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Background: Influenza outbreaks can spread rapidly in confined settings such as military training establishments, impacting operational capability. There are few published examples of influenza outbreak investigations in contemporary Australian military settings. Methods: An outbreak investigation was conducted in response to an increase in acute respiratory illness (ARI) cases presenting to an Australian military base health centre in June/July 2019. The investigation included a case test-negative analysis and an estimate of the 2019 influenza vaccine effectiveness in the outbreak population. Results: A total of 66 cases presented during the outbreak; 27 (40.9%) with confirmed influenza cases, 4 (6.1%) with suspected cases of influenza and 35 (53.0%) cases of non-influenza ARI. Those with confirmed influenza infection were significantly more likely to be from the main training unit on base, have a recorded fever over 38oC, and have not received the 2019 influenza vaccine. Cases of confirmed influenza also had significantly more time off work than those with non-influenza ARI. Vaccine effectiveness was estimated at 83% (95% CI = 42% to 95%), with an odds ratio of 0.17 (95% CI = 0.052 to 0.554) of confirmed influenza in those with 2019 influenza vaccination record compared to those without. Conclusion: This outbreak investigation reinforced the Australian Defence Force's policy on influenza vaccination. It highlighted the impact that influenza can have on training and work capability, the need for ongoing outbreak surveillance and investigation, and areas for consideration in improving future outbreak control. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: The coronavirus (CoV) disease 2019 pandemic has drawn attention to the CoV virus family. However, in community settings, there is limited information on these viruses in healthy children. We explored the epidemiology of the 4 endemic (non--severe acute respiratory syndrome CoV 2) human coronaviruses (HCoVs) by species, including acute illness episodes, risk factors, and health care burden in Australian children in the first 2 years of life. METHODS: The Observational Research in Childhood Infectious Diseases community-based cohort was a prospective study of acute respiratory illnesses in children from birth until their second birthday. Parents recorded daily symptoms, maintained an illness-burden diary, and collected weekly nasal swabs, which were tested for 17 respiratory viruses, including HCoVs, by real-time polymerase chain reaction assays. RESULTS: Overall, 158 children participating in Observational Research in Childhood Infectious Diseases provided 11 126 weekly swabs, of which 168 were HCoV-positive involving 130 incident episodes. HCoV-NL63 and HCoV-OC43 were most commonly detected, accounting for two-thirds of episodes. Whereas 30 children had different HCoVs detected on different occasions, 7 were reinfected with the same species. HCoV incidence in the first 2 years of life was 0.76 episodes per child-year (95% confidence interval [CI] 0.63 to 0.91), being greatest in the second year (1.06; 95% CI 0.84 to 1.33) and during winter (1.32; 95% CI 1.02 to 1.71). Fifty percent of HCoV episodes were symptomatic, and 24.2% led to health care contact. CONCLUSIONS: In children, HCoV infections are common, recurrent, and frequently asymptomatic. In future studies, researchers should determine transmission pathways and immune mechanisms. [ABSTRACT FROM AUTHOR]

Background: Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies–including protective ventilation and early renal replacement therapy (RRT)–have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach. Methodology/Principal findings: All cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients' demographics, presentation, management and clinical course were examined. The 55 patients' median (interquartile range (IQR)) age was 47 (32–62) years and their median (IQR) APACHE III score was 67 (48–105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175–3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities. Conclusion: In patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes. Author summary: Severe leptospirosis continues to carry a high mortality. To improve outcomes, several countries have developed national guidelines for the management of severe disease. However, there is substantial variation in these guidelines despite the fact that severe leptospirosis has a very similar presentation around the world. In tropical Australia, the case-fatality rate of severe leptospirosis is only 4%. This retrospective study reviewed 55 patients with leptospirosis requiring support in an Australian Intensive Care Unit (ICU) in an effort to identify the management strategies that might explain these excellent outcomes. The low case-fatality rate was associated with prompt multimodal ICU support that included early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for renal replacement therapy initiation and corticosteroid therapy. However prospective, multinational studies–which include the resource-poor settings that bear the greatest burden of disease–are necessary to define which of these interventions have the greatest therapeutic value. [ABSTRACT FROM AUTHOR]

