A National human papilloma virus (HPV) Vaccination Programme for the prevention of HPV infection and associated disease using the quadrivalent HPV vaccine (4vHPV) has been funded and implemented in ...Australia since 2007, initially for girls only and extended to boys in 2013, with uptake rates among the highest observed worldwide.
We report on the impact of this national programme on HPV prevalence and associated disease burden and estimate the potential impact of adopting a nonavalent HPV (9vHPV) vaccine.
We performed a non-systematic literature review of studies measuring the burden of HPV-associated disease and infection in Australia before and after introduction of HPV vaccination. We also included key national reports with estimates of HPV-related disease burden.
Substantial declines in high-grade cervical disease and genital warts among vaccine-eligible women have been observed. Reductions in genital warts incidence and HPV prevalence among heterosexual men of similar age were observed before introduction of the male vaccination programme, indicating a substantial herd effect. 9vHPV vaccine is expected to prevent up to 90% of cervical and 96% of anal cancers. Of an estimated 1,544 HPV-associated cancers in 2012, 1,242 would have been preventable by the 4vHPV vaccine and an additional 187 anogenital cancers by the 9vHPV vaccine.
Vaccination using 4vHPV vaccine has had a large demonstrable impact on HPV-related disease in Australia. A switch to 9vHPV could further reduce the HPV-associated cancer burden. With continued high coverage among both males and females, elimination of vaccine-type HPV disease seems achievable in Australia.
While the 23-valent pneumococcal polysaccharide vaccine (PPV23) has demonstrated its role in preventing severe pneumococcal disease, its impact on more non-specific conditions like acute respiratory ...tract infection (ARI) and lower respiratory tract infections (LRTI) remains unclear. We aimed to investigate the role of PPV23 in prevention of presentations for ARI and LRTI and related antibiotic prescriptions among older adults in primary care.
Using a nationwide general practice dataset, we followed a cohort of regularly attending patients aged ≥65 years from 1 January 2014 until 31 December 2018 for presentations for ARI, LRTI, and related antibiotic prescriptions. Associations between PPV23 receipt and each outcome were assessed using a multiple failures survival model to estimate hazard ratios (HR) adjusted for age, sex, socioeconomic status, and various health measures.
A cohort of 75,264 patients aged ≥65 years (mean 75.4, 56% female) in 2014 was followed. The incidence of presentations for ARI, ARI-related antibiotic prescription, LRTI, and LRTI-related antibiotic prescription was 157.6, 76.0, 49.6, and 24.3 per 1000 person-years, respectively. Recent PPV23 vaccine receipt was associated with a small reduction in ARI presentations (adjusted HR vaccinated vs. unvaccinated 0.96; 95%CI 0.94-0.98; p = 0.002); however, there was no reduction in ARI-related antibiotic prescription, LRTI presentation, nor LRTI-related antibiotic prescription (adjusted HR were 0.9995%CI 0.96-1.03, 1.0495%CI 0.99-1.09, 1.0795%CI 1.00-1.14).
PPV23 vaccination in older adults may result in a small reduction in the incidence of total ARI presentations in primary care. However, the effect is small and residual confounding cannot be excluded.
Objectives: To describe trends in the age‐specific incidence of serogroup B invasive meningococcal disease (IMD) in Australia, 1999–2015.
Design, setting, participants: Analysis in February 2017 of ...de‐identified notification data from the Australian National Notifiable Diseases Surveillance System of all notifications of IMD in Australia with a recorded diagnosis date during 1999–2015.
Major outcomes: IMD notification rates in Australia, 1999–2015, by age, serogroup, Indigenous status, and region.
Results: The incidence of meningococcal serogroup B (MenB) disease declined progressively from 1.52 cases per 100 000 population in 2001 to 0.47 per 100 000 in 2015. During 2006–2015, MenB accounted for 81% of IMD cases with a known serogroup; its highest incidence was among infants under 12 months of age (11.1 95% CI, 9.81–12.2 per 100 000), children aged 1–4 years (2.82 95% CI, 2.52–3.15 per 100 000), and adolescents aged 15–19 years (2.40 95% CI, 2.16–2.67 per 100 000). Among the 473 infants under 2 years of age with MenB, 43% were under 7 months and 69% under 12 months of age. The incidence of meningococcal serogroup C (MenC) disease prior to the introduction of the MenC vaccine in 2003 was much lower in infants than for MenB (2.60 cases per 100 000), the rate peaking in people aged 15–19 years (3.32 per 100 000); the overall case fatality rate was also higher (MenC, 8%; MenB, 4%). The incidence of MenB disease was significantly higher among Indigenous than non‐Indigenous Australians during 2006–2015 (incidence rate ratio IRR, 3.8; 95% CI, 3.3–4.5).
