Evaluation of the neonatal hepatitis B vaccination program in infants born to Chinese mothers.
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Child Health Services↗
Biomedical subjects
M J Ferson
Publications and source records attributed to M J Ferson.
Hepatitis B and C in New South Wales prisons: prevalence and risk factors.
OBJECTIVES: To determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among inmates entering the New South Wales correctional system and to examine risk factors for infection. DESIGN: Cross-sectional survey. SETTING: Reception Centre at Long Bay Correctional Centre, Sydney, New South Wales, June to December 1994. PARTICIPANTS: 408 adult male inmates received at the Reception Centre (28% of the 1450 new inmates eligible for compulsory HIV testing). OUTCOME MEASURES: Presence of HBV core and surface antibody and surface antigen; HCV antibody; risk factors; inmates' knowledge about risk factors. RESULTS: 37% of inmates tested positive for HCV antibody, 31% for HBV core antibody and 3.2% for HBV surface antigen (indicating recent infection or carrier status). Among those who reported a history of injecting illegal drugs, rates rose to 66% for HCV antibody and 43% for HBV core antibody. Prevalence of HBV and HCV antibodies was similar in Aboriginal and non-Aboriginal inmates, but HBV antigen carrier rate was significantly higher among Aboriginals (12% versus 2.2%). Knowledge about hepatitis risk factors was poor (only 20% named injecting drug use), although recidivists were significantly better informed than those new to the correctional system. Multivariate analysis identified injecting drug use, past exposure to hepatitis B virus and previous imprisonments as significant predictors for HCV infection, and age over 25 years and HCV antibodies for HBV infection. CONCLUSIONS: Results suggest that about a third of adult male prisoners entering the NSW correctional system may have been infected with HBV or HCV. Measures such as education about hepatitis risk factors and HBV vaccination are needed to reduce hepatitis transmission in this population.
Acquired Immunodeficiency Syndrome↗
Longitudinal study of rotavirus infection in child-care centres.
OBJECTIVE: To describe the epidemiology of symptomatic and asymptomatic rotavirus infection among young children attending Sydney child-care centres during the 1994 rotavirus season. METHODS: Children aged 0-36 months in 11 child-care centres participated in the study. A weekly stool specimen was collected from each subject and tested for rotavirus antigen by commercial enzyme immunoassay. RESULTS: One hundred and seventy-eight children (76 girls and 102 boys) with a mean age of 18.2 +/- 6.5 (SD) months were enrolled for a total of 2249 child-weeks. Of 1653 weekly faecal specimens, 59 (3.6%) were positive for rotavirus antigen. Positivity for rotavirus antigen peaked at 8.0% and 7.4% of specimens in weeks 6 and 7, respectively. The 59 positive specimens were obtained from 44 children in eight of the 11 study centres. One child appeared to suffer a second episode. Eighty-two per cent of episodes were associated with symptoms of gastroenteritis. Overall, 32% of the children in the eight affected centres were infected; 52% of those < 12 months were infected compared to 26% of older children. Secondary spread to household contacts was also documented. CONCLUSIONS: Rotavirus infection poses a significant health problem in under-3-year-old children attending child-care centres in Sydney. We believe that these results are applicable to all Australian children of this age attending group child care.
Animals↗
Antibiotic management of pneumococcal infections in an era of increased resistance.
Pneumococci are a leading cause of bacterial meningitis and bacteraemia, as well as pneumonia, otitis media and sinusitis in childhood. These organisms recently have shown a dramatic increase in antibiotic resistance. Penicillin-resistant pneumococci are of special concern as they are often resistant to other unrelated antibiotics. This is of particular significance to Aboriginal children who have among the highest rates of pneumococcal infection in the world. Laboratories should now test all invasive pneumococcal isolates for penicillin and third generation cephalosporin resistance. Local treatment guidelines are required for pneumococcal infections, especially for meningitis, taking into account the prevalence of resistant strains within the community. At present, penicillin and amoxycillin remain the drugs of choice for pneumococcal infections, with the exception of meningitis where initial empirical therapy must be with a third generation cephalosporin. Judicious antibiotic use, which avoids over-prescribing and unnecessary use of broad-spectrum agents, improved living standards in underprivileged communities and introduction of an effective conjugate vaccine, able to reduce the rates of pneumococcal infection and hopefully colonization, may limit the spread of resistant strains.
Anti-Bacterial Agents↗
Surveillance for tuberculosis among residents of hostels for homeless men.
