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School closure is often purported to reduce influenza transmission, but little is known about its effect on families. We surveyed families affected by pandemic (H1N1) 2009-related school closures in Perth, Western Australia, Australia. Surveys were returned for 233 (58%) of 402 students. School closure was deemed appropriate by 110 parents (47%); however, 91 (45%) parents of 202 asymptomatic students reported taking ≥1 day off work to care for their child, and 71 (35%) had to make childcare arrangements because of the class closures. During the week, 172 (74%) students participated in activities outside the home on ≥1 occasion, resulting in an average of 3.7 out-of-home activities for each student. In our survey, activities outside the home were commonly reported by students affected by school closure, the effect on families was substantial, and parental opinion regarding school closures as a means to mitigate the outbreak of pandemic (H1N1) 2009 was divided. [ABSTRACT FROM AUTHOR]

Introduction: Dentists can prescribe medications for prophylactic and therapeutic purposes. In Australia, dental graduates can autonomously practise within the scope of their qualifications without needing to undertake an internship post‐graduation. Although previous research has identified knowledge gaps amongst dental students in Australia on pharmacology and pharmacotherapeutic knowledge, there has been no published research that qualitatively highlights dental students' knowledge of medication prescribing in Australia. This study aimed to undertake a qualitative analysis of Western Australian dental students' attitudes towards and knowledge of medication prescribing. Methods: This qualitative case study design employed semi‐structured interviews as means of collecting data. It utilised a purposive sampling in penultimate and final year dental students at the University of Western Australia. Results: Twenty dental students participated in the study. Five key themes were identified in the data: current and previous education, application when delivering pharmacology and pharmacotherapeutics, teaching to ensure patient‐centred care, supervision and referral to relevant resources. Participants agreed that having previous knowledge in the area provides students with confidence regarding medication prescribing. Furthermore, students in this study valued having guidance when prescribing medications. Conclusions: This study highlights the complexity of medication prescribing for dental students. It also highlights their experience with the current pharmacology and pharmacotherapeutics curriculum. All students interviewed valued application‐based teaching, making it specific to dentistry. If curriculum were to be redeveloped, considering their perceptions may be a valuable tool. [ABSTRACT FROM AUTHOR]

Background: Antenatal influenza and pertussis vaccination prevent serious disease in mothers and infants. Aboriginal individuals are at increased risk of infection yet little is known about vaccine coverage among Aboriginal mothers. Aims: To estimate the uptake of influenza and pertussis vaccination among pregnant Aboriginal women in Western Australia and identify barriers and enablers to vaccination. Materials and methods: Four hundred Aboriginal women, aged ≥18 years, who gave birth to a live infant between April and October 2015, were randomly selected and invited to participate in telephone interviews. Of the 387 women who did not decline, 178 had a functioning phone number and 100 completed the survey. Analyses were weighted by maternal residence. Results: During pregnancy the majority of Aboriginal mothers were recommended influenza (66%; unweighted, 65/96 = 68%) and pertussis (65%; unweighted, 62/94 = 66%) vaccines, with 62% (unweighted, 56/94 = 56%) and 63% (unweighted, 60/93 = 65%) receiving the vaccinations, respectively. Almost all vaccinated women (98%) reported wanting to protect their baby as the reason for immunisation. Rural mothers were more likely than metropolitan mothers to have been vaccinated against influenza (odds ratio (OR) 4.1, 95% CI 1.7–10.2) and pertussis (OR 3.1, 95% CI 1.2–7.6). Recommendation by a healthcare provider was strongly associated with vaccine uptake (influenza: OR 15.6, 95% CI 4.9–49.5; pertussis: OR 13.3, 95% CI 4.6–38.0). Conclusion: Vaccination uptake among Western Australian Aboriginal mothers is comparable with rates reported for non‐Aboriginal populations worldwide. Provider recommendation is the single most important factor associated with vaccination uptake, underlining the importance of integrating vaccination into routine antenatal care. [ABSTRACT FROM AUTHOR]

Background There is increasing evidence demonstrating influenza vaccine effectiveness (VE) in the prevention of influenza in children, including the very young. Data demonstrating the effectiveness against severe disease, including hospitalisation, are limited. We aimed to determine the VE of the southern hemisphere trivalent inactivated influenza vaccine (TIV) in preventing laboratory-confirmed influenza-associated hospitalisation in children. Patients and Methods Laboratory records were used to identify children with confirmed influenza hospitalised (i.e., cases) during a 5 year period (2008, 2010–2013) at the only tertiary paediatric facility in Western Australia. Cases and time, age and ward matched controls were retrospectively reviewed to determine risk factors, vaccination status and outcome. Adjusted odds ratios and VE estimates were derived using conditional logistic regression models. Results Three hundred and eighty five cases were identified (Influenza A, 64.9%; Influenza B, 35.1%). Influenza-like illness and pneumonia were the most frequent presentation (74.5% and 23.9%, respectively). The median length of stay was 2 days (Interquartile range 1–4 days). Twenty children (5.2%) required admission to the intensive care unit. Vaccine uptake in cases and controls was low (4.9% and 8.5%, respectively). Three hundred and six case-control pairs were included in the VE analysis, of which 19 pairs were informative with discrepant vaccination status. VE (fully vaccinated vs. unvaccinated) was estimated to be 62.3% (95% CI: −6.6%, 86.7%). Conclusion In this study, the point estimate for the effectiveness of TIV in preventing influenza-associated hospitalisation in children was similar to that reported for emergency or outpatient attended, laboratory-confirmed influenza, yet confidence intervals were wide. Vaccine uptake remains low. Studies, enroling larger numbers of children, ideally with higher vaccine uptake, are needed to provide additional evidence on TIV protection against influenza hospitalisation in children. [ABSTRACT FROM AUTHOR]

Background: Although influenza vaccination is recommended during pregnancy as standard of care, limited surveillance data are available for monitoring uptake. Our aim was to evaluate the validity of existing surveillance in Western Australia for measuring antenatal influenza immunisations.Methods: The self-reported vaccination status of 563 women who delivered between April and October 2013 was compared against three passive data collection sources: a state-wide antenatal influenza vaccination database maintained by the Department of Health, a public maternity hospital database, and a private health service database. Sensitivity, specificity, and positive and negative predictive values were calculated for each system using self-report as the "gold standard."Results: The state-wide antenatal vaccination database detected 45.7 % (95 % CI: 40.1-51.4 %) of influenza vaccinations, the public maternity hospital database detected 66.7 % (95 % CI: 55.1-76.9 %), and the private health service database detected 29.1 % (95 % CI: 20.5-39.4 %). Specificity exceeded 90 % and positive predictive values exceeded 80 % for each system. Sensitivity was lowest for women whose antenatal care was provided by a private obstetrician.Conclusions: Existing resources for surveillance of antenatal influenza vaccinations detect 29-67 % of vaccinations. Considering the importance of influenza immunisation as a public health intervention, particularly in pregnant women, improvements to routine monitoring of influenza vaccination is warranted. [ABSTRACT FROM AUTHOR]

Background Trivalent influenza vaccine ( TIV) has been recommended for pregnant women in Australia for more than a decade and funded since 2009, yet vaccination coverage remains low. Misperceptions of the safety of TIV in pregnancy have been identified as a major contributor to low vaccination rates. Ongoing safety monitoring with dissemination of results could help improve antenatal influenza vaccine uptake. Aim To implement a real-time safety monitoring program for TIV administered to pregnant women. Materials and Methods Between March and July 2013, a cohort of 3,173 pregnant women who received the 2013 TIV agreed to follow-up regarding possible adverse events following immunisation ( AEFI); 3,047 (96%) provided a mobile telephone number and were sent a short message service ( SMS) inquiring whether they had experienced an AEFI; attempts were made to contact the remaining 126 (4%) women by voice telephone call. Results Responses were obtained from 2,885 (90.9%) women, 413 (14.3%) of whom reported a suspected AEFI. Local reactions were the most frequently reported AEFI (4.9%), followed by headache (3.3%), fever (2.7%), fatigue (2.5%), diarrhoea (2.5%) and malaise (1.2%); 39 women (1.4%) sought medical advice and no serious vaccine-related AEFIs were identified. Response rates were higher for SMS compared to telephone (84% vs 63%; P < 0.001). Conclusions These findings support the safety of TIV in pregnant women. Mobile phone technology proved an efficient method for timely surveillance of adverse events following vaccination. The low level of AEFI observed should be reassuring to antenatal patients and their providers and help promote TIV uptake. [ABSTRACT FROM AUTHOR]

