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Influenza is a common cause of acute respiratory infection, and is a major cause of morbidity and mortality. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2019 influenza season. The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. Cases were defined as patients hospitalised at any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data were also collected on a frequency matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 1 April to 31 October 2019 (the 2019 influenza season), there were 4,154 patients admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 44% were elderly (>= 65 years), 21% were children (< 16 years), 7.7% were Aboriginal and Torres Strait Islander peoples, 1.7% were pregnant and 73% had chronic comorbidities. Most admissions were due to influenza A infection (85%). Estimated vaccine coverage was 75% in the elderly, 49% in non-elderly adults with medical comorbidities, and 27% in young children (< 5 years). The estimated vaccine effectiveness in the target adult population was 42% (95% confidence interval [95% CI]: 36%, 49%). There were a larger number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2019 than in 2018.Copyright © Commonwealth of Australia CC BY-NC-ND.

Introduction: Influenza is a common cause of acute respiratory infection, and is a major cause of morbidity and mortality. Coronavirus disease 2019 (COVID-19) is an acute respiratory infection that emerged as a pandemic worldwide before the start of the 2020 Australian influenza season. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza and COVID-19 during the 2020 influenza season in a sentinel surveillance system. Method(s): The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. Influenza and COVID-19 cases were defined as patients hospitalised at sentinel hospitals and confirmed by nucleic acid detection. Result(s): There were 448 patients with COVID-19 admitted between 16 March and 31 December 2020, and only 20 patients with influenza admitted between 1 April and 30 November 2020, to one of 22 FluCAN hospitals. Of the COVID-19 cases, 173 (39%) were > 65 years of age, 36 (8%) were children (< 16 years), 6 (1%) were Aboriginal and Torres Strait Islander peoples, 4 (1%) were pregnant and 289 (65%) had chronic comorbidities. COVID-19 hospital admissions peaked between weeks 13 and 15 (first wave) nationally, and again between weeks 31 and 35 (Victoria), with most admissions represented by those above 40 years of age. Discussion(s): There was an unusually low number of hospital admissions with laboratory-confirmed influenza in this season, compared to recent seasons. This is likely to be due to effective public health interventions and international border closures as a result of a rise in COVID-19 respiratory infections and associated hospitalisations.Copyright © Commonwealth of Australia CC BY-NC-ND.

Introduction: Influenza is a common cause of acute respiratory infection, and is a major cause of morbidity and mortality. Coronavirus disease 2019 (COVID-19) is an acute respiratory infection that emerged as a pandemic worldwide before the start of the 2020 Australian influenza season. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza and COVID-19 during the 2020 influenza season in a sentinel surveillance system. Methods: The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. Influenza and COVID-19 cases were defined as patients hospitalised at sentinel hospitals and confirmed by nucleic acid detection. Results: There were 448 patients with COVID-19 admitted between 16 March and 31 December 2020, and only 20 patients with influenza admitted between 1 April and 30 November 2020, to one of 22 FluCAN hospitals. Of the COVID-19 cases, 173 (39%) were > 65 years of age, 36 (8%) were children (< 16 years), 6 (1%) were Aboriginal and Torres Strait Islander peoples, 4 (1%) were pregnant and 289 (65%) had chronic comorbidities. COVID-19 hospital admissions peaked between weeks 13 and 15 (first wave) nationally, and again between weeks 31 and 35 (Victoria), with most admissions represented by those above 40 years of age. Discussion: There was an unusually low number of hospital admissions with laboratory-confirmed influenza in this season, compared to recent seasons. This is likely to be due to effective public health interventions and international border closures as a result of a rise in COVID-19 respiratory infections and associated hospitalisations.