Conclusions: Based on disease incidence at its current low endemic levels, priority at risk age/population groups for MenB vaccination include all children between 2 months and 5 years of age, Indigenous children under 10 years of age, and all adolescents aged 15–19 years. Given marked variation in meningococcal disease trends over time, close scrutiny of current epidemiologic data is essential.
Objective: To evaluate trends in the proportion and severity of community‐acquired pneumonia (CAP) attributable to Streptococcus pneumoniae (pneumococcus) in Australians aged 18 years and over.
Study ...design: Systematic review with unpublished data from the largest study.
Data sources: Multiple key bibliographic databases to June 2016.
Study selection: Australian studies on the aetiology of CAP in adults.
Data synthesis: In the 12 studies identified, pneumococcus was the most common cause of CAP. Four studies were assessed as being of good quality. Participants in two studies were predominantly non‐Indigenous (n = 991); the proportion of pneumococcal CAP cases declined from 26.4% in 1987–88 to 13.9% in 2004–06, and the proportion with bacteraemia decreased from 7.8% to 3.8%. In two studies with predominantly Indigenous participants (n = 252), the proportion with pneumococcal bacteraemia declined from 6.8% in 1999–2000 to 4.2% in 2006–07. In the largest study (n = 885; 2004–06), 50.8% (60/118) of pneumococcal CAP occurred in people who were ≥ 65 years old. Among patients aged ≥ 65 years, intensive care unit admission and death were more common in patients who were ≥ 85 years old compared with younger patients (12.5% v 6.8%; 18.8% v 6.8% respectively), and also more common in the 19 patients with bacteraemia than in those without it (15.8% v 2.6%; 10.5% v 7.9% respectively). Of 17 cases of bacteraemia serotyped, 12 were due to 13‐valent pneumococcal conjugate vaccine (13vPCV) serotypes and three to additional serotypes in 23‐valent pneumococcal polysaccharide vaccine (23vPPV).
Conclusions: Available data suggest that the proportion of CAP attributable to pneumococcus (both bacteraemic and non‐bacteraemic) has been declining in Australian adults. Should 13vPCV replace the 23vPPV currently funded by the National Immunisation Program for persons aged ≥ 65 years, surveillance to track non‐bacteraemic pneumococcal CAP will be essential to evaluate the impact.
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 individually linked for children aged <5 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 <2 doses of PCV at <12 months of age and no doses at greater than or equal to12 months of age. Potential confounding variables were selected for adjustment a priori with the assistance of a directed acyclic graph. 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.
ObjectivesTo examine the reported incidence and features of disseminated varicella zoster virus (VZV) infection following live attenuated herpes zoster vaccine live (ZVL: Zostavax, Merck) in ...immunocompromised people in Australia.Design and settingZVL was funded in 2016 in Australia for people aged 70 years, with a catch-up programme for those 71–79 years. From 2016 to 2020, three deaths due to disseminated vaccine-strain VZV infection occurred following inadvertent ZVL administration in individuals with varying levels of immunocompromise. This descriptive study examined 4 years of national surveillance data reported to the Therapeutic Goods Administration’s Adverse Event Monitoring System (AEMS). Denominator data for rates were from doses recorded in the Australian Immunisation Register.ParticipantsIndividuals vaccinated between 1 November 2016 and 31 December 2020 who experienced adverse event(s) following immunisation (AEFI) after ZVL recorded in the AEMS.Primary and secondary outcome measuresRates and outcomes of confirmed (Oka strain positive) or probable disseminated VZV infection, and inadvertent administration of ZVL in immunocompromised individuals.Results854 AEFI were reported from 1 089 966 doses of ZVL administered (78.4 per 100 000 doses). Of those, 14 were classified as confirmed (n=6, 0.55 per 100 000) or probable (n=8) disseminated VZV infection. The confirmed cases were all hospitalised, and most (5/6) were immunocompromised; three cases died. Thirty-seven individuals were reported as vaccinated despite a contraindication due to immunocompromise (3.4 per 100 000), with 12/37 (32%) hospitalised.ConclusionsDisseminated VZV is potentially life-threatening and occurs mostly in those with severe immunocompromise. Inadvertent administration of ZVL to immunocompromised individuals has occurred despite initial provider guidance and education. Multiple additional strategies to assist providers to identify contraindications have been implemented to prevent adverse outcomes.
