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Biomedical subjects

A Herceg

Publications and source records attributed to A Herceg.

11 recordsLinked to original sources
PubMed1999

Surveillance of acute flaccid paralysis in Australia, 1995-97. Australian Paediatric Surveillance Unit.

OBJECTIVE: Acute flaccid paralysis (AFP) surveillance in Australia as part of the World Health Organization (WHO) certification process for polio eradication in the Western Pacific region. METHODS: Active monthly AFP surveillance through the Australian Paediatric Surveillance Unit, from March 1995 to December 1997. RESULTS: Based on 80 cases, the reported overall rate of AFP was 0.73 per 10(5) children < 15 years (below the expected 1 per 10(5)). The major causes of AFP were Guillain-Barré syndrome (51%) and transverse myelitis (19%). According to the WHO virological classification, there was no case of poliomyelitis, 37.5% were 'non-polio' and 62.5% cases were 'polio compatible' due to inadequate stool testing and follow-up. However, case review by an expert panel enabled 95% to be classified as 'non-polio'. CONCLUSION: Australia must improve AFP surveillance to confirm absence of wild poliovirus. Paediatricians can help Australia meet its certification requirements and contribute to the global eradication effort by reporting and investigating all cases of AFP.

Adolescent↗
PubMed1998

Vaccinating children with a history of serious reactions after vaccination or of egg allergy.

OBJECTIVE: To describe the results of vaccinating children with a history of serious adverse reactions after vaccination or of egg allergy at a special clinic established for that purpose. DESIGN: Retrospective case series. PATIENTS: Children who attended the clinic between 1 August 1994 and 31 July 1996 after being referred by vaccine providers. SETTING: A clinic conducted in the Emergency Department of The Canberra Hospital, Australian Capital Territory. MAIN OUTCOME MEASURES: Reasons for referral; vaccinations given; and subsequent adverse vaccination events. RESULTS: 91 children received 155 vaccinations at the clinic, and only one serious event--a hypotonic/hyporesponsive episode (HHE) after diphtheria-tetanus-whole-cell pertussis (DTPw), oral polio and Haemophilus influenzae type b vaccination--was subsequently reported; this child recovered spontaneously. Fifty-three children referred because of a previous serious adverse vaccination event were revaccinated at the clinic with whole-cell pertussis vaccine (47), combined diphtheria and tetanus vaccine (4), tetanus toxoid (1), and typhoid vaccine (1). Three children (referred because of previous meningitis, subdural haemorrhage or parental suspicion of allergy to DTPw) received their first dose of pertussis vaccine at the clinic. The remaining 35 children had a history of egg allergy and were given measles-mumps-rubella vaccine. CONCLUSIONS: We successfully vaccinated children with histories of serious reactions to vaccination, including HHEs, convulsions, apnoea, high temperatures and persistent screaming, as well as those with egg allergy. We believe special clinics can improve vaccination coverage.

Adolescent↗
PubMed1997

Reported general practitioner vaccination procedures, 1994 and 1996.

OBJECTIVE: To determine general practitioner (GP) vaccination procedures during the first two years of implementation of the National Childhood Immunisation Program. DESIGN: Two cross-sectional self-completion mail surveys of Australian GPs, in October/November 1994 (Survey 1) and April/May 1996 (Survey 2). PARTICIPANTS: 1417 systematically selected (Survey 1) and 1482 randomly selected (Survey 2) GPs. INTERVENTION: Mailing of a package of publications on immunisation to all GPs, a community education campaign, and the introduction of the Australian Childhood Immunisation Register. State and Territory and local initiatives on immunisation, changes in vaccine distribution and funding, and media coverage of vaccination issues may also have affected GPs' procedures. MAIN OUTCOME MEASURES: Reported vaccination procedures consistent with National Health and Medical Research Council (NHMRC) recommendations. RESULTS: Response rates were 77% (Survey 1) and 78% (Survey 2). There were statistically significant rises in the proportions of GPs who reported vaccination procedures consistent with NHMRC recommendations for simultaneous administration of vaccines, injection site, vaccination of children taking antibiotics or those with mild upper respiratory tract infection, and vaccine storage. There was a reduction in reported opportunistic vaccination, and no change in reported procedures regarding pertussis vaccination. CONCLUSIONS: Many factors may have contributed to these changes in GP vaccination procedures. While the changes mostly show an improvement in adherence to NHMRC guidelines, further progress needs to be made, particularly in the areas of opportunistic vaccination, pertussis vaccination and vaccine storage. The best method of informing GPs of current vaccination recommendations needs to be explored.

Adult↗
PubMed1997

The decline of Haemophilus influenzae type b disease in Australia.

Between July 1993 and June 1996, there were 412 cases of invasive Haemophilus influenzae type b (Hib) disease reported to the Hib Case Surveillance Scheme, 71% in children under the age of five years. Meningitis was the most frequent illness reported, followed by epiglottitis, septicaemia and pneumonia. There were 18 deaths. Thirty-four cases were classified as vaccine failures. The number of vaccine failures increased over time and the total number of cases of Hib disease fell, consistent with an increase in Hib vaccine coverage. Based on an estimated vaccine coverage of 50% in April 1995, the vaccine efficacy for all vaccines in the period was estimated to be 89%. Invasive Hib is a serious illness of childhood which is being significantly reduced by the use of Hib vaccines, and has the potential to be eliminated from this country. Vaccination providers should aim to immunise all children against Hib disease on time and according to the National Health and Medical Research Council Standard Vaccination Schedule.