Tuberculosis has been recognised as an important health problem among homeless persons. The New South Wales tuberculosis screening program for residents of hostels for the homeless has been in operation for several years, but has not yet been evaluated. This study reviewed the performance of the tuberculosis surveillance program (which uses mobile chest x-ray screening) between 1989 and 1993 at the five major hostels for homeless men in the eastern Sydney area. Reports of the screening x-rays and records of subsequent follow-up examinations at chest clinics were examined; information on cases detected by the screening program was compared with notifications in the same population. Of 3555 residents screened during 23 visits, 506 (14.2 per cent) were found to have an abnormal chest x-ray. However, only two active cases of tuberculosis were diagnosed as a result of the screening program, while seven cases were notified on the basis of clinical presentation. About 50 per cent of those with an abnormal chest x-ray from the screening program were lost to follow-up. Possible reasons for loss to follow-up were: long delays in making chest clinic appointments; short-stay residents changing shelters without trace; and high prevalence of severe mental illness or organic brain syndrome among residents. Raising awareness of the disease among primary health care and welfare staff who work with homeless men may be a more effective approach to improving identification of cases of active tuberculosis in this population.
Health Services Needs and Demand↗
Faecal pollution of ocean swimming pools and stormwater outlets in eastern Sydney.
We determined the levels of faecal contamination over a three-year period from 1991 to 1993 at selected ocean swimming pools and stormwater outlets to assess whether these levels represented a threat to public health. Three popular ocean swimming pools and three nearby stormwater outlets located in Sydney's eastern suburbs were included in the analysis. The ocean swimming pools consistently had elevated levels of faecal coliform bacteria; the highest microbe levels were observed in a pool used largely by children. Faecal coliform bacteria counts in the ocean pools at times reach levels likely to be associated with illness in bathers. Stormwater outlets at three locations had reducing counts over the three-year period. An improved system of sampling, testing and risk communication appears to be needed to reduce potential health risks to users of these popular ocean pools.
Colony Count, Microbial↗
Fragmentation of scheduled visits and missed doses among infants receiving multiple injected vaccines.
A retrospective cohort study was used to determine the extent to which immunisation visits due in the first year of life are split into separate visits. A one-month birth cohort of infants registered in early childhood health centres in the former Eastern Sydney Health Area was followed up when the infants were 8 to 11 months of age. A telephone questionnaire sought documented dates of each dose in the primary series of diphtheria-tetanus-pertussis (DTP), Haemophilus influenzae type b (Hib) and hepatitis B (HBV) vaccination. Of the 141 subjects, 130 had received all due doses of DTP and Hib vaccines and 63 (45 per cent) had been enrolled in the neonatal hepatitis B program. Infants in the latter group received the first DTP-Hib dose on average one week later than did those not in the hepatitis B program (DTP, P = 0.016; Hib, P = 0.047). The greatest percentage of missed DTP or Hib doses occurred in infants not receiving HBV vaccination (7.1 per cent of doses) or those high-risk infants enrolled in the neonatal hepatitis B program (2.9 per cent). Overall, 12 infants had 28 (6.9 per cent) of the 404 possible scheduled visits fragmented into two separate visits. In all cases, parents reported that this was at the suggestion of the general practitioner. We found no greater likelihood of fragmentation for infants who had also received hepatitis B vaccine. Only 17 infants (29 per cent) had received the third hepatitis B vaccine and DTP doses at the same visit, as recommended. These findings confirm anecdotal reports of fragmentation of scheduled visits and missed doses for infants due to receive multiple injections, and some delay in uptake among those receiving hepatitis B vaccine. Universal infant hepatitis B immunisation should not be considered until combination vaccines (which should also include a Hib component) become available in Australia.
Australia↗
Outbreak of hepatitis A among homosexual men in Sydney.
OBJECTIVES: This study examined an outbreak of hepatitis A in eastern Sydney during 1991-1992. METHODS: Data were based on cases of hepatitis A in eastern Sydney residents reported from January 1991 to October 1992. RESULTS: Five hundred seventy cases of hepatitis A were reported. Of these, 515 (90%) occurred in male patients, of whom 330 were reported to be homosexual or bisexual. The highest attack rate (71/10,000) occurred in men aged 20 to 29 years of age. CONCLUSIONS: This outbreak affected large numbers of young homosexual men living in the inner eastern suburbs of Sydney. Hepatitis A vaccination should be considered for all susceptible homosexual men. Further research into the use of hepatitis A vaccine as an outbreak control measure is also recommended.
Adolescent↗
Hospitalisations for rotavirus gastroenteritis among children under five years of age in New South Wales.
OBJECTIVE: To estimate the number of children under five years of age hospitalised for rotavirus gastroenteritis in New South Wales. DESIGN: Retrospective survey with comparison of patterns of hospital admissions for acute gastroenteritis in children under five with laboratory reports of rotavirus infection. SETTING: New South Wales, January 1991-December 1993. OUTCOME MEASURES: Laboratory reports of rotavirus infection to the Eastern Sydney Laboratory Surveillance Program (a voluntary laboratory reporting scheme) and hospital admissions of children under five with principal diagnosis classified under international classification of diseases, 9th revision, clinical modification (ICD-9-CM) codes 008.6, 008.8, 009.0-009.3 and 558.9 from NSW Inpatient Statistics Collection. RESULTS: Rotavirus infections were reported throughout each year (mean, 57 reports per month), with incidence peaks in August or September. Admissions for gastroenteritis showed the same seasonal pattern (correlation coefficient, 0.93). About 3700 children under five were admitted for rotavirus gastroenteritis annually in NSW at an estimated annual cost of 4.6 million dollars. Annual rates were highest for children aged 12-23 months (1800 per 100000 population in age group), intermediate for those aged 0-11 and 24-35 months (810 and 1000 per 100000 in age group, respectively) and lowest for those aged 36-47 and 48-59 months (450 and 190 per 100000 population, respectively, in age group). CONCLUSIONS: Rotavirus is a major cause of morbidity among young children in NSW. Routine infant vaccination against rotavirus could reduce this morbidity and the resulting health costs.
