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Biomedical subjects

Peter B McIntyre

Publications and source records attributed to Peter B McIntyre.

At least 19 recordsLinked to original sources
PubMed2006

Tetanus in the elderly--An important preventable disease in Australia.

Notification trends from countries with well-established immunisation programs show increasing tetanus cases among the elderly, corresponding to seroepidemiologic data showing declining immunity with advanced age. We examined Australian trends in tetanus to review the likely value of routine funded immunisation at 65 years. Since 1993, 62% (36/58) of notifications, 44% (67/151) of hospitalisations and 83% (10/12) of deaths were in people aged over 65 years. Taking into account higher vaccine coverage at 65 years, versus the current recommended age in Australia of 50 years, we estimate that routine funded tetanus vaccine would prevent 9% more hospitalisations and 28% more deaths than the most favourable outcome from the current unfunded recommendation at 50 years. This is likely to be applicable to other industrialised countries.

Adolescent↗
PubMed2006

Timeliness of childhood immunisation in Australia.

There are few data, especially outside the United States, examining the timeliness of childhood vaccination, although it is of key importance for diseases such as pertussis, and invasive disease due to Haemophilus influenzae type b and Streptococcus pneumoniae. The aim of this study was to use the unique resource of the Australian Childhood Immunisation Register (ACIR) to examine trends in and factors associated with timeliness of infant vaccination at the national level. As in previous studies, age-appropriate immunisation was defined as within 30 days of the recommended age. Vaccination delays became more common for later doses, given at an older age, but long delay (greater than 6 months) occurred in only 1-2%. Although immunisation coverage increased over time, timeliness did not improve. Among Indigenous infants, long delays occurred in 5-12% of those residing in very remote areas, but by 2 years of age, overall immunisation coverage was similar to non-Indigenous children. With immunisation coverage at the key indicator ages of 12 and 24 months now high in most industrialised countries including Australia, timeliness of vaccine doses should be the next benchmark to aim for in program performance, especially in specific sub-groups such as Indigenous children who stand to gain most from prevention of early onset disease.

Australia↗
PubMed2006

Rapid turnover of tissue nitrogen of primary consumers in tropical freshwaters.

Stable isotopes are widely used as time-integrating tracers of trophic interactions, but turnover rates of isotopes in animal tissues remain poorly understood. Here, we report nitrogen (N) isotope turnover rates in tissues of four primary consumer species: Ancistrus triradiatus armored catfish (muscle, fins, and whole blood), Tarebia granifera snails (muscle), and Rana palmipes tadpoles (muscle) from a Venezuelan river, and Lavigeria grandis snails (muscle) from Lake Tanganyika, East Africa. Turnover was estimated from the dilution of a 15N label introduced into consumer tissues by feeding on 15N-enriched periphyton. Muscle turnover rates were rapid (0.5-3.8% per day), and were attributable to metabolic replacement of N as well as growth in catfish and snails. N turnover in catfish muscle decreased with size, and fin tissue turned over more rapidly than whole blood or muscle, though the difference was not significant. Our results indicate that stable isotope signatures of these tropical species could change markedly within weeks following a shift in diet. However, generalization across taxa or latitudes is complicated by the strong size-dependence of isotope turnover rates. The enrichment-dilution approach outlined here may facilitate measurement of isotopic turnover in a wide variety of consumers under field conditions.

Animals↗
PubMed2006

Cellulitis in childhood invasive pneumococcal disease: a population-based study.

AIM: There are few detailed data on the age-specific incidence and clinical pattern of pneumococcal cellulitis in children. We conducted a retrospective review of cellulitis as a subset of prospectively collected laboratory-identified invasive pneumococcal disease (IPD) and performed a systematic review of published literature. METHODS: Prospective laboratory surveillance in urban regions of New South Wales, Australia, 1 June 1997-31 December 2001. Medical notes reviewed for each identified case and defined literature search strategy applied. RESULTS: There were 1067 cases of IPD in children aged 0-17 years; 38 (3.3%) were cellulitis (32 periorbital, 6 buccal). Compared with other types of IPD, a greater proportion of cellulitis cases occur in children<2 years (30/38, 79% vs. 617/1029, 60.0%; P=0.004) in whom underlying illness was less common (0/30, 0% vs. 53/590, 9%; P=0.06). Initially, another diagnosis was made in 13 (34%) of cases; only five had a lumbar puncture, all normal. Of the 239 cases of pneumococcal cellulitis documented in the literature, 28 (11.7%) had the diagnosis made by means other than positive blood culture and 95% were facial or orbital with underlying illness (6%) and associated meningitis (1.9%) uncommon. CONCLUSION: Cellulitis is an uncommon focus in IPD in children, and is almost always facial. Most cases occur under 2 years of age, are seldom associated with meningitis or other complications, and are frequently not recognised on admission.