Background In 2017, Australia experienced record influenza notifications. Two surveillance programs combined to summarize the epidemiology of hospitalized influenza in children and report on vaccine effectiveness (VE) in the context of a limited nationally funded vaccination program. Methods Subjects were prospectively recruited (April–October 2017). Case patients were children aged ≤16 years admitted to 11 hospitals with an acute respiratory illness and laboratory-confirmed influenza. Controls were hospitalized with acute respiratory illness and tested negative for influenza. VE estimates were calculated using the test-negative design. Results A total of 1268 children were hospitalized with influenza: 31.5% were <2 years old, 8.3% were indigenous, and 45.1% had comorbid conditions predisposing to severe influenza. Influenza B was detected in 34.1% with influenza A/H1N1 and A/H3N2 detected in 47.2% and 52.8% of subtyped influenza A specimens. The median length of stay was 3 days (interquartile range, 1–5), 14.5% were admitted to the intensive care unit, and 15.9% received oseltamivir. Four in-hospital deaths occurred (0.3%): one was considered influenza associated. Only 17.1% of test-negative-controls were vaccinated. The VE of inactivated quadrivalent influenza vaccine for preventing hospitalized influenza was estimated at 30.3% (95% confidence interval, 2.6%–50.2%). Conclusions Significant influenza-associated morbidity was observed in 2017 in Australia. Most hospitalized children had no comorbid conditions. Vaccine coverage and antiviral use was inadequate. Influenza vaccine was protective in 2017, yet VE was lower than previous seasons. Multiple Australian states have introduced funded preschool vaccination programs in 2018. Additional efforts to promote vaccination and monitor effectiveness are required. [ABSTRACT FROM AUTHOR]

Background. There is increasing interest in measuring the quality of survivorship for patients admitted to the intensive care unit for acute respiratory failure (ARF). However, there is substantial variability in patient outcomes reported in studies evaluating these patients, with few data on which outcomes are essential to inform clinical practice. Objective. The objectives of this study were to determine clinicians' perspectives on the outcome domains that should always be reported in studies evaluating people who have had ARF after hospital discharge and to compare findings about US and Australian perspectives. Design. A modified Delphi method was used for the study. Methods. A survey with 19 possible domains was developed to iteratively elicit clinicians' perspectives on core outcome domains via a modified Delphi method. The survey was initially administered online. The survey results were then discussed independently at meetings at scientific conferences in the United States and Australia, and the survey was repeated at the meetings after the discussions. Results. The numbers of participants who responded to both the online and the real-time polling were 44 of 100 (44%) in the United States and 78 of 85 (92%) in Australia. Most respondents were intensive care unit-based clinicians (United States: 33 [75%]; Australia: 76 [97%]). For the 19 domains evaluated, both US and Australian groups ranked physical function and symptoms as the most important domain, with quality of life, cognitive function and symptoms, and survival being the next 3 most important domains. These data yielded a total of 4 domains meeting the criteria for inclusion as core domains at both meetings. Limitations. Several key constituencies, including patients and caregivers, were not represented in this study; their perspectives are also important and ideally should be included in the development of a comprehensive core outcome set. Conclusions. Clinicians agreed that physical function and symptoms, quality of life, cognitive function, and survival were domains that should always be measured in research evaluating outcomes for people who have had ARF after hospital discharge. [ABSTRACT FROM AUTHOR]

Objective: To analyse the dose-dependent effect of body mass index (BMI) categories for common pregnancy outcomes. Methods: A retrospective cohort study of all deliveries that occurred between 1 January 2005 and 31 December 2009 in a tertiary maternity centre, in Sydney Australia. Common pregnancy outcomes were analysed against World Health Organization (WHO) BMI categories using multiple logistic regression analysis. Results: From a total of 18,304 pregnancies, 9087 singleton pregnancies with complete data-sets were identified. Of these pregnancies, 4000 (44%) had a normal BMI, 470 (5.2%) were underweight, 2293 (25.2%) were overweight, 1316 (14.5%) were obese class I, 630 (6.9%) were obese class II and 378 (4.2%) were obese class III. Using the normal BMI category as the reference, there was a clear dose effect of BMI categories for hypertension (P< 0.001), pre-eclampsia (P < 0.001), caesarean section (P < 0.001), macrosomia (P < 0.001), large for gestational age (P < 0.001), small for gestational age (P < 0.001) and neonatal respiratory distress (P = 0.039). In contrast, despite a significant association with BMI (P < 0.001), a dose-dependent effect was not found for gestational diabetes. Conclusion: The results of our study have important clinical significance as the data, using WHO BMI categories, more accurately help stratify risk assessment in a clinically relevant dose-dependent relationship. [ABSTRACT FROM AUTHOR]

Veno-venous extracorporeal membrane oxygenation is increasingly used for severe but potentially reversible acute respiratory failure in adults; however, there are limited data regarding long-term morbidity. At our institution, most patients requiring veno-venous extracorporeal membrane oxygenation have been followed up by a single physician. Our primary aim was to describe the serial long-term morbidity for respiratory, musculoskeletal and psychological functioning., A retrospective audit of inpatient and outpatient medical records was conducted. A total of 125 patients treated with veno-venous extracorporeal membrane oxygenation for primary respiratory failure were included. The patients were young (mean (standard deviation) age 43.7 (4.1) years), obese (mean (standard deviation) body mass index 30.8 (10.4) kg/m 2 ), and mostly were male (59%). Most patients (60%) had no comorbidities., The survival rate to discharge was 70%, with body mass index and the number of comorbidities being independent predictors of survival on multiple logistic regression analysis. Over half (57%) of the Australian survivors had regular outpatient follow-up. They had a median of three reviews (range 1-9) over a median of 11.8 months (range 1.5-79) months. Breathlessness and weakness resolved in most within six months, with lung function abnormalities taking longer to resolve. Over half (60%) returned to employment within six months of discharge. Over a quarter (29%) displayed symptoms of anxiety, depression or post-traumatic stress disorder.