Age Distribution↗
Acyclovir for the prevention and treatment of varicella zoster in children, adolescents and pregnancy.
Varicella causes a mild, self-limiting childhood disease that may reactivate years later as shingles. In immunocompromised patients with altered cell mediated immunity, and rarely in healthy individuals, varicella results in a life-threatening infection. The antiviral drug, acyclovir, substantially reduces the mortality and risk of severe disease in these groups of patients. Early commencement of acyclovir is recommended for children with both varicella and altered cell mediated immunity, newborns during the first 2 weeks of life, preterm infants in the neonatal nursery, and severe varicella or shingles (including ocular zoster) in any patient, as well as during pregnancy. Acyclovir may be considered in children with serious cardiopulmonary disease or chronic skin disorders where varicella may exacerbate the underlying disease or increase the risk of secondary bacterial sepsis. Acyclovir, however, is not recommended for healthy individuals without severe disease, as a prophylactic agent against varicella, for asthmatics receiving aerosolized or low-dose oral steroids and/or as treatment of the post-varicella syndromes. When acyclovir is prescribed it should be given intravenously to those with severe disease, those at risk of dissemination and in children younger than 2 years of age.
Acyclovir↗
Difficulties in clinical diagnosis of measles: proposal for modified clinical case definition.
OBJECTIVE: To examine the accuracy of clinical diagnosis of measles and to develop an improved measles clinical case definition. DESIGN: Case survey. SETTING: Eastern Sydney, December 1990 to August 1993. SUBJECTS: All cases of measles notified to the Eastern Sydney Public Health Unit without or before serological confirmation. OUTCOME MEASURES: Demographic and clinical details, measles- and rubella-specific IgM and measles complement fixation titres in acute and convalescent (when available) sera and epidemiological links with confirmed measles cases. RESULTS: Of 49 subjects reported and with complete follow-up, 24 were confirmed with measles, four with rubella and 21 had no definite diagnosis. Clinical diagnosis of measles had a false positive rate of 51%. Subjects with confirmed measles were significantly more likely to have a cough (23/24) than those with no definite diagnosis (15/21; P = 0.03) and to be febrile on the day of rash onset (23/24 versus 10/21; P = 0.001). The Centers for Disease Control definition had a sensitivity of 92% but specificity of only 24%. A modified case definition of rash, cough and fever present at onset of rash had equal sensitivity but greater specificity (57%). CONCLUSIONS: As measles is no longer common in Australia, clinical diagnosis is unreliable. When a public health response is needed, cases should be confirmed by serological tests or, if not available, we propose use of our modified clinical case definition.
Adolescent↗
School health nurse interventions to increase immunisation uptake in school entrants.
In New South Wales, health screening of school entrants provides the only mechanism for routine monitoring of immunisation uptake in children. School health nurses are in the best position to improve the compliance with immunisation at this age. We compared two interventions to be used by the nurses to increase immunisation uptake in school entrants who reported missing either the measles-mumps vaccine and/or the pre-school diphtheria-tetanus toxoid and oral polio vaccine boosters. Parents in the passive intervention group were sent a letter and leaflet encouraging immunisation; the active intervention group received a telephone reminder from the nurse in addition to the written materials. Both groups were followed up at a later date to assess final immunisation outcome. Of 817 children screened, 88.2% had been immunised against measles and 73.6% had received the booster; 239 children were randomised to the two interventions. Excluding children lost to follow up and those fully immunised at the start of the study, 20 (37%) of 54 were immunised following the passive intervention, and 35 (71%) out of 49 following the active intervention (P = 0.001). Receipt of the letter and leaflet was associated with an increased uptake of booster vaccination (P = 0.036). The active intervention required 14.7 telephone calls and 1.6 uses of the interpreter service per completed immunisation. The passive intervention resulted in worthwhile increases in immunisation rate with minimum cost. A greater improvement in immunisation outcome was achieved by the active intervention, but its use was labour intensive and may only be warranted if high immunisation rates in this age-group are given priority.
Child↗
Another vaccine, another treadmill?
OBJECTIVE: Attention is drawn to possible disadvantages arising from the introduction of universal varicella vaccination in infancy. METHODOLOGY: Comparisