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Biomedical subjects

P B McIntyre

Publications and source records attributed to P B McIntyre.

At least 19 recordsLinked to original sources
PubMed2000

Epidemiology of invasive pneumococcal disease in urban New South Wales, 1997-1999.

OBJECTIVES: To describe the serotypes, incidence and morbidity of invasive pneumococcal disease in urban New South Wales. DESIGN: Prospective laboratory surveillance. SETTING: Microbiology laboratories and hospitals in the Sydney, Hunter and Illawarra Statistical Divisions of NSW, June 1997 to May 1999. RESULTS: 1270 cases were identified in two years. Incidence of disease was highest in those aged < 2 years (96.4 per 100,000; 95% CI, 83.7-107.9) and > or = 85 years (100.1 per 100,000; 95% CI, 81.8-121.3). Incidence of disease increased significantly from the age of 60 years, compared with low rates in those aged 5-59 years. Underlying diseases predisposing to pneumococcal infection increased with age, from 4% (< 2 years) to 60% (> or = 65 years). A seven-valent conjugate vaccine would have covered 84.8% of serotypes in those aged 0-14 years, falling to 69% in those > or = 15 years. Penicillin resistance was significantly higher in the < 5 years group (19.0%) than in older people (14.6%). CONCLUSIONS: Incidence of invasive pneumococcal disease was higher in this study using active surveillance than in previous Australian studies. An effective sevenvalent conjugate pneumococcal vaccine could prevent more than 80% of cases in children aged < 5 years.

Adolescent↗
PubMed2000

Conjugate pneumococcal vaccines for non-indigenous children in Australia.

Childhood pneumococcal disease is associated with substantial morbidity and mortality, but total disease burden is more difficult to measure than for invasive disease caused by Haemophilus influenzae type b (Hib). A safe, effective seven-valent conjugate pneumococcal vaccine will be available in Australia by early 2001, and will certainly be indicated for high-risk groups and purchased in the private sector, as was Hib vaccine. The status of this vaccine on the Australian Standard Vaccination Schedule will require more detailed consideration of the burden and serotype distribution of pneumococcal disease in Australian children and the vaccine's likely cost-effectiveness. Postmarketing surveillance will be particularly important.

Australia↗
PubMed2000

Survey of pertussis morbidity in adults in western Sydney.

OBJECTIVE: To estimate morbidity due to Bordetella pertussis infection in a representative population of Australian adults. DESIGN: Telephone survey using structured questionnaire. PARTICIPANTS: Adults (aged 20 years and over) notified with pertussis to a public health unit in western Sydney between 1 December 1997 and 31 May 1998. MAIN OUTCOME MEASURES: Duration of cough; time to improvement; symptoms and complications; time to diagnosis; health resource use; lost work days. RESULTS: Of 90 eligible patients, 73 (81%) completed questionnaires. Cough lasted a median of 60 days, but persisted over 90 days in 20 people (27%). Presentation was within a median of seven days of symptom onset, but diagnosis of pertussis took a median of 21 days. Participants reported a mean of 3.7 general practitioner visits and 1.2 prescription drugs. Of those employed, 17 (35%) missed more than five work days (range, 0-93 days). CONCLUSIONS: B. pertussis infection in adults can result in prolonged, significant disruption to social and working life. Results suggest that, in 1998, there were more than 8000 general practitioner visits and 15,000 lost work days caused by pertussis in Australian adults.

Adult↗
PubMed2000

Factors influencing vaccination uptake. Workshop report. Current Australian research on the behavioural, social and demographic factors influencing immunisation, Royal Alexandra Hospital for Children, Sydney, March 1998.

Current Australian research on factors influencing vaccination was discussed at a workshop held at the Royal Alexandra Hospital for Children, Sydney, in March 1998, sponsored by the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS). The application of decision making theory to vaccination behaviour, the expectations and experiences of mothers, and reasons why parents fail to vaccinate their children were considered. Mothers' perceptions of the risks of vaccines, preferences of parents and providers for the mode of vaccine delivery, and community and social factors were all found to be part of the framework within which vaccination is accepted in Australia. Consumer considerations, media influences and overseas comparisons were discussed.

Child↗
PubMed2000

Immunisation coverage reporting through the Australian Childhood Immunisation Register--an evaluation of the third-dose assumption.