Adolescent↗
PubMed2006

When science is not enough - a risk/benefit profile of thiomersal-containing vaccines.

Without a preservative, such as thiomersal (known as thimerosal in the US), multi-dose liquid presentations of vaccine are vulnerable to bacteriological contamination that can result in death or serious illness of the recipient. Concerns about levels of mercury exposure from thiomersal-containing vaccines were first raised in the US during 1999 in the context of Hepatitis B vaccine for newborns. Since then, a large body of evidence from animal and epidemiological studies has accumulated on the safety of thiomersal. Ironically, these data have become largely irrelevant in wealthy countries, where mono-dose, thiomersal-free vaccines have been introduced as a precautionary measure in almost all childhood vaccines, in part related to residual public scepticism. In poor countries, multi-dose vials remain important for vaccine delivery. There is a real danger that this controversy may result in the loss to the world of thiomersal as a preservative, simply from popular pressure. In reality, it would be impossible to cease overnight using thiomersal and maintain the supply of vital vaccines. This paper reviews and summarises the data available from published studies on mercury toxicity, and thiomersal in vaccines in particular, that overwhelmingly indicate continued use of thiomersal is safe in those countries where it is most needed.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Australia's notifiable diseases status, 2004, annual report of the National Notifiable Diseases Surveillance System.

In 2004, 60 diseases and conditions were nationally notifiable in Australia. States and Territories reported a total of 110,929 cases of communicable diseases to the National Notifiable Diseases Surveillance System (NNDSS): an increase of 4 per cent on the number of notifications in 2003. In 2004, the most frequently notified diseases were sexually transmissible infections (46,762 cases; 42% of total notifications), gastrointestinal diseases (25,247 cases; 23% of total notifications) and bloodborne diseases (19,191 cases; 17% of total notifications). There were 13,206 notifications of vaccine preventable diseases, 6,000 notifications of vectorborne diseases, 1,799 notifications of other bacterial infections (includes, legionellosis, leprosy, meningococcal infections and tuberculosis) and 877 notifications of zoonotic diseases.

Adolescent↗
PubMed2005

Annual report: surveillance of adverse events following immunisation in Australia, 2004.

This report summarises Australian passive surveillance data on adverse events following immunisation (AEFI) for 2004 and describes reporting trends over the five years, 2000 to 2004. AEFIs are notified to the Adverse Drug Reactions Advisory Committee by state and territory health departments, hospitals, doctors and other health providers, vaccine manufactures, and the public. There were 975 AEFI records for vaccines received in 2004. This is an annual AEFI reporting rate of 4.8 per 100,000 population, the lowest since 2000, and a 33 per cent decrease compared with 2003 (1,460 records; 7.1 AEFI records per 100,000 population). Dose-based AEFI reporting rates in 2004 were 1.8 per 100,000 doses of influenza vaccine for adults aged > or = 18 years and 11.8 per 100,000 doses of scheduled vaccines for children aged < 7 years. The majority of records described non-serious events while nine per cent (n = 88) described AEFIs defined as 'serious'. There were no reports of death related to immunisation. The most frequently reported individual AEFI was injection site reaction in children following a fifth dose of an acellular pertussis-containing vaccine (67 reports per 100,000 doses). The marked reduction in the AEFI reporting rate in 2004 coincided with the removal of the fourth dose of acellular pertussis vaccine, due at 18 months of age, from the vaccination schedule in September 2003 and fewer people receiving meningococcal C vaccine through the national catch-up vaccination program for those aged 1-19 years in 2004, compared with 2003. The consistently low reporting rate of serious AEFIs demonstrates the high level of safety of vaccines in Australia.