INTRODUCTION: Influenza is a common cause of acute respiratory infection, and is a major cause of morbidity and mortality. Coronavirus disease 2019 (COVID-19) is an acute respiratory infection that emerged as a pandemic worldwide before the start of the 2020 Australian influenza season. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza and COVID-19 during the 2020 influenza season in a sentinel surveillance system. METHODS: The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. Influenza and COVID-19 cases were defined as patients hospitalised at sentinel hospitals and confirmed by nucleic acid detection. RESULTS: There were 448 patients with COVID-19 admitted between 16 March and 31 December 2020, and only 20 patients with influenza admitted between 1 April and 30 November 2020, to one of 22 FluCAN hospitals. Of the COVID-19 cases, 173 (39%) were > 65 years of age, 36 (8%) were children (< 16 years), 6 (1%) were Aboriginal and Torres Strait Islander peoples, 4 (1%) were pregnant and 289 (65%) had chronic comorbidities. COVID-19 hospital admissions peaked between weeks 13 and 15 (first wave) nationally, and again between weeks 31 and 35 (Victoria), with most admissions represented by those above 40 years of age. DISCUSSION: There was an unusually low number of hospital admissions with laboratory-confirmed influenza in this season, compared to recent seasons. This is likely to be due to effective public health interventions and international border closures as a result of a rise in COVID-19 respiratory infections and associated hospitalisations.

Introduction/Aim. To estimate the burden of oral corticosteroid (OCS) use for asthma in Australia, referenced to potentially toxic cumulative thresholds (>=1000 mg prednisolone-equivalent). Methods. This retrospective cohort study used a 10% random sample of the Australian Pharmaceutical Benefits Scheme to identify asthma patients aged >=12 years based on inhaled controller medication dispensing. The primary outcome was cumulative OCS dispensing for asthma over five years. The association between overall dispensing of OCS, with that of diabetes and osteoporosis medication, was examined. The secondary outcome was >=1000 mg prednisolone-equivalent dose dispensing over 12 months, stratified by inhaled controller therapy dose and usage. Results. The national OCS burden can be estimated by multiplying study results by ten. Over five years, 34,580 individuals (27.9%) of the study asthma population were dispensed cumulative prednisoloneequivalent doses of >=1000 mg, and a further 29,532 (23.8%) dispensed doses <1000 mg. Patients on any inhaler accounted for 49.3% of all cumulative dispensing >=1000 mg in the 10% PBS sample. Overall, patients dispensed >=1000 mg prednisolone-equivalent also had higher dispensing rates of diabetes and osteoporosis medication. Over 12 months, 4,633 patients with asthma on high-dose controllers were dispensed >=1000 mg prednisolone-equivalent, more than half of whom had inadequate (<50%) controller therapy usage. Conclusion. Cumulative exposure to OCS in Australia reaches levels associated with toxicity in a quarter of asthma patients on inhaled controller therapy. Potentially toxic OCS use often occurs in patients taking insufficient inhaled controller medication. Better approaches are needed to improve asthma outcomes whilst minimising OCS burden and toxicity.

The Influenza Complications Alert Network (FluCAN) is a sentinel-hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2017 influenza season. In this observational surveillance system, cases were defined as patients admitted to any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data are also collected on a frequency-matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 3 April to 31 October 2017 (the 2017 influenza season), 4,359 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 52% were elderly (>=65 years), 14% were children (<16 years), 6.5% were Aboriginal and Torres Strait Islander peoples, 1.6% were pregnant and 78% had chronic comorbidities. A significant proportion were due to influenza B (31%). Estimated vaccine coverage was 72% in the elderly (>=65 years), 50% in non-elderly adults with medical comorbidities and 24% in children (<16 years) with medical comorbidities. The estimated vaccine effectiveness (VE) in the target population was 23% (95% CI: 7%, 36%). There were a large number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2017, with case numbers more than twice that reported in 2016.Copyright © Commonwealth of Australia CC BY-NC-ND.

