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Deborah Lehmann

Publications and source records attributed to Deborah Lehmann.

14 recordsLinked to original sources
PubMed2006

Comparison between nasal swabs and nasopharyngeal aspirates for, and effect of time in transit on, isolation of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis.

We assessed the impact of the use of nasal swabs or nasopharyngeal aspirates and the time from specimen collection to storage at -70 degrees C on bacterial isolation. Haemophilus influenzae was isolated significantly less often from swabs than from nasopharyngeal aspirates. Samples in transit for >3 days were half as likely to grow Streptococcus pneumoniae and H. influenzae as those in transit for < or =3 days. There was no statistically significant difference for either Moraxella catarrhalis or Staphylococcus aureus.

Child, Preschool↗
PubMed2006

Modelling the co-occurrence of Streptococcus pneumoniae with other bacterial and viral pathogens in the upper respiratory tract.

Otitis media (OM) is a major burden for all children, particularly for Australian Aboriginal children. Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae and viruses (including rhinovirus and adenovirus) are associated with OM. We investigated nasopharyngeal microbial interactions in 435 samples collected from 79 Aboriginal and 570 samples from 88 non-Aboriginal children in Western Australia. We describe a multivariate random effects model appropriate for analysis of longitudinal data, which enables the identification of two independent levels of correlation between pairs of pathogens. At the microbe level, rhinovirus infection was positively correlated with carriage of S. pneumoniae, H. influenzae and M. catarrhalis, and adenovirus with M. catarrhalis. Generally, there were positive associations between bacterial pathogens at both the host and microbe level. Positive viral-bacterial associations at the microbe level support previous findings indicating that viral infection can predispose an individual to bacterial carriage. Viral vaccines may assist in reducing the burden of bacterial disease.

Child, Preschool↗
PubMed2006

Has the seven-valent pneumococcal conjugate vaccine had an impact on invasive pneumococcal disease in Western Australia?

Enhanced surveillance for invasive pneumococcal disease (IPD) has been ongoing in Western Australia since 1996. We describe the epidemiology of invasive pneumococcal disease in children aged <2 years between 1996 and 2005. Pneumococcal conjugate vaccine has been offered to Aboriginal children and other high-risk children since July 2001 and to all Australian children since January 2005. A total of 1655 IPD cases were reported of whom 361 (55 Aboriginal) were aged <2 years. From 1996-2001 to 2002-2005, IPD incidence declined from 192 to 124/100,000/annum in Aboriginal children and from 70 to 56/100,000/annum in non-Aboriginal children. Incidence of IPD due to vaccine serotypes (VT) declined from 118 to 43/100,000/annum (p=0.05) in Aboriginal children and from 59 to 45/100,000/annum in non-Aboriginal children (p<0.001), with no increased incidence of disease due to non-vaccine serotypes. Continued surveillance is essential to measure the impact of the childhood pneumococcal conjugate vaccination program on IPD incidence and to identify the emergence of disease due to non-vaccine serotypes.

Adolescent↗
PubMed2006

Upper respiratory tract bacterial carriage in Aboriginal and non-Aboriginal children in a semi-arid area of Western Australia.

BACKGROUND: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are associated with otitis media (OM). Indigenous children experience particularly high rates of OM. Few studies worldwide have described upper respiratory tract (URT) carriage in Indigenous and non-Indigenous children living in the same area. AIM: The aim of this study was to describe URT bacterial carriage in Aboriginal and non-Aboriginal children in the Kalgoorlie-Boulder area, Western Australia, as part of an investigation into causal pathways to OM. METHODS: Five hundred four and 1045 nasopharyngeal aspirates were collected from 100 Aboriginal and 180 non-Aboriginal children, respectively, followed from birth to age 2 years. Standard procedures were used to identify bacteria. RESULTS: Overall carriage rates of S. pneumoniae, M. catarrhalis and H. influenzae in Aboriginal children were 49%, 50% and 41%, respectively, and 25%, 25% and 11% in non-Aboriginal children. By age 2 months S. pneumoniae and M. catarrhalis had been isolated from 37% and 36% of Aboriginal children and from 11% and 12% of non-Aboriginal children, respectively. From age 3 months onward, carriage rates in Aboriginal children were 51% to 67% for S. pneumoniae and M. catarrhalis and 42% to 62% for H. influenzae; corresponding figures for non-Aboriginal children were 26% to 37% for S. pneumoniae and M. catarrhalis and 11% to 18% for H. influenzae. Non-Aboriginal children had higher carriage rates in winter than in summer, but season had little effect in Aboriginal children. Staphylococcus aureus carriage was highest under age 1 month (55% Aboriginal, 61% non-Aboriginal) and was always higher in non-Aboriginal than Aboriginal children. CONCLUSIONS: Interventions are needed to reduce high transmission and carriage rates, particularly in Aboriginal communities, to avoid the serious consequences of OM.