OBJECTIVE: The Australian Childhood Immunisation Register (ACIR) currently classifies those children who have the third dose recorded as fully immunised at 12 months of age, even if records of earlier doses are missing. This analysis assesses the impact this "third-dose assumption" has on immunisation coverage estimates for children aged 12 months. METHODS: ACIR records from three equally spaced cohorts of children at 12 months of age, which relied on the third-dose assumption, were examined for variation in doses and vaccine types recorded by jurisdiction and Medicare registration status. RESULTS: Although the percentage reduction in coverage without application of the third-dose assumption decreased through the three cohorts examined, the proportion classified as fully immunised still decreased by 11-12% (to < 75%) if the third-dose assumption was not used in the most recent cohort. "Fully immunised" status among children with delayed Medicare registration or in jurisdictions with a high proportion of paper reporting to the ACIR was disproportionately reduced without use of the assumption. CONCLUSIONS AND IMPLICATIONS: While independent sources of data continue to show that the ACIR incorrectly classifies some children as not fully immunised even with the third-dose assumption, its use seems appropriate for reporting population trends in immunisation coverage. Earlier Medicare registration and increased electronic reporting to the ACIR, together with incentives for parents and providers to ensure complete ACIR records, should eventually eliminate the need for the third-dose assumption.

Australia↗
PubMed2000

Pneumococcal disease in Australia.

The proceedings of the Pneumococcal Disease in Australia Workshop, held on 26-27 March 1999 are presented in this report. The world-wide epidemiology of the pneumococcus, with its predilection for the very young and the very old, differs between the developing and the developed world, and between indigenous and non-indigenous populations. Sources of data on pneumococcal disease in each of the Australian States, clinical aspects of invasive and non-invasive disease, and the role of the public health laboratory in surveillance of serotypes and antimicrobial sensitivity, both nationally and over time, were discussed at the Workshop. Polysaccharide pneumococcal vaccines are recommended for those over 65 years of age and for at-risk groups, but are supplied free of charge only in Victoria and for indigenous Australians over 50 years of age. Children will require conjugate vaccines, which are likely to be licensed in the United States of America early in 2000. In Australia indigenous children, especially in rural areas, will be the priority group for conjugate vaccines.

Australia↗
PubMed2000

A re-evaluation of immunisation coverage estimates from the Australian Childhood Immunisation Register.

Immunisation coverage reporting using data from the Australian Childhood Immunisation Register is likely to underestimate immunisation uptake. Since 1997, several initiatives have been introduced to improve both immunisation uptake and notification of immunisation encounters. These initiatives seemed likely to have changed previous coverage estimates. Re-calculation of immunisation coverage estimates for the previously reported cohorts was undertaken. This used current Australian Childhood Immunisation Register data--especially the immunisation history form and the impact of catch-up immunisations--to evaluate delayed reporting. Previous coverage estimates published in Communicable Diseases Intelligence were shown to be at least 2% to 4% below estimates based on data now held by the Australian Childhood Immunisation Register, with greater differences observed in particular jurisdictions.

Algorithms↗
PubMed2000

Notifications of vaccine preventable diseases in Australia. Quarterly report (January-March 2000).

Vaccine preventable disease notifications for Australia with disease onset dates between January and March 2000 are reviewed. During this quarter, numbers of notifications for Haemophilus influenzae type b disease and measles were the lowest ever recorded, while those for rubella were the lowest recorded since before the epidemic of spring 1992. These are promising trends that are likely to represent a true reduction in disease incidence. Numbers of pertussis notifications declined compared with the last quarter of 1999, but remain high, making up 88% of notifications for the vaccine preventable diseases reported here.

Adolescent↗
PubMed1999

A population-based study of children with cerebral tuberculosis in New South Wales.

OBJECTIVE: To determine the incidence of childhood cerebral tuberculosis (tuberculous meningitis [TBM] and tuberculoma) in a defined population. DESIGN: Retrospective, population-based study. SETTING AND PARTICIPANTS: All resident children aged up to 14 years in New South Wales diagnosed with cerebral tuberculosis, from 1982 to 1996. MAIN OUTCOME MEASURE: Population-based incidence of childhood TBM. RESULTS: 10 children with TBM and one with tuberculoma were identified in the 15 years. The incidence of TBM was 0.053 (95% CI, 0.025-0.097) per 100,000. Eight of the 10 TBM patients were born in Australia and five were of white European origin. Only one had been vaccinated with BCG vaccine. Three of the children died. CONCLUSIONS: The incidence of childhood TBM in New South Wales is low, and comparable with that in other First World countries.

Adolescent↗
PubMed1999

Immunisation coverage in Australian children: a systematic review 1990-1998.

The Australian Childhood Immunisation Register (ACIR) commenced operation in January 1996 and provides a comprehensive database of children's immunisations in Australia. The ACIR enables implementation of an immunisation recall and reminder system and improved surveillance and reporting of immunisation coverage. Before the introduction of the ACIR, the methods used in assessing coverage varied widely in design and quality, with few studies measuring coverage at national or statewide level. This is a systematic review of the scope and reliability of estimates of immunisation coverage available in Australia from 1990 to 1998. A total of 108 studies were identified of which 51 were classified as higher quality based on a range of criteria including whether they had a response rate of 50% or better.

