 2·3, 95% confidence interval (CI) 1·60–3·32], Indigenous ethnicity (RR 1·7, 95% CI 1·03–2·83) and receiving fewer than two doses of pertussis vaccine (RR 4·1, 95% CI 1·37–12·11). A combination of strategies aimed at improving direct protection for newborns, vaccination for the elderly, and reducing transmission from close contacts of infants are required for prevention of severe pertussis disease.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.VACCINE.2016.09.040
Abstract: There is limited knowledge of adolescent views and attitudes towards immunisation. Our study investigated adolescent attitudes to immunisation and compared differences in vaccination attitudes between adolescents and adults. This study was a cross-sectional, national online survey. Recruitment was stratified by state and gender to ensure findings were nationally representative. Regression analyses were performed to assess and compare adolescent and adult views on vaccine benefits, community protection, risks, side effects, sources of information, and decision-making preference. In 2013, 502 adolescents and 2003 adults completed the online survey. Lower levels of vaccine confidence were observed in adolescents with adolescents less likely to believe vaccines are beneficial and/or safe compared to adults (p=0.043). Compared to females, males were less confident of vaccine benefits (p<0.05) but less concern about vaccine side effects (p<0.05). Adolescents were more concerned about vaccine side effects than adults for pain (p<0.001), redness or swelling (p<0.001), and fever (p=0.006). Adolescents were less likely than adults to consider health professionals (p<0.001) and the media (e.g. internet) (p=0.010) as important sources of information, and were more likely to seek information from social networks (p<0.001) including families and schools. Although 62.0% of adolescents agreed that parents should make the decision about vaccination for them, adolescents were more likely to prefer a joint decision with parents (p<0.001) or by themselves (p=0.007) compared with adults. Adolescents have a lesser understanding of vaccine safety and benefits than adults and have higher concerns about potential vaccine reactions. Improving adolescent awareness and knowledge of the benefits and risks of vaccination through school-based educational programs may improve confidence in and uptake of vaccines for adolescents and increase vaccine confidence in the next generation of parents.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
DOI: 10.1097/AOG.0000000000001888
Abstract: To assess antenatal, birth, and infant outcomes for pregnant women, fetuses, and infants after antenatal vaccination with any antigen present in combination pertussis vaccines. PubMed, EMBASE, Literature in the Health Sciences in Latin America and the Caribbean, ClinicalTrials.gov, Cochrane Library, and World Health Organization (inception to May 5, 2016). Studies reporting outcomes for pregnant women, their fetus, or infant after antenatal exposure to either monovalent or combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) or inactivated polio vaccines were considered for inclusion. A total of 21 studies were included in this review. Point estimates ranged from 0.47 to 1.50 for preterm birth (less than 37 weeks of gestation), 0.65–1.00 for small for gestational age (birth weight less than the 10th percentile), 0.36–0.85 for stillbirth, 0.16–1.00 for neonatal death, 0.76–1.20 for low birth weight (less than 2,500 g), and 0.20–0.91 for congenital anomalies. All lower 95% confidence intervals (CIs) were less than 1.0. Of three retrospective studies assessing chorioamnionitis after vaccination, one showed a small but statistically significant increase. Point estimates for all anomalies after antenatal tetanus toxoid vaccination ranged from 1.20 to 1.60 and had 95% CIs that crossed 1.0. There was substantial clinical and methodologic heterogeneity from mainly retrospective observational studies with an overall high risk of bias. Objective rates of fever were low, 3% or below, and more common systemic events observed included headache, malaise, and myalgia. Evidence suggests that antenatal combined Tdap administered during the second or third trimester of pregnancy is not associated with clinically significant harms for the fetus or neonate. Medically attended events in pregnant women are similar between vaccinated and unvaccinated groups.
No related grants have been discovered for Michelle Clarke.