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Background: Intravenous immunoglobulin (IVIg) is a critical replacement therapy for immunodeficiencies and immunomodulatory treatment for autoimmune and inflammatory diseases. Adequate supply of IVIg is a global issue, necessitating supply restrictions. In Australia, despite strict criteria for use, demand for IVIg has increased over time and exceeds domestic supply. Objective: Factors associated with the upward trend in overall IVIg use were examined, including in the number of unique patients, IVIg dosing and treatment frequency and variations by prescribing discipline and disease group. Methods: De‐identified data of IVIg dispensed in the largest Australian state (New South Wales) from 2007 to 2013 were provided by Australian Red Cross Lifeblood. Trends and projections were calculated using log‐linear regression of unique patients, treatment episodes and grams of IVIg for overall use and use stratified by discipline and disease group. Results: During the study period, 169 453 treatment episodes were recorded for 12 547 unique patients accounting for 5 827 787 g of IVIg use. Overall, IVIg use increased by 12.0% (11.5–12.6%) per year representing a 97.7% increase (91.6–104%) over the study period. The highest growth was among neurological conditions (16.0% (14.9–17.1%) per year). An increase in the number of unique patients was the primary driver of this growth, augmented by increases in the frequency and average dose per treatment. Conclusions: Clinically acceptable measures to improve management of IVIg supply are needed including optimising dose, frequency and duration of treatment. Formal evaluation of IVIg versus alternatives, including cost‐effectiveness and comparative efficacy, is warranted. [ABSTRACT FROM AUTHOR]

Background Vaccine-preventable infections are generally well controlled in Australia. However, gaps in immunity can lead to outbreaks and are important to identify. Young adults are a highly mobile population and a potential source of imported infections. We aimed to evaluate anti- measles, mumps, rubella and varicella (MMR&V) IgG seroprevalence and explore factors relating to antibody seropositivity. Methods A cross-sectional online survey was conducted among students from a large Australian university to collect demographic, vaccination, infection and travel characteristics. Blood samples were collected to measure MMR&V seroprevalence. Logistic regression was used to identify factors associated with seropositivity. Results Among 804 university students, seroprevalence (positive or equivocal) for measles was 82.3% (95% CI 79.6–84.8%), mumps 79.5% (95% CI 76.7–82.3%), rubella 91.5% (95% CI 89.6–93.5%) and varicella 86.2% (95% CI 84.1–88.8%), with 452 (56.2%, 95% CI 52.8–59.6) seropositive to all four viruses. Varicella seropositivity was highest in the older birth cohort (born 1988–1991). Measles seropositivity was higher for international students compared to domestic students. Among international students, mumps seroprevalence was significantly lower than measles and rubella seroprevalence. International travel in the previous 12 months was reported by 63.1% of students, but only 18.2% of travellers reported seeking pre-travel health advice prior to most recent international travel. Conclusions Overall, this study suggests immunity to MMR&V is sub-optimal. We found the university student population to be highly mobile and unlikely to seek pre-travel advice; thus, they are a potential source of infection importation. The implementation of university immunization policies could address the gaps identified and our findings can inform the development of targeted vaccination campaigns. [ABSTRACT FROM AUTHOR]

Objective To examine trends in varicella and herpes zoster (HZ) hospitalization following the availability and subsequent National Immunization Programme funding of one-dose varicella vaccination in Australia. Methods Varicella vaccination coverage for children born between 2001 and 2009 was obtained from the Australian Childhood Immunization Register. Principal or any coded varicella or HZ hospitalizations were retrieved from the national hospital morbidity database from 1998 to 2010. Trends in hospitalization rates In different age groups and indigenous status were assessed. Incidence rate ratios (IRR) were calculated between periods before and after implementation of immunization programme funding. Findings In the first year of the funded immunization programme, varicella vaccine coverage reached 75% in children aged 24 months and more than 80% in children aged 60 months. Compared with the pre-vaccine period, varicella hospitalization rates during the funded programme were significantly lower for age groups younger than 40 years; with the greatest reduction In children aged 18-59 months (IRR: 0.25; 95% confidence interval, CI: 0.22-0.29). Indigenous children had a higher varicella hospitalization rate compared with non-indigenous children before vaccine implementation (IRR: 1.9; 95% CI: 1.4-2.7), but afterwards reached equivalence (IRR: 1.1; 95% CI: 0.7-1.6). The age-standardized HZ hospitalization rate declined between the periods (IRR: 0.95; 95% CI: 0.92-0.97). Conclusion Rapid attainment of high coverage reduced varicella hospitalizations in the targeted age group, particularly for indigenous children, but also in non-targeted age groups, with no Increase in HZ hospitalizations. This suggests high one-dose varicella vaccine coverage can have a substantial Impact on severe disease. Objectif Examiner les tendances dans les hospitalisations dues a la varicelle et l'herpes zoster (HZ) apres la disponibilite et le financement du programme de vaccination national qui a suivi, pour la vaccination monodose contre la varicelle en Australie. Methodes La couverture vaccinale contre la varicelle pour les enfants nes entre 2001 et 2009 a ete obtenue a partir du registre australien de vaccination desenfants. Toutes les hospitalisations dues principalement a ou codifiees comme etant dues a la varicelle ou au HZ ont ete extraites de la base de donnees nationale de morbidite hospitaliere pour la periode 1998-2010. Les tendances dans les taux d'hospitalisation des differents groupes d'age et le statut d'autochtone ont ete evaluees. Les rapports de taux d'incidence (RTI) ont ete calcules entre les periodes avant et apres la mise en oeuvre du financement du programme de vaccination. Resultats Pendant la premiere annee du programme finance de vaccination, la couverture vaccinale contre la varicelle a atteint 75% chez les enfants ages de 24 mois et plus de 80% chez les enfants ages de 60 mois. Par rapport a la periode prevaccinale, les taux d'hospitalisation due a la varicelle pendant le programme finance etaient significativement plus faibles dans les groupes d'ages de moins de 40 ans; avec la plus grande reduction chez les enfants ages de 1859 mois (RTI: 0,25; intervalle de confiance de 95%, IC 95%: 0,22-0,29). Les enfants autochtones avaient un taux d'hospitalisation due a la varicelle plus eleve que les enfants non autochtones avant la mise en oeuvre du vaccin (RTI: 1,9; IC 95%: 1,4-2,7), mais ce taux est devenu equivalent par la suite (RTI: 1,1; IC 95%: 0,7-1,6). Le taux d'hospitalisation due au HZ normalise selon l'age a baisse entre les deux periodes (RTI: 0,95; IC 95%: 0,92-0,97). Conclusion La realisation rapide de la couverture elevee a reduit le nombre d'hospitalisations dues a la varicelle dans le groupe d'age cible, en particulier pour les enfants autochtones, mais egalement dans les groupes d'age non cibles, sans augmentation du nombre d'hospitalisations dues au HZ. Cela suggere que la couverture vaccinale monodose contre la varicelle peut avoir un impact important sur cette maladie grave. Objetivo Examinar las tendencias de la hospitalizacion por varicela y herpes zoster (HZ) siguiendo la disponibilidad y la subsecuente financiacion del Programa Nacional de Vacunacion de la vacuna monodosis de la varicela en Australia. Metodos La cobertura de la vacunacion contra la varicela para los ninos nacidos entre 2001 y 2009 se obtuvo del Registro Australiano de Vacunacion Infantil (Australian Childhood Immunization Register). Las hospitalizaciones por varicela o HZ principales o codificadas fueron sacadas de la base de datos del hospital nacional sobre morbilidad en el periodo comprendido entre 1998 y 2010. Se evaluaran las tendencias de las tasas de hospitalizacion en diferentes grupos de edad y estados Indigenas. Las tasas de incidencia (TI) se calcularon entre los periodos previos y posteriores a la implementacion de la financiacion del programa de vacunacion. Resultados En el primer ano del programa de vacunacion financiado, la cobertura de la vacuna de la varicela llego al 75% en los ninos de 24 meses y a mas del 80% en los ninos de 60 meses. En comparacion con el periodo previo a las vacunas, las tasas de hospitalizacion por varicela durante el programa financiado fueron significativamente menores en grupos de edad menores de 40 anos, con la reduccion mas importante en los ninos de entre 18-59 meses (TI: 0,25; 95% intervalo de confianza, 1C: 0,22-0,29). Los ninos indigenas tenian una tasa de hospitalizacion por varicela mas alta que los no indigenas antes de la implementacion de la vacuna (TI: 1,9; 95% IC: 1,4-2,7), pero tras esta se alcanzo una igualdad (TI: 1,1; 95% IC: 0,7-1,6). La tasa de hospitalizacion por herpes zoster estandarizada por edad disminuyo entre los periodos (TI: 0,95; 95% IC: 0,92-0,97). Conclusion La rapida consecucion de la cobertura alta redujo las hospitalizaciones por varicela en el grupo de edad al que se dirigia, especialmente en ninos indigenas aunque tambien en grupos de edad a los que no iba dirigido, sin incrementar las hospitalizaciones por herpes zoster. Esto sugiere que la cobertura de la vacuna monodosis de la varicela puede tener un Impacto importante en la grave enfermedad., Introduction Prior to the introduction of varicella vaccination in Australia, primary infection with the varicella-zoster virus (VZV) was a common childhood disease, with the majority (88%) of the population experiencing [...]

