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Biomedical subjects

D R Lennon

Publications and source records attributed to D R Lennon.

18 recordsLinked to original sources
PubMed2002

Palivizumab prophylaxis of respiratory syncytial virus infection in high-risk infants.

Palivizumab prophylaxis significantly reduces hospitalization for respiratory syncytial virus (RSV) disease in preterm infants. However, palivizumab is very expensive. Data from a New Zealand cost-effectiveness analysis were considered by representatives of the Infectious Diseases and Immunisation, Fetus and Newborn, and Respiratory Committees of the Paediatric Society of New Zealand. Prophylaxis in all high-risk groups was associated with net cost. The consensus panel recommends that the priority for palivizumab be given to babies discharged on home oxygen with chronic lung disease, followed by babies born at 28 weeks or less gestation.

Antibodies, Monoclonal↗
PubMed2002

Early-onset neonatal group B streptococcal infections in New Zealand 1998-1999.

OBJECTIVE: To determine in New Zealand infants the attack rates, risk factors, preventive policies, strain serotype and antibiotic susceptibilities of early-onset neonatal group B streptococcus (GBS) infection. METHOD: A 2-year prospective active surveillance study was conducted in New Zealand's 19 neonatal units. Cases had to present within 48 h of delivery, be unwell, possess abnormal haematological indices and have GBS isolated from sterile sites. RESULTS: Of the 112 402 infants born in New Zealand during 1998-1999, 56 had early-onset GBS infection, an attack rate of 0.5 per 1000 live births (95% confidence interval [CI] 0.38, 0.65). Seven had meningitis and there was one death (case fatality rate of 1.8%; upper 95% CI 9.5%). Univariate analysis identified young maternal age, parity, preterm labour, prolonged membrane rupture, maternal fever and assisted delivery as risk factors. Preventive policies for GBS were reported by 14 (74%) obstetric centres associated with neonatal units. Of the 56 cases, five (9%) were born to mothers receiving intrapartum antibiotics, 32 (57%) had mothers with risk factors but were not treated with antibiotics, and 19 (34%) were born to mothers without identifiable risk factors for GBS prevention. Serotypes Ia and III predominated, while two isolates were resistant to erythromycin and/or clindamycin. CONCLUSIONS: Rates of early-onset GBS infection are similar to other countries following the introduction of prevention policies. Further reductions are possible with full implementation of these guidelines. Meanwhile, emergence of antibiotic resistance complicates the management of women with penicillin allergy. Vaccine development therefore remains a priority.

Adult↗
PubMed2002

Cost-effectiveness of palivizumab in New Zealand.

OBJECTIVE: To establish the preterm infant hospitalization risks from respiratory syncytial virus (RSV) in New Zealand and the net cost per hospitalization averted by palivizumab. METHODS: The 437 infants born < 32 weeks' gestation in 1997 and treated at five major neonatal units were identified. Subsequent admissions during the next 2 years for bronchiolitis, pneumonia and croup were tracked, and information collected on RSV tests performed. Data on the length of stay and hospital costs were used to calculate the potential net cost per hospitalization averted associated with the use of palivizumab and the number needed to treat (NNT) to prevent one hospitalization. RESULTS: Estimated RSV readmission risk before 1 year corrected age in infants < 32 weeks' gestation discharged home on oxygen, and those " 28 weeks' gestation, or between 29 and 31 weeks' gestation with or without chronic lung disease was 42%, 23%, 19%, 10% and 8%, respectively. The NNT with palivizumab to prevent one hospitalization ranged from six to 26 across subgroups. Mean (range) net cost per hospitalization averted was 60,000 New Zealand dollars ($28,000-$166,700). In no subgroup would prophylaxis result in net cost saving. Prophylaxis for all NZ infants " 28 weeks' gestation would cost approximately $1,090,000 net and prevent 29 hospitalizations annually, being equivalent to $37,000 net per hospitalization averted, with eight infants treated to prevent one hospitalization. Alternative assumptions about cost and efficacy failed to alter these findings. CONCLUSION: If value is placed on preventing morbidity, the priority groups for palivizumab prophylaxis are preterm infants discharged home on oxygen, followed by preterm infants of 28 weeks' gestation or less.