Australia↗
PubMed1997

Pertussis notifications in Australia, 1991 to 1997.

Although pertussis is a vaccine-preventable disease, it has been epidemic in Australia since 1993 and recently claimed the lives of four children under three months of age. We reviewed national notifications of pertussis from 1991 to 1997 and found notification rates ranged from 2.0 per 100,000 population in 1991 to a peak of 30.5 per 100,000 population in 1994 despite pertussis vaccination coverage approaching 90% for the three-dose primary course. We found that notification rates were highest in infants (< 1 year of age) and school aged children (5-14 years of age). Although there was a resurgence of pertussis in 1996, age-specific notification rates decreased for children aged 1-7 years and it appears that the diphtheria-tetanus-pertussis (DTP) booster introduced as a fifth dose at 4-5 years may be having an effect. We raise the possibility that the current whole cell pertussis vaccine may be providing only short-term immunity and that our results may reflect low or inadequate vaccine coverage among both the population at large and the individual cases. We identify gaps in the national surveillance system which require attention including under-reporting and the need for information on vaccination status of notified cases; method of diagnosis; and date of birth or age in months to identify the proportion of infants in the highest risk group, that is under six months of age.

Age Factors↗
PubMed1995

A population-based survey of immunisation coverage in two-year-old children.

A cross-sectional, population-based, cluster-sample survey of 187 children was conducted in the Newcastle area to assess the proportion of two-year-old children who were fully immunised, to ascertain whether administration of these vaccines was age-appropriate and to look for factors predicting incomplete immunisation. Parents or guardians were interviewed at their homes and the immunisation status of the children was verified either by the parent-held record or by the immunisation-provider-held record. Levels of full immunisation were 77 per cent at the time of interview and 72 per cent at the second birthday if Haemophilus influenzae type b (Hib) vaccine was excluded. If it was included, the full immunisation level was 51 per cent. Coverage was highest for oral polio vaccine and lowest for Hib vaccine. Twenty-nine per cent of all immunisations were given early, 44 per cent were given on time and 20 per cent were given late. Doses of vaccines due at older ages were more likely to be given late or not at all. Factors predicting incomplete immunisation were: the principal caregiver being aged under 25 years, being born outside Australia, having post-secondary qualifications, being female and having more than one child in the household. Immunisation coverage levels were not high enough to protect against outbreaks of pertussis and measles and cases of Haemophilus influenzae type b. Immunisation providers should aim to increase coverage to protect the population against all vaccine preventable diseases, and aiming at high-risk groups could more effectively do this.

Adult↗
PubMed1994

Risk factors and outcomes associated with low birthweight delivery in the Australian Capital Territory 1989-90.

The objectives of this study were to describe outcomes of low birthweight (LBW; < 2500 g) babies born in the Australian Capital Territory (ACT) and to identify risk factors associated with LBW in the ACT. A cohort study was conducted involving all births recorded in the ACT Maternal and Perinatal Data Collection sets for 1989-90. Status at discharge is presented for 9373 births each weighing more than 499 g born in 1989 and 1990, classified by birthweight. Other outcomes are given for live births (n = 9309) only. Adjusted odds ratios for significant risk factors for LBW are given for 9084 singleton births whose computer records contained all relevant information. Perinatal mortality rates for LBW babies are consistent with other States, apart from 500-999 and 1500-1999 g babies which have higher rates. Eighteen per cent of LBW babies are transferred to other hospitals. Low birthweight babies are more likely than normal birthweight babies to have 1 and 5 min Apgar scores less than 7, to need resuscitation and to take more than 5 min to establish respiration. Risk of LBW is associated with maternal primiparity, age 35 years or more in primiparous women, history of one or more spontaneous abortions, induced abortions or perinatal deaths, chronic illness, public health insurance and single marital status, and with fetal female sex and congenital anomalies. Babies born weighing less than 2500 g in the ACT have more adverse outcomes and are much more likely to be transferred than normal birthweight babies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

An outbreak of measles in a highly immunised population: immunisation status and vaccine efficacy.

An outbreak of 18 cases of measles in a primary school in the Australian Capital Territory in August and September 1993 provided the opportunity to study measles immunisation status and measles vaccine efficacy. Parents of 384 (78 per cent) of 491 children answered a questionnaire on recent illness consistent with measles and measles immunisation. Parents transcribed details of measles immunisation from the personal health record of the child to the questionnaire. Thirty-three per cent of cases and 3.4 per cent of the other children had not been immunised. Overall, 95 per cent of children had been immunised. The efficacy for all measles vaccines was estimated to be 90 per cent (95 per cent confidence interval (CI) 75 to 96) and for measles-mumps vaccine 87 per cent (CI 70 to 95). All of the immunised cases had received measles-mumps vaccine. There was no increased risk of measles infection in those who had been immunised at under 15 months of age compared with those immunised at 15 months or older, or in those who could not provide a date of immunisation compared with those who could. None of the children who had received two doses of vaccine caught measles. The date of immunisation was provided by 65 per cent of the respondents who said their children had been immunised. Asking parents to provide this date instead of viewing the health record is a less expensive way of assessing immunisation status but this method needs to be evaluated. Measles outbreaks still occur in highly immunised populations when vaccine efficacy appears to be acceptable.

Australia↗