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.Copyright © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

During the period 1 April to 30 October 2016 (the 2016 influenza season), 1,952 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 46% were elderly (e65 years), 18% were children (<16 years), 5% were Aboriginal and Torres Strait Islander peoples, 3% were pregnant and 76% had chronic co-morbidities.Copyright This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that r

Objectives To describe the point prevalence of respiratory viruses/atypical bacteria using PCR and evaluate the impact of respiratory viruses/atypical bacteria and atopy on acute severity and clinical recovery in children with hospitalised and non-hospitalised asthma exacerbations. Design This was a prospective study performed during 2009–2011. Setting The study was performed in the emergency departments of two hospitals. Patients 244 children aged 2–16 years presenting with acute asthma to the emergency departments were recruited. A nasopharyngeal aspirate and allergen skin prick test were performed. Main outcome measures The outcomes were divided into (1) acute severity outcomes (Australian National Asthma Council assessment, hospitalisation, Functional Severity Scale, Acute Asthma Score, asthma quality of life questionnaires for parents (PACQLQ) on presentation, asthma diary scores (ADS) on presentation and length of hospitalisation) and (2) recovery outcomes (PACQLQ for 21 days, ADS for 14 days and representation for asthma for 21 days). Results PCR for viruses/atypical bacteria was positive in 81.7% of children (75.1% human rhinovirus, codetection in 14.2%). Mycoplasma pneumoniae and Chlamydophila pneumoniae were rarely detected. The presence of micro-organisms had little impact on acute asthma or recovery outcomes. Children with atopy were significantly more likely to relapse and represent for medical care by day 14 (OR 1.11, 95% CI 1.00 to 1.23). Conclusions The presence of any viruses is associated with asthma exacerbations but does not appear to influence asthma recovery. In contrast, atopy is associated with asthma relapse. M. pneumoniae and C. pneumoniae are rare triggers of acute asthma in young children.

The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all states and territories in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2015 influenza season. In this observational study, cases were defined as patients admitted to one of the sentinel hospitals with an acute respiratory illness with influenza confirmed by nucleic acid detection. During the period 1 April to 30 October 2015 (the 2015 influenza season), 2,070 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 46% were elderly (>= 65 years), 15% were children (< 16 years), 5% were Indigenous Australians, 2.1% were pregnant and 75% had chronic co-morbidities. A high proportion were due to influenza B (51%). There were a large number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2015 with case numbers similar to that reported in 2014. The national immunisation program is estimated to avert 46% of admissions from confirmed influenza across all at-risk groups, but more complete vaccination coverage in target groups could further reduce influenza admissions by as much as 14%.

Introduction/Aim: When assessing the economic burden associated with severe asthma, calculation of work productivity loss should include absenteeism, not being at work and 'presenteeism'-attendance but with disease-related reduced productivity. Limited Australian data regarding work productivity in severe asthma exist. Method(s): An Australasian multi-centre severe asthma registry, (Severe Asthma Web-based Database 'SAWD') was established and baseline data collected. Severe disease was defined as asthma requiring maximal inhaled corticosteroids plus a second controller to maintain control or, asthma, which remained uncontrolled (regular symptoms, frequent severe exacerbations, hospitalization or airflow limitation). Participants with non-severe controlled asthma were recruited for comparison. The effect of health on work productivity was assessed using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI:GH). Health status was measured using the Juniper Asthma Quality of Life Questionnaire: standardized (AQLQ:S). Result(s): Of 188 enrolled registry participants, the median age was 57 years, 114 were women and 52% were never smokers. A total of 80% had severe asthma. Participants with severe asthma reported significantly poorer quality of life than those with non-severe asthma in all AQLQ domains (P < 0.0001, n = 176). The WPAI:GH was completed by 164 participants, of whom 46%reported current employment. Of those employed, severe asthma participants reported amedian (Q1,Q3) 20 (10,40)%presenteeism compared to 0 (0,10)%in non-severe asthma in the preceding week (P = 0.001). Median absence from work (absenteeism) was 0 in both groups. Median (Q1,Q3) work productivity loss was 20 (10,40) % in severe and 0 (0,10) % in nonsevere asthma (P = 0.0008). Median (Q1,Q3) general activity impairment was 40 (20,70) % in severe asthma and 20 (0,30) % in non-severe asthma (P = 0.003, n = 164). Conclusion(s): People with severe asthma have reduced quality