Antibodies, Monoclonal↗
PubMed2001

Intravenous immunoglobulin in acute rheumatic fever: a randomized controlled trial.

BACKGROUND: Acute rheumatic fever (ARF) remains the leading cause of acquired heart disease in children worldwide. No therapeutic agent has been shown to alter the clinical outcome of the acute illness. Immunological mechanisms appear to be involved in the pathogenesis of ARF. Intravenous immunoglobulin (IVIG), a proven immunomodulator, may benefit cardiac conditions of an autoimmune nature. We investigated whether IVIG modified the natural history of ARF by reducing the extent and severity of carditis. METHODS AND RESULTS: This prospective, double-blind, randomized, placebo-controlled trial evaluated IVIG in patients with a first episode of rheumatic fever, stratifying patients by the presence and severity of carditis before randomization. Patients were randomly allocated to receive 1 g/kg IVIG on days 1 and 2 and 0.4 g/kg on days 14 and 28, or they received a placebo infusion. Clinical, laboratory, and echocardiographic evaluation was performed at 0, 2, 4, 6, 26, and 52 weeks. Fifty-nine patients were treated, of whom 39 had carditis (including 4 subclinical) and/or migratory polyarthritis (n=39). There was no difference between groups in the rate of normalization of the erythrocyte sedimentation rate or acute-phase proteins at the 6-week follow-up. On echocardiography, 59% in the IVIG group and 69% in the placebo group had carditis at baseline. There was no significant difference in the cardiac outcome, including the proportion of valves involved, or in the severity of valvar regurgitation at 1 year. At 1 year, 41% of the IVIG and 50% of the placebo group had carditis. CONCLUSIONS: IVIG did not alter the natural history of ARF, with no detectable difference in the clinical, laboratory, or echocardiographic parameters of the disease process during the subsequent 12 months.

Acute Disease↗
PubMed1999

Trauma-related hospitalizations among urban adolescents in New Zealand: priorities for prevention.

PURPOSE: To: (a) determine the magnitude, characteristics, and in-patient costs of injury among hospitalized urban adolescents in New Zealand (NZ); (b) identify regional priorities for injury prevention and investigative research; and (c) compare the study findings with published data from other industrialized countries. METHODS: The 1989-1993 files of the NZ Hospital Discharge Database were accessed to identify and analyze trauma-related admissions of adolescents residing in NZ's largest metropolitan region. RESULTS: The estimated 9569 hospitalizations for injury accounted for one-fourth of all adolescent admissions in the region, a mean annual hospitalization rate of 1292/100,000 population and a minimum annual cost of NZ $5.8 million for in-patient care. Males and indigenous Maori youth had comparatively higher rates of hospitalizations for most major causes of injury. Falls, pedal cyclist injury, cuts, and piercing injuries were leading causes of hospitalization for trauma in early adolescence. Admission rates for motorcylist and other motor vehicle occupant trauma and self-inflicted injury increased substantially among older adolescents. Sport and recreational activities comprised at least one-sixth of injury admissions. CONCLUSIONS: The overall rates of injury resulting in hospitalization among Auckland adolescents were comparable to those reported from Australia and France, but higher than those from the United States, Canada, and Israel. By identifying priority issues and high-risk groups, this study provides a foundation for regional injury control initiatives. It also demonstrates the utility and limitations of E-coded hospital discharge registries in defining the burden of serious nonfatal trauma.

Adolescent↗
PubMed1998

New Zealand epidemic of meningococcal disease identified by a strain with phenotype B:4:P1.4.

New Zealand is experiencing an epidemic of serogroup B meningococcal disease, which has taken the rate of disease from an average of 1.5/100,000 population in the preepidemic years of 1989 and 1990 to 14.0/100,000 in 1996. Sterile-site isolates of Neisseria meningitidis from cases of invasive disease have been phenotypically characterized by serogrouping, serotyping, and serosubtyping, revealing the involvement of a strain with phenotype B:4:P1.4. Macrorestriction analysis using pulsed-field gel electrophoresis on 667 meningococci isolated from cases during the epidemic has identified the clonal relationship of meningococci expressing the PorA P1.4 antigen. Multilocus enzyme electrophoresis has shown the epidemic strain B:4:P1.4 to belong to lineage III. The recorded characteristics of New Zealand's epidemic are consistent with previous serogroup B epidemics in other parts of the world.