Adolescent↗
PubMed2005

Influenza and pneumococcal vaccine coverage among a random sample of hospitalised persons aged 65 years or more, Victoria.

This study was undertaken to assess the uptake of influenza and pneumococcal vaccination based on provider records of the hospitalised elderly, a group at high risk of influenza and pneumococcal disease. The study used a random sample of 3,204 admissions at two Victorian teaching hospitals for patients, aged 65 years or more who were discharged between 1 April 2000 and 31 March 2002. Information on whether the patient had received an influenza vaccination within the year prior to admission or pneumococcal vaccination within the previous five years was ascertained from the patient's nominated medical practitioner/vaccine provider. Vaccination records were obtained from providers for 82 per cent (2,804/2,934) of eligible subjects. Influenza vaccine coverage was 70.9 per cent (95% CI 68.9-72.9), pneumococcal coverage was 52.6 per cent (95% CI 50.4-54.8) and 46.6 per cent (95% CI 44.4-48.8) had received both vaccines. Coverage for each vaccine increased seven per cent over the two study years. For pneumococcal vaccination, there was a marked increase in 1998 coinciding with the introduction of Victoria's publicly funded program. Influenza and pneumococcal vaccine coverage in eligible hospitalised adults was similar to, but did not exceed, estimates in the general elderly population. Pneumococcal vaccination coverage reflected the availability of vaccine through Victoria's publicly funded program. A nationally funded pneumococcal vaccination program for the elderly, as announced recently, should improve coverage. However, these data highlight the need for greater awareness of pneumococcal vaccine among practitioners and for systematic recording of vaccination status, as many of these subjects will soon become eligible for revaccination.

Aged↗
PubMed2004

High levels of antibody in adults three years after vaccination with a reduced antigen content diphtheria-tetanus-acellular pertussis vaccine.

There is increasing interest in prevention of pertussis in adults by vaccination, but little is known about the duration of the antibody response to pertussis, diphtheria or tetanus in reduced antigen content vaccines formulated for adult use. Follow-up of a clinical trial including 550 adults comparing responses to reduced antigen content diphtheria-tetanus-acellular pertussis (dTpa) vaccine, or a licensed Td vaccine, provided the opportunity to evaluate this. Blood samples were collected at 0, 1, 12, 24 and 36 months following vaccination; of the original cohort of 550, 387 subjects (dTpa group N=310, Td+pa group N=77) were tested at month 36. Following a decrease in antibody levels against all vaccine antigens between one and 24 months following vaccination, levels stabilized during the third year, remaining higher at 36 months than pre-vaccination for all vaccine antigens. In particular, more than 90% of subjects remained seropositive for pertussis toxin and pertactin antibodies at 36 months after vaccination, suggesting ongoing protection against pertussis. Adult-formulated dTpa vaccines could replace Td for routine booster vaccination of older individuals.

Adult↗
PubMed2004

Effectiveness of a publicly funded pneumococcal vaccination program against invasive pneumococcal disease among the elderly in Victoria, Australia.

Within Australia, Victoria is the only jurisdiction where the 23-valent polysaccharide pneumococcal vaccine (23vPPV) has been publicly funded for the elderly (aged > or = 65 years). We compared age-specific rates of invasive pneumococcal disease (IPD) for periods before and after implementation of the program, and data from a comparable Australian population that does not have a funded program. Vaccine effectiveness (VE) was estimated using the screening and indirect cohort methods. Compared to the pre-program period, there was a 36% reduction in the reported rates of IPD among persons aged > or = 65 years. Adjusted for under-reporting in the referent rate, the decrease was equivalent to an annual reduction of 112 cases and an estimated 14 deaths among persons > or = 65 years. VE was 71% (95% CI 54-82) using the screening method and 79% (95% CI -14 to 96) by the indirect cohort method. Both point estimates were consistent with the VE expected among persons aged > or = 65 years, although the small number of isolates meant the indirect cohort method was inconclusive at the lower 95% confidence limit. Consideration should be given to publicly funding pneumococcal vaccine for this age group in other settings.