Introduction/Aim: Severe asthma (SA) is a heterogeneous and high impact disease. Disease registries enable characterization of SA and its phenotypes. Eosinophilic and allergic phenotypes of SA are of relevance because of the increasing availability of targeted therapies. The aim of this study was to describe the characteristics of SA phenotypes. Method(s): An Australasian multi-centre registry, the Severe Asthma Web-based Database (SAWD), was established, and baseline data were systematically collected. Severe disease was defined as asthma requiring maximal inhaled corticosteroids plus a second controller to maintain control, or asthma, which remained uncontrolled (regular symptoms, frequent severe exacerbations, hospitalization or airflow limitation). Participants with non-severe controlled asthma were recruited for comparison. Available peripheral blood eosinophil, serum IgE and sputum eosinophil levels were obtained. Result(s): Therewere 188 asthmatics (80%SA), with amedian (Q1,Q3) age of 57 (44,66) years, 114 women, 52%never-smokers andmean pre-bronchodilator FEV1% predicted 71+/-22 (SD). Blood eosinophils (>300/muL) identified 50/162 as eosinophilic asthma (EA). They were of similar age to those with low (<150/muL) or mid-level (150-300/muL) eosinophils, but EA displayed a higher median (Q1,Q3) serum IgE level of 309 (116928) IU/mL, atopy (89%, 87% mid-level, 71% low, P = 0.048) and significantly higher prevalence of severe exacerbations (70%, 58%, 46%, P = 0.04). Median (Q1,Q3) sputum eosinophil % (n = 44) was 6 (1.75, 19.25) in EA, 1.25 (0.48, 3.0)% and 1.5(0.5, 4.0)%, respectively (P = 0.047). Asthma control scores and respiratory medication use were similar. Participants with allergic asthma (IgE >=76 IU/mL) were younger, median (Q1,Q3) 52 (40,60) compared to 62 (46,67) years (P = 0.029), and had poorer asthma control. In SA, the allergic phenotype was more common (71/94, 76%) than EA (33/94, 35%). A combined EA/allergic phenotype was observed in combinatio

The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance programme operating in all states and territories in Australia. We summarise the epidemiology of children hospitalised with laboratory-confirmed influenza in 2014 and reports on the effectiveness of inactivated trivalent inactivated vaccine (TIV) in children. In this observational study, cases were defined as children admitted with acute respiratory illness (ARI) with influenza confirmed by PCR. Controls were hospitalised children with ARI testing negative for influenza. Vaccine effectiveness (VE) was estimated as 1 minus the odds ratio of vaccination in influenza positive cases compared with test-negative controls using conditional logistic regression models. From April until October 2014, 402 children were admitted with PCR-confirmed influenza. Of these, 28% were aged < 1 year, 16% were Indigenous, and 39% had underlying conditions predisposing to severe influenza. Influenza A was detected in 90% of cases of influenza; influenza A(H1N1)pdm09 was the most frequent subtype (109/141 of subtyped cases) followed by A(H3N2) (32/141). Only 15% of children with influenza received antiviral therapy. The adjusted VE of one or more doses of TIV for preventing hospitalised influenza was estimated at 55.5% (95% confidence intervals (CI): 11.6–77.6%). Effectiveness against influenza A(H1N1)pdm09 was high (91.6%, 95% CI: 36.0–98.9%) yet appeared poor against H3N2. In summary, the 2014 southern hemisphere TIV was moderately effective against severe influenza in children. Significant VE was observed against influenza A(H1N1)pdm09