Adolescent↗
PubMed1997

A comparison of two pertussis epidemics in Auckland.

AIM: To determine if the addition of the 6 week dose of pertussis vaccine in 1984 was associated with any change in the hospitalisation rate for children with pertussis and the higher hospitalisation rates for Maori and Pacific Islander children with pertussis. METHODS DESIGN: Population based study of pertussis hospitalisations using a retrospective chart review of hospitalisation data for children during the 1991 epidemic, which was compared to previously published data from the 1982 epidemic. SETTING: Princess Mary and Middlemore hospitals, Auckland. SUBJECTS: Children aged 0-14 years resident in metropolitan Auckland and hospitalised in Auckland during 1982 or 1991 with pertussis. MEASUREMENTS: Hospitalisation rates were calculated as number of children with a discharge diagnosis of pertussis per 1000 children aged 0-14 years based on 1981 and 1991 census data. 1982 data were converted to person-years as published report was for an 8 month period. Hospitalisation rates were compared as a relative risk (RR) of hospitalisation in 1991 versus 1982. RESULTS: There were 84 cases during 8 months in 1982 and 66 cases in 1991. Rates of hospitalisation by ethnic group; in 1982 were 0.24 Other/European (OE), 1.98 Maori (M), 1.37 Pacific Islander (PI); and in 1991 were 0.22 OE, 0.51 M, 0.40 PI. Compared to 1982 the relative risk of hospitalisation in 1991 adjusted for ethnicity was 0.43 (CI 0.33, 0.58, p < 0.0001). Compared to 1982 there was a significant reduction in the hospitalisation rate in 1991 for M (RR = 0.26, CI 0.16, 0.43, p < 0.0001); and PI children (RR = 0.29, CI 0.16, 0.54, p < 0.0001); but not for OE children (RR = 0.91, 95% CI 0.57, 1.46, p = 0.70). CONCLUSIONS: There was a significant reduction in the rate of hospitalisation for pertussis in 1991 compared to 1982. This reduction in hospitalisation rate was due to a reduction in rates for Maori and Pacific Islander children.

Adolescent↗
PubMed1997

The immunogenicity of Haemophilus influenzae: meningococcal protein conjugate vaccine in Polynesian and non-Polynesian New Zealand infants.

OBJECTIVE: To examine the comparative immunogenicity of the Haemophilus influenzae type b-meningococcal protein (PRP-OMP) conjugate vaccine in Polynesian and non-Polynesian New Zealand infants. METHODOLOGY: Fifty-six Polynesian and 53 non-Polynesian infants aged 2-7 months recruited from primary health care settings in Auckland received a two-dose primary series of PRP-OMP. A sub-sample of 83 participants received a booster dose of PRP-OMP at 12-16 months of age. Anti-PRP antibody concentrations were measured in pre- and post-vaccination blood samples. RESULTS: Antibody responses consistent with long-term protection (> or = 1.00 microgram/mL) were observed in 72, 85 and 95% of children following the first, second and booster doses. CONCLUSIONS: Despite differences in disease epidemiology, PRP-OMP was highly immunogenic in Polynesian and non-Polynesian infants.

Antibody Formation↗
PubMed1993

Analysis of costs of acute rheumatic fever and rheumatic heart disease in Auckland.