Aged↗
PubMed2004

Effects of behavioral and morphological plasticity on risk of predation in a Neotropical tadpole.

Predator-induced phenotypic plasticity is widespread among aquatic animals, however the relative contributions of behavioral and morphological shifts to reducing risk of predation remain uncertain. We tested the phenotypic plasticity of a Neotropical tadpole ( Rana palmipes) in response to chemical cues from predatory Belostoma water bugs, and how phenotype affects risk of predation. Behavior, morphology, and pigmentation all were plastic, resulting in a predator-induced phenotype with lower activity, deeper tail fin and muscle, and darker pigmentation. Tadpoles in the predator cue treatment also grew more rapidly, possibly as a result of the nutrient subsidy from feeding the caged predator. For comparison to phenotypes induced in the experiment, we quantified the phenotype of tadpoles from a natural pool. Wild-caught tadpoles did not match either experimentally induced phenotype; their morphology was more similar to that produced in the control treatment, but their low swimming activity was similar to that induced by predator cues. Exposure of tadpoles from both experimental treatments and the natural pool to a free-ranging predator confirmed that predator-induced phenotypic plasticity reduces risk of predation. Risk of predation was comparable among wild-caught and predator-induced tadpoles, indicating that behavioral shifts can substantially alleviate risk in tadpoles that lack the typical suite of predator-induced morphological traits. The morphology observed in wild-caught tadpoles is associated with rapid growth and high competition in other tadpole species, suggesting that tadpoles may profitably combine a morphology suited to competition for food with behaviors that minimize risk of predation.

Analysis of Variance↗
PubMed2004

Effectiveness of the linkage of child care and maternity payments to childhood immunisation.

In 1998, Australia enacted comprehensive national legislation making receipt of the maternity immunisation allowance (MIA) and the child care benefit (CCB) conditional on evidence of age-appropriate immunisation. We assessed the impact of this policy on immunisation status using a nationally representative population-based case-control study of 589 fully immunised controls and 190 incompletely immunised cases, aged 28-31 months. Immunisation status was significantly associated with parent awareness of the MIA (adjusted odds ratio (aOR) = 3.34, 95% CI = 2.28 - 4.91) and CCB (aOR = 2.08, 95% CI = 1.30 - 3.34). Only 31% of the 219 control parents who were receiving the CCB reported that they could continue to afford child care without the assistance of the CCB. The use of legislated financial immunisation incentives for parents appears to be widely accepted among Australian parents and to have had an impact on immunisation uptake. The policy may serve as a model for other comparable countries.

Australia↗
PubMed2004

Evaluation of immunisation coverage for aboriginal and Torres Strait Islander children using the Australian Childhood Immunisation Register.

OBJECTIVE: To estimate immunisation coverage for routinely administered vaccines among children using receipt of a particular Hib vaccine (PRP-OMP) as a proxy for Indigenous status. METHODS: Until May 2000, PRP-OMP was provided only for Indigenous children in all jurisdictions except the Northern Territory. In three one-year ACIR-derived birth cohorts, any child recorded on the ACIR as receiving one or more doses of PRP-OMP as the only Hib vaccine was presumed to be Aboriginal and Torres Strait Islander. Using this proxy, estimated numbers of Indigenous children were compared with Australian Bureau of Statistics estimates, and immunisation status for recommended vaccines was estimated at 12 and 24 months by jurisdiction and remoteness compared with children who received other Hib vaccines (presumed non-Indigenous). RESULTS: The numbers of Aboriginal and Torres Strait Islander children estimated using this 'proxy method' are approximately 42% of those estimated by the ABS. Immunisation coverage (among proxy Indigenous children) at 12 months (72-76%) and 24 months (64-73%) was considerably lower than others (90-94% and 81-88%, respectively). These children had significantly lower coverage when living in accessible areas than remote areas. CONCLUSIONS AND IMPLICATIONS: These data provide the first national measure of immunisation status and are likely to be a valid measure among those identified. Aboriginal and Torres Strait Islander immunisation coverage is 17% lower with the biggest gaps in urban areas, indicating the need for better quality data informing appropriate interventions.

Australia↗