Australia↗
PubMed2004

Benefits of routine immunizations on childhood survival in Tari, Southern Highlands Province, Papua New Guinea.

BACKGROUND: Non-specific beneficial as well as deleterious effects of childhood immunizations have been reported in areas of high mortality. This study aimed to determine the effects of diphtheria-tetanus-whole-cell-pertussis (DTP), BCG, hepatitis B, and measles vaccines on mortality in the highlands of Papua New Guinea (PNG). METHODS: Demographic events for children born in 1989-1994 who were under monthly demographic surveillance in Tari were recorded from birth until age 2 years, out-migration, death, or the end of the study period. Data on BCG, hepatitis B, DTP, measles and pneumococcal polysaccharide vaccination were collected monthly from clinic records. To allow for different characteristics of immunized and non-immunized children, analysis included conditioning on a propensity score for vaccination, adjusting for differences in children's background characteristics. RESULTS: In all, 101/3502 children (3%) who had at least one vaccine died between ages 29 days and 24 months were compared to 112/546 (21%) who had none. BCG was associated with lower mortality in the 1-5 month age group (hazard ratio [HR] = 0.17, 95% CI: 0.09, 0.34), measles vaccine with lower mortality at age 6-11 months (HR = 0.42, 95% CI: 0.17, 1.01), and pneumococcal polysaccharide vaccine with lower mortality at age 12-23 months (HR = 0.42, 95% CI: 0.19, 0.93). One or more doses of DTP was associated with lower overall mortality (HR = 0.27, 95% CI: 0.16, 0.44), particularly in the 1-5 month age group (HR = 0.19, 95% CI: 0.10, 0.34), and also in those who had had prior BCG (HR = 0.45, 95% CI: 0.22, 0.91). CONCLUSION: Routine immunizations are effective in reducing overall mortality in young children in an area of high mortality. In particular, DTP, whether considered separately or in addition to BCG, was associated with a lowering of overall mortality, in contrast to findings reported from Guinea-Bissau.

BCG Vaccine↗
PubMed2003

Benefits of swimming pools in two remote Aboriginal communities in Western Australia: intervention study.

OBJECTIVE: To determine the health impact of swimming pools built with the aim of improving quality of life and reducing high rates of pyoderma and otitis media. DESIGN: Intervention study assessing prevalence of ear disease and skin infections before and at six monthly intervals after opening of swimming pools. SETTING: Two remote Aboriginal communities in Western Australia. PARTICIPANTS: 84 boys and 78 girls aged < 17 years. MAIN OUTCOME MEASURES: Changes in prevalence and severity of pyoderma and perforation of tympanic membranes with or without otorrhoea over 18 months after opening of pools. RESULTS: In community A, 61 children were seen before the pool was opened, and 41, 46, and 33 children were seen at the second, third, and fourth surveys. Equivalent figures for community B were 60, 35, 39, and 45. Prevalence of pyoderma declined significantly from 62% to 18% in community A and from 70% to 20% in community B during the 18 months after the pools opened. Over the same period, prevalence of severe pyoderma fell from 30% to 15% in community A and from 48% to 0% in community B. Prevalence of perforations of the tympanic membrane fell from 32% in both communities to 13% in community A and 18% in community B. School attendance improved in community A. CONCLUSION: Swimming pools in remote communities were associated with reduction in prevalence of pyoderma and tympanic membrane perforations, which could result in long term benefits through reduction in chronic disease burden and improved educational and social outcomes.

Absenteeism↗
PubMed2003

Studies of maternal immunisation with pneumococcal polysaccharide vaccine in Papua New Guinea.

In two studies, pneumococcal polysaccharide (Pnc PS) vaccine was given to more than 400 pregnant Papua New Guinean women. No deleterious effects were found. The vaccine prevented acute lower respiratory infection (ALRI) among offspring in utero or aged 1-17 months at the time of maternal immunisation, suggesting protection through breast feeding. Serum IgG antibody titres were higher in vaccinated than unvaccinated groups for 2-4 months after delivery and no immune suppression, evaluated by the response to subsequent Pnc PS vaccination, was detected. Breast milk IgA to four serotypes was 1.1-1.8 times higher in immunised than unimmunised women for 6 months postpartum. Given results from several developing countries, large-scale safety and efficacy trials are now justified. Postpartum maternal immunisation is another intervention under consideration.