AIM: This analysis aims to identify the direct costs of rheumatic fever and its sequelae to the Auckland Area Health Board and to describe the indirect and intangible costs to patients. METHODS: The annual cost was estimated using primarily 1987 data costed in 1991 dollars. The cost analysis was undertaken in five sections: (1) acute rheumatic fever admissions; (2) surgical admissions; (3) rheumatic heart disease related admissions (nonsurgical); (4) outpatient clinic appointments; and (5) secondary prophylaxis programme. Non hospital board direct costs and indirect and intangible costs are described. Ethnic distribution and subsequent economic burden were analysed for each section. RESULTS: The total cost to the health board was estimated to be $3.60M. The management of chronic rheumatic heart disease accounts for 71% of the cost. Rheumatic heart disease related nonsurgical admissions cost $1,228,495 (34%), surgical admissions $846,235 (23%) and outpatient clinic appointments $490,060 (14%) respectively. Both Maori (30% of costs, $1.1M) and Pacific Island people (36% of costs, $1.3M) are disproportionately affected by this largely preventable disease. Of the total cost 13% is spent on coordinated secondary prevention programmes. CONCLUSION: An energetic secondary prevention programme over 10 years to prevent recurrences and the development of carditis has only partially reduced the rate of rheumatic heart disease. A targeted primary prevention pilot programme should be actively considered.

Acute Disease↗
PubMed1990

Kawasaki disease in Auckland, 1979-1988.

Records of 34 children diagnosed as having Kawasaki disease in the Auckland region from 1979 to 1988 inclusive were reviewed. Diagnostic and associated features were similar to those reported from North America and Japan. The incidence (average 5.1 per year per 100,000 less than 5 years of age) was similar to that reported in Europe and North America amongst nonorientals and was similar in Polynesians and nonPolynesians. Coronary artery abnormalities were found in five cases (15%), and two cases, both of whom presented before five months of age, died. Those with abnormal coronary arteries had fever for a significantly longer period than those with normal coronary arteries.

Child, Preschool↗
PubMed1987

Measles epidemic in Auckland 1984-85.

Epidemics of measles had been seen biennially over the past two decades at Princess Mary Hospital, Auckland, until 1980. After a four year gap, there has been a further epidemic. The medical records of 201 measles cases seen between July 1984 and August 1985 were reviewed. Maori and Pacific Island children were over-represented (86%), as were children aged less than 2 years (53%). Two children died. The most common complications were otitis media (98 cases), pneumonia (70 cases) and croup (28 cases, for which five children were ventilated). The epidemic was chiefly due to low immunisation rates and represents a failure of current immunisation programmes. Recommendations are made for improved immunisation strategies.

Child↗
PubMed1984

Patients with rheumatic fever recurrences.

An evaluation is made as to the effectiveness of a rheumatic fever followup clinic in preventing recurrences. Forty-nine recurrences are known to have occurred in 228 patients. Oral rather than intramuscular benzathine penicillin prophylaxis, positive oral or pharyngeal culture of Streptococcus pyogenes and large sibship were found to be associated with recurrences.

Child↗
PubMed1984

High admission rate of infants and young children with whooping cough: clinical aspects and preventive implications.

Eighty-five children hospitalized with clinical whooping cough over an 8 month period were studied. Of the 53 cultured for Bordetella pertussis, 29 (55%) were culture positive. There was a preponderance of young infants who required a long hospitalization (35% were less than 3 months of age). Many of these children had apnoeic attacks requiring active intervention. Pulmonary atelectasis-consolidation was found in 46% in spite of negative viral and bacterial studies. Over-crowding and poor socioeconomic status was noted frequently in those hospitalized. This group makes the least use of child health services, and has the lowest rate of immunizations.

Age Factors↗
PubMedDate not supplied

Variations in bronchiolitis management between five New Zealand hospitals: can we do better?

OBJECTIVES: To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement. METHODS: Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random sample of these admissions were reviewed. RESULTS: Out of the 409 infants admitted overnight, 8% had been born less than or=32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986-1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001). CONCLUSIONS: Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.

Anti-Bacterial Agents↗
PubMedDate not supplied

Longitudinal study of influenza B symptomatology and interferon production in children and college students.

A longitudinal study of symptomatology and interferon production in 35 patients (13 children, 20 college students and 2 medical staff members) with influenza B viral infections is presented. The mean duration of illness was 11.3 days. Cough persisted for 9.8 days and nasal symptoms continued for 8.5 days. The mean duration of fever was 4.7 days. Diarrhea occurred in 8 patients; it had its onset on about the fourth day and persisted for 4 days. Interferon levels correlated directly with fever and generally with systemic symptoms but not with other aspects of disease severity, duration or serum hemagglutination-inhibiting antibody responses.

Adolescent↗