Adolescent↗
PubMed1999

Incidence of invasive pneumococcal disease in Sydney children, 1991-96.

OBJECTIVE: Few data are available on invasive disease due to Streptococcus pneumoniae in representative Australian childhood populations. This study aimed to determine the age-specific incidence of invasive pneumococcal disease in Sydney children. METHODOLOGY: Population-based prospective study where isolates of Streptococcus pneumoniae from normally sterile sites were identified through an established laboratory surveillance network. Isolates came from children aged under 15 years living within the boundaries of Central, Eastern. Southern, Western and South-western Sydney Area Health Services from 1 July 1991 to 30 June 1996. RESULTS: Invasive pneumococcal disease was identified in 320 children during a 5-year period, of whom 193 (60%) were under 2 years of age. The incidence per 100,000 children was 12.7 per 100,000 (95% CI: 11.4-14.2/100,000) under 15 years; 31.7 (95% CI 28.1-35.7) under 5 years, and 45.5 (95% CI 38.9-53.3) under 2 years. The incidence of pneumococcal meningitis in children aged under 2 years was 10.5 per 100,000 (95% CI: 7.4-14.5/100,000). CONCLUSIONS: The incidence of childhood invasive pneumococcal disease in Sydney was stable during 1991-96 and comparable to rates reported from other industrialized countries. There was no evidence of any change in pneumococcal disease incidence with reduction in invasive Haemophilus influenzae type b (Hib) disease following introduction of Hib immunization.

Adolescent↗
PubMed1999

Measuring immunisation coverage in Australia. A review of the Australian Childhood Immunisation Register.

BACKGROUND: Before the establishment of the Australian Childhood Immunisation Register (ACIR), measurement of childhood immunisation coverage in Australia involved a variety of methods at varying intervals by general practice (GP) divisions, state health departments and the Australian Bureau of Statistics. Such surveys may underestimate (child health records) or overestimate (parental recall) true immunisation coverage. OBJECTIVE: The establishment of the ACIR in 1996 (a world first), was a huge undertaking involving 15,000 immunisation providers (60% GPs) notifying over 3 million immunisations annually. This review summarises the operation of the ACIR, how it calculates coverage, the accuracy of estimates from the ACIR and how Australia's immunisation coverage compares with that of other similar countries. Currently, the accuracy of the records on the register is questioned, especially in urban areas, but available data suggest that failure to report to the ACIR is the main source of data discrepancies. DISCUSSION: The ACIR has the potential to measure immunisation coverage at any practice or local level with accuracy and timeliness. With full provider participation, the ACIR is capable of identifying areas of low immunisation coverage for targeted interventions and will play a key role in the current measles campaign, the General Practice Immunisation Incentives scheme and in payments to parents. Achieving the highest possible completeness and timeliness of the ACIR is in the interests of providers, consumers and health planners.

Australia↗
PubMed1999

Parent and general practitioner preferences for infant immunisation. Reactogenicity or multiple injections?

AIM: To explore the relative importance parents and general practitioners place on less reactogenic vaccines and multiple injections at each childhood immunisation encounter. METHOD: A random sample of western Sydney parents (n = 162) and GPs (n = 154) completed telephone questionnaires about their preference for either a single injection of pentavalent vaccine (whole-cell pertussis/diphtheria/tetanus/Hib/hepatitis B), or regimen containing the less reactogenic acellular pertussis vaccine requiring two separate injections (acellular pertussis/diphtheria/tetanus and Hib or three separate injections (acellular pertussis/diphtheria/tetanus and Hib and hepatitis B). Potential confounders were examined by univariate and multivariate analysis. RESULTS: Regimens containing acellular pertussis vaccine (2 injections or 3 injections) were preferred by 72% and 58% of parents respectively. Those whose children were already vaccinated were less concerned about side effects and were twice (or = 2.0, 95% CI 1.0-4.0) as likely to select the pentavalent (single injection) option. 69% and 77% of GPs preferred the pentavalent rather than the two or three injection acellular option, although previous experience with a systemic adverse reaction to immunisation increased their preference for the acellular pertussis vaccine (or = 2.9, 95% CI 1.1-7.6). Only 54% of parents and 28% of GPs favoured three injections at one visit. CONCLUSION: Parent and GP concerns regarding reactogenicity and multiple injections differ. Parents are more concerned about vaccine reactogenicity than multiple injections. However, if the GP recommends a particular regimen, it is likely to be accepted by parents.

Analysis of Variance↗