Adult↗
PubMed2003

Predictors of neonatal sepsis in developing countries.

BACKGROUND: Neonatal infections are a major cause of death worldwide. Simple procedures for identifying infants with infection that need referral for treatment are therefore of major public health importance. METHODS: We investigated 3303 infants <2 months of age presenting with illness to health facilities in Ethiopia, The Gambia, Papua New Guinea and The Philippines, using a standardized approach. Historical factors and clinical signs predicting sepsis, meningitis, hypoxemia, deaths and an ordinal scale indicating severe disease were investigated by logistic regression, and the performance of simple combination rules was explored. RESULTS: In multivariable analysis, reduced feeding ability, no spontaneous movement, temperature >38 degrees C, being drowsy/unconscious, a history of a feeding problem, history of change in activity, being agitated, the presence of lower chest wall indrawing, respiratory rate >60 breaths/min, grunting, cyanosis, a history of convulsions, a bulging fontanel and slow digital capillary refill were independent predictors of severe disease. The presence of any 1 of these 14 signs had a sensitivity for severe disease (defined as sepsis, meningitis, hypoxemia, or radiologically proven pneumonia) of 87% and a specificity of 54%. More stringent combinations, such as demanding 2 signs from the list, resulted in a considerable loss of sensitivity. By contrast only slight loss of sensitivity and considerable gain of specificity resulted from reducing the list to 9 signs. Requiring the presence of fever and any other sign produced a diagnostic rule with extremely low sensitivity (25%). CONCLUSIONS: Physical signs can be used to identify young infants at risk of severe disease, however with limited specificity, resulting in large numbers of unnecessary referrals. Further studies are required to validate and refine the prediction of severe disease, especially in the first week of life, but there appear to be limits on the accuracy of prediction that is achievable.

Bacterial Infections↗
PubMed2002

Maternal immunization with pneumococcal polysaccharide vaccine in the highlands of Papua New Guinea.

In Tari, Southern Highlands Province (SHP), Papua New Guinea (PNG), pneumococcal polysaccharide (Pnc PS) vaccine was offered to women at 28-38 weeks gestation. Blood samples were collected for measurement of pneumococcal antibody titres prior to immunization, from mother and cord at delivery and from their children at ages 1-3 and 4-6 months; samples were also collected in a subset of children before and 1 month after Pnc PS vaccine was given at age 8-9 months. Serum was collected from unimmunized women and their children at delivery and from children of unimmunized women at the same ages in infancy. There were no differences in neonatal or post-neonatal mortality rates or congenital abnormalities in the children of 235 immunized and 202 unimmunized women. There was a significant increase in antibody titres to pneumococcal serotypes 5, 14 and 23F in immunized women but not for serotype 7F. Geometric mean titres (GMTs) of antibodies for serotypes 5 and 23F were significantly higher in children of immunized women than in the unimmunized group up to age 2 months and for serotype 14 significantly higher to age 4 months. Maternal immunization did not significantly affect the children's capacity to make antibody responses to immunization with Pnc PS vaccine in infancy. The findings of this study and those in several other developing countries provide support for the concept of Pnc PS maternal immunization and justify the planning of large-scale efficacy trials.

Adult↗
PubMedDate not supplied

Demography and causes of death among the Huli in the Tari Basin.

Monthly demographic surveillance by local reporters was continuous in the Tari Basin from 1971 until 1995 and cause of death was determined primarily by verbal autopsy. In 1982 the de jure population was 26,500, 15% aged less than 5 years. Crude birth rate was 34/1000/annum in 1980-1984; from 1977 to 1983 crude mortality rate was 15/1000/annum and life expectancy at birth 50 years. Infant mortality fell from 160 in the 1920s to 72/1000 livebirths in the 1970s, the greatest decline occurring between 1952 and 1971 when antibiotics became widely available. Respiratory disease (particularly chronic lung disease in adults) accounted for 39% of all deaths, and pneumonia for 50% and 33% of infant and toddler deaths respectively. Very few deaths from pigbel have occurred since the introduction of pigbel vaccine. Initially childhood mortality from diarrhoea declined following introduction of an oral rehydration program but subsequently rose when medical attention was no longer sought and children were inadequately treated at home. The higher mortality in the lower-lying Iumu area was attributed to malaria. Since the opening of the Highlands Highway in 1981, there has been a dramatic increase in short-term movement of both men and women in and out of Tari resulting in increased incidence of sexually transmitted diseases and viral infections such as measles. If restored, the Tari Research Unit could continue to play a key role in assisting the Department of Health in making decisions on appropriate interventions to improve the quality of life of Papua New Guineans.

Adolescent↗