The article reviews several studies on the characteristics of patients with influenza A (H1N1)-associated acute respiratory distress syndrome in Australia and New Zealand. It cites extracorporeal membrane oxygenation (ECMO) as treatment with 71% survival for patients with H1N1. It presents an inception cohort study during the winter period where almost 10% of patients infected with the 2009 H1N1 virus were pregnant women. It mentions a study that measured the mortality rate in patients with HIV infection diagnosed with Pneymocystis carinii pneumonia.

Introduction: The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) continues to cause havoc globally, resulting in unprecedented healthcare, societal and economic disruption. People with diabetes have been shown to be at higher risk of complications and death when exposed to pneumonia, influenza and other coronaviruses. Despite pandemic scale infection, there is currently limited understanding on the potential impact of coronavirus disease (COVID-19) on people with diabetes.Aims: (1) To characterise the outcomes of COVID-19 for people with diabetes and (2) add value to current recommendations for healthcare providers and people with diabetes to encourage optimal management.Methods: A search of PubMed, Embase and MEDLINE to March 2020 was undertaken, using search terms pertaining to diabetes, coronavirus and acute respiratory distress syndrome (ARDS). We briefly reviewed the epidemiology and pathophysiology of SARS-CoV-2 in the context of diabetes.Conclusion: People with diabetes are at greater risk of severe infection and death with COVID-19. COVID-19 has significantly impacted the daily lives of individuals living with diabetes through financial implications, food and medication scarcity and its burden on mental health. In Australia, delivery of medical care has been adapted to reduce the risk of transmission, with a particular emphasis on telehealth and remote monitoring. [ABSTRACT FROM AUTHOR]

Background Pleural ultrasound guidance reduces complications of pleural procedures, and lung ultrasound can diagnose the cause of acute respiratory failure. Yet as recently as 5 years ago, many respiratory physicians lacked sufficient access, training and expertise to perform a chest ultrasound. Aims This study examines whether progress has been achieved in chest ultrasound amongst respiratory physicians in Australia and New Zealand. Methods We conducted a web-based chest ultrasound survey of adult respiratory physicians across Australia and New Zealand. We also surveyed advanced trainees. Results The response rate was 38% among respiratory physicians. Between 2011 and 2016, access to bedside ultrasound increased from 53 to 90%. The proportion arranging ultrasound guidance for pleural aspiration rose from 66 to 95%. The proportion demonstrably competent in pleural ultrasound increased from 4 to 21%. In 2016, 67% of physicians and 80% of advanced trainees reported available workplace supervision for ultrasound training. Use of lung ultrasound to diagnose acute pulmonary oedema and consolidation improved from 2011 but remained low at 25 and 20% respectively. Conclusion These results establish pleural ultrasound guidance for pleural procedures as the standard of care in our region. However, lung ultrasound remains underutilised. Ultrasound training can and should be incorporated into specialist respiratory training. [ABSTRACT FROM AUTHOR]

Background: There are conflicting reports regarding the role of surgical lung biopsies in patients who present to the intensive care unit (ICU) with unexplained respiratory failure and diffuse pulmonary infiltrates on imaging., Aim: To describe the utility of surgical lung biopsies in patients presenting to the ICU with unexplained respiratory failure and diffuse pulmonary infiltrates., Methods: A retrospective cohort study was performed. All patients admitted to the ICU who underwent a surgical lung biopsy for the investigation of respiratory failure and unexplained pulmonary infiltrates between 1998 and 2012 were included. The primary outcome measures for this descriptive study were the biopsy histopathology, changes in patient management following biopsy and in-hospital mortality., Results: A total of 30 patients was included in the review. Biopsies in 22 patients (73%) demonstrated diffuse alveolar damage (DAD), with 15 of these biopsies (50%) suggesting a specific underlying aetiology. In 73% of cases (n = 22), the biopsy finding was associated with a change in management, although this generally involved the escalation of an existing therapy rather than initiation of a new treatment. Biopsies were performed at a median 10 days after admission (interquartile range 5-17 days), with the majority of patients being treated empirically prior to the biopsy with systemic steroids and broad-spectrum antimicrobials. Mortality was 53%., Conclusion: In this series, DAD was the most frequent pathology. The biopsy result was associated with a change in management in a majority of the subjects, most frequently an escalation of prior empiric therapy. Mortality was high., (© 2016 Royal Australasian College of Physicians.)