Summary Female-only vaccination programmes for human papillomavirus (HPV) have been introduced in many countries aimed at the prevention of cervical cancer in women. One HPV vaccine is registered for ...male vaccination, but boys, men, or both, are not yet included in nationally funded HPV vaccination programmes. In this Review we discuss the different considerations relevant to the introduction of population-wide HPV vaccination of boys in Australia, which was the first country to publicly fund HPV vaccination of girls. Several factors need to be taken into account during decision making around the introduction of population-based vaccination programmes, such as local disease burden, vaccine efficacy, vaccine safety, and cost-effectiveness. Social and ethical factors are also important. Although evidence for men is increasing in these areas, uncertainties need to be kept in mind. The features discussed in this Review are likely to be applicable, with caveats, to policy making in other developed countries.
Objective: To evaluate the impact and effectiveness of the 23‐valent polysaccharide pneumococcal vaccine (23vPPV) in ≥ 65‐year‐old Australians in the context of concurrent 7‐valent pneumococcal ...conjugate vaccine (7vPCV) use in infants.
Design, patients and setting: Ecological analysis of trends in invasive pneumococcal disease (IPD) notification rates and vaccine effectiveness estimation using the screening method, using data on Australians aged ≥ 65 years (23vPPV funded) and 50–64 years (23vPPV not funded).
Intervention: National 23vPPV program for people aged ≥ 65 years and national 7vPCV program for infants, both commencing in 2005.
Main outcome measures: IPD incidence rate ratios, 2002–2004 to 2010–2011, and 23vPPV effectiveness against 23vPPV‐type IPD.
Results: The proportion of people aged ≥ 65 years who were vaccinated within the previous 5 years in jurisdictions excluding Victoria ranged from 41% to 64% over the study period, with no clear trend over time. Incidence rate ratios in the ≥ 65‐year age group were 0.11 (95% CI, 0.09–0.14) for 7vPCV serotypes, 1.64 (95% CI, 1.41–1.91) for 23vPPV–non‐7vPCV serotypes and 2.07 (95% CI, 1.67–2.57) for non‐23vPPV serotypes. The incidence rate ratio for total IPD was 0.65 (95% CI, 0.59–0.71) for people aged ≥ 65 years, and 0.80 (0.71–0.90) for people aged 50–64 years. The estimate of 23vPPV effectiveness was 61.1% (95% CI, 55.1%–66.9%).
Conclusions: The greater reduction in IPD among ≥ 65‐year‐olds compared with 50–64‐year‐olds did not reach statistical significance. However, vaccine effectiveness was significant. Greater reductions in IPD in ≥ 65‐year‐olds would be expected from the indirect effects of using 13‐valent pneumococcal conjugate vaccine in infants (introduced for Australian infants in 2011) and an increase in 23vPPV coverage.
Summary Objective To explore the reasons why nursing staff use the subjective “worried” Medical Emergency Team (MET) calling criterion and compare the outcomes of calls activated using the “worried” ...criterion with those calls activated using “objective” criteria such as vital sign abnormalities. Methods A descriptive study of MET calls in six acute hospitals over a 12 months period. Outcomes for “objective” and “worried” calls were compared. Results The “worried” criterion was used to activate 29% of 3194 MET calls studied; it was the single most common reason for a MET call. Half (51.7%) of the “worried” calls were related to problems with Airway, Breathing, Circulation or Neurology. ‘Breathing’ problems accounted for the largest proportion (35.2%). A low oxygen saturation by pulse oximetry (SpO2 ) ( n = 249, 26.9%) and ‘respiratory distress’ ( n = 133, 14.4%) were the most common reasons for a “worried” call. Only 1.1% (10) of calls triggered by the “worried” criteria had cardiac arrest as an outcome compared with 170 calls (7.6%) for “objective” criteria. The proportion of patients who remained in a general ward area after MET calls was higher for the “worried” calls. Conclusions The “worried” criterion was the most frequent reason for MET calls, implying a high degree of empowerment and independent action by nursing staff. Low SpO2 and respiratory distress were the most common causes for concern. There was a significant difference between MET calls triggered by “worried” criteria and “objective” criteria for outcomes immediately following MET ( p < 0.001). Further assessment and refinement of MET triggers particularly in relation to respiratory distress and pulse oximetry may be needed.
Highlights ► Coding and testing patterns affect rotavirus burden and vaccine impact assessments. ► Only 36% of acute gastroenteritis hospitalisations had rotavirus stool testing. ► Rotavirus ICD code ...had low sensitivity (62%) to detect lab confirmed cases. ► Adjusted estimates were 6-fold higher than identified by rotavirus code only. ► Direct and adjusted methods gave similar reductions (over 65%) following vaccination.
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