During 2010–2012 the strain composition of the influenza vaccine in the Southern Hemisphere did not change, but the circulating virus type/subtype did. We pooled data for these years from the Western Australian sentinel medical practice surveillance system for influenza to estimate vaccine effectiveness (VE) by influenza virus type and subtype. A case test-negative design was used with VE estimated as (1-odds ratio) × 100%. There were 2182 patients included in the analysis across the 3 years studied. The predominant subtype was A/H1pdm09 in 2010 and 2011, and A/H3 in 2012. The overall adjusted VE estimate against all influenza for 2010–2012 was 51% (95% CI: 36, 63). Estimates were highest against A/H1pdm09 at 74% (95% CI: 47, 87), followed by 56% (95% CI: 33, 71) for influenza B and lowest against A/H3 at 39% (95% CI: 13, 57). When analyses were restricted to compare influenza-positive patients with patients who tested positive for a non-influenza virus, overall adjusted VE was 59% (95% CI: 39, 72). These results suggest moderate protection against influenza by vaccination in Western Australia over the period 2010–2012, and are consistent with findings from other settings. [ABSTRACT FROM AUTHOR]

Background Influenza-like illness (ILI) definitions have been infrequently studied in young children. Despite this, clinical definitions of ILI play an important role in influenza surveillance. This study aims to identify clinical predictors of influenza infection in children ≤5 years old from which age-specific ILI definitions are then constructed. Methods Children aged 6–59 months with a history of fever and acute respiratory symptoms were recruited in the Western Australia Influenza Vaccine Effectiveness (WAIVE) Study. Clinical data and per-nasal specimens were obtained from all children. Logistic regression identified significant predictors of influenza infection. Different ILI definitions were compared for diagnostic accuracy. Results Children were recruited from 2 winter influenza seasons (2008–2009; n = 944). Of 919 eligible children, 179 (19.5%) had laboratory-confirmed influenza infection. Predictors of infection included increasing age, lack of influenza vaccination, lower birth weight, fever, cough, and absence of wheeze. An ILI definition comprising fever ≥38°C, cough, and no wheeze had 58% sensitivity (95% confidence interval [CI], 50–66), 60% specificity (95% CI, 56–64), 26% positive predictive value (95% CI, 21–31), and 86% negative predictive value (95% CI, 82–89). The addition of other symptoms or higher fever thresholds to ILI definition had little impact. The Centers for Disease Control and Prevention definition of ILI (presence of fever [≥37.8°C] and cough and/or sore throat) was sensitive (92%; 95% CI, 86–95), yet lacked specificity (10%; 95% CI, 8–13) in this population. Conclusions Influenza-like illness is a poor predictor of laboratory-confirmed influenza infection in young children but can be improved using age-specific data. Incorporating age-specific ILI definitions and/or diagnostic testing into influenza surveillance systems will improve the accuracy of epidemiological data. [ABSTRACT FROM AUTHOR]

Background: Influenza and pertussis vaccines have been recommended in Australia for women during each pregnancy since 2010 and 2015, respectively. Estimating vaccination coverage and identifying factors affecting uptake are important for improving antenatal immunisation services.Methods: A random sample of 800 Western Australian women ≥18 years of age who gave birth between 4th April and 4th October 2015 were selected. Of the 454 (57%) who were contactable by telephone, 424 (93%) completed a survey. Data were weighted by maternal age and area of residence to ensure representativeness. The proportion immunised against influenza and pertussis was the main outcome measure; multivariate logistic regression was used to identify factors significantly associated with antenatal vaccination. Results from the 2015 study were compared to similar surveys conducted in 2012-2014.Results: In 2015, 71% (95% CI 66-75) of women received pertussis-containing vaccine and 61% (95% CI 56-66) received influenza vaccine during pregnancy; antenatal influenza vaccine coverage was 18% higher than in 2014 (43%; 95% CI: 34-46). Pertussis and influenza vaccine were co-administered for 68% of the women who received both vaccines. The majority of influenza vaccinations in 2015 were administered during the third trimester of pregnancy, instead of the second trimester, as was observed in prior years. Women whose care provider recommended both antenatal vaccinations had significantly higher odds of being vaccinated against both influenza and pertussis (OR 33.3, 95% CI: 15.15-73.38). Of unvaccinated mothers, 53.6% (95% CI: 45.9-61.3) and 78.3% (95% CI: 70.4-85.3) reported that they would have been vaccinated against influenza and pertussis, respectively, if their antenatal care provider had recommended it.Conclusions: Pertussis vaccination coverage was high in the first year of an antenatal immunisation program in Western Australia. Despite a substantial increase in influenza vaccination uptake between 2014 and 2015, coverage remained below that for pertussis. Our data suggest influenza and pertussis vaccination rates of 83% and 94%, respectively, are achievable if providers were to recommend them to all pregnant women. [ABSTRACT FROM AUTHOR]