Elimination of endemic measles transmission is the culmination of a range of control measures at a national level. Current documentation of elimination proposed by WHO's regional offices requires achieving specific targets for surveillance process indicators. We demonstrate how Australia, although not meeting these specific targets, has satisfied multiple criteria that justify the formal declaration of measles elimination. Our review shows that few countries previously declaring measles elimination-have satisfied the current WHO surveillance targets. We argue that the requirements for recognition of measles elimination should not restrict countries to a particular type of surveillance system or surveillance criteria. L'elimination de la transmission endemique de la rougeole est le point culminant d'une serie de mesures de lutte contre cette maladie au niveau national. Pour attester de l'elimination de la rougeole, les Bureaux regionaux de l'OMS proposent actuellement que les indicateurs servant a la surveillance aient atteint des objectifs specifiques. Nous demontrons comment l'Australie, bien que n'ayant pas atteint ces objectifs, a rempli plusieurs criteres justifiant la declaration formelle de l'elimination de la rougeole. Notre analyse montre que peu de pays ayant anterieurement declare la rougeole comme eliminee ont rempli les objectifs actuels en matiere de surveillance de l'OMS. A notre avis, les exigences pour reconnaitre l'elimination de la rougeole ne devraient pas imposer aux pays l'utilisation d'un type particulier de systeme ou de critere pour la surveillance. La eliminacion de la transmision endemica del sarampion supone la culminacion de toda una serie de medidas de control desplegadas a nivel nacional. La actual documentacion sobre la eliminacion propuesta por las oficinas regionales de la OMS requiere que se alcancen metas concretas para los indicadores del proceso de vigilancia. Explicamos aqui de que manera Australia, si bien no ha alcanzado esas metas especificas, ha satisfecho muchos criterios que justifican la declaracion oficial de eliminacion del sarampion. Nuestro analisis muestra que, entre los paises que han declarado haber eliminado esta enfermedad, son pocos los que han alcanzado las actuales metas de vigilancia de la OMS. Se argumenta que, entre los requisitos para el reconocimiento de la eliminacion del sarampion, no se debe exigir a los paises que apliquen solo un sistema de vigilancia o unos criterios de vigilancia determinados., Defining elimination Several WHO regions have set target dates for the elimination of the transmission of endemic measles. The WHO Regional Office for the Western Pacific (WPRO) has nominated the [...]

Abstract Background Pre-travel health assessments aim to promote risk reduction through preventive measures and safe behavior, including ensuring travelers are up-to-date with their immunizations. However, studies assessing pre-travel health-seeking practices from a variety of medical and non-medical sources and vaccine uptake prior to travel to both developing and developed countries within the Asia-Pacific region are scarce. Methods Cross-sectional surveys were conducted between July and December 2007 to assess pre-travel health seeking practices, including advice from health professionals, health information from other sources and vaccine uptake, in a sample of travelers departing Sydney and Bangkok airports. A two-stage cluster sampling technique was used to ensure representativeness of travelers and travel destinations. Pre-travel health seeking practices were assessed using a self-administered questionnaire distributed at the check-in queues of departing flights. Logistic regression models were used to identify significant factors associated with seeking pre-travel health advice from a health professional, reported separately for Australian residents, residents of other Western countries and residents of countries in Asia. Results A total of 843 surveys were included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, pre-travel health information from any source was sought by 415 (49%) respondents with 298 (35%) seeking pre-travel advice from a health professional, the majority through general practice. Receipt of a pre-travel vaccine was reported by 100 (12%) respondents. Significant factors associated with seeking pre-travel health advice from a health professional differed by region of residence. Asian travelers were less likely to report seeking pre-travel health advice and uptake of pre-travel vaccines than Australian or other Western travelers. Migrant Australians were less likely to report seeking pre-travel health advice than Australian-born travelers. Conclusions This study highlights differences in health-seeking practices including the uptake of pre-travel health advice by region of residence and country of birth. There is a public health need to identify strategies targeting these travel groups. This includes the promotion of affordable and accessible travel clinics in low resource countries as traveler numbers increase and travel health promotion targeting migrant groups in high resource countries. General practitioners should play a central role. Determining the most appropriate strategies for increasing pre-travel health preparation, particularly for vaccine preventable diseases in travelers is the next stage in advancing travel medicine research.

Abstract Background Forward planning and preventative measures before travelling can significantly reduce the risk of many vaccine preventable travel-related infectious diseases. Higher education students may be at an increased risk of importing infectious disease as many undertake multiple visits to regions with higher infectious disease endemicity. Little is known about the health behaviours of domestic or international university students, particularly students from low resource countries who travel to high-resource countries for education. This study aimed to assess travel-associated health risks and preventative behaviours in a sample of both domestic and international university students in Australia. Methods In 2010, a 28 item self-administered online survey was distributed to students enrolled at the University of New South Wales, Sydney, Australia. Multiple methods of distributing links to the online survey were utilised. The survey examined the international travel history, travel intentions, infection control behaviours and self-reported vaccination history. Results A total of 1663 respondents completed the online survey, 22.1% were international students and 83.9% were enrolled at an undergraduate level. Half had travelled internationally in the previous 12 months, with 69% of those travelling only once during that time with no difference in travel from Australia between domestic and international students (p = 0.8). Uptake of pre-travel health advice was low overall with 68% of respondents reporting they had not sought any advice from a health professional prior to their last international trip. Domestic students were more likely to report uptake of a range of preventative travel health measures compared to international students, including diarrhoeal medication, insect repellent, food avoidance and condoms (P < 0.0001). Overall, students reported low risk perception of travel threats and a low corresponding concern for these threats. Conclusions Our study highlights the need to educate students about the risk associated with travel and improve preventative health-seeking and uptake of precautionary health measures in this highly mobile young adult population. Although immunisation is not an entry requirement to study at Universities in Australia, large tertiary institutions provide an opportunity to engage with young adults on the importance of travel health and provision of vaccines required for travel, including missed childhood vaccines.

Abstract Background On the 30th September 2009, the pandemic (H1N1) 2009 influenza vaccine was made available to adults and children aged 10 years and over, in Australia. Acceptance of a novel vaccine is influenced by perceptions of risk including risk of infection, risk of death or severe illness and risk of serious vaccine side-effects. We surveyed a sample of residents from Sydney, Australia to ascertain their risk perception, attitudes towards the pandemic and willingness to accept the pandemic (H1N1) 2009 influenza vaccine. Methods We sampled residents using a cross-sectional intercept design during the WHO Phase 6. Members of the public were approached in shopping and pedestrian malls to undertake the survey during September and October 2009. The survey measured perceived risk, seriousness of disease, recent behavioural changes, likely acceptance of the pandemic (H1N1) 2009 vaccine and issues relating to uptake and perceived safety. Results Of the 627 respondents, the majority felt that they had a "very low to low" (332/627, 52.9%) risk of acquiring H1N1. 24.5% (154/627) of respondents believed that the disease would "very seriously or extremely" affect their health. Nearly half (305/627, 48.6%) reported that in response to the "swine flu" outbreak they had undertaken one or more of the investigated behavioural changes. Overall, the self-reported likelihood of accepting vaccination against novel H1N1 was 54.7% (343/627). Conclusions While, most participants did not believe they were at high risk of acquiring pandemic H1N1 2009, over half of the sample indicated that they would accept the vaccine. Participants who were vaccinated against the seasonal influenza were more likely to receive the H1N1 vaccine. Concerns about safety, the possibility of side effects and the vaccine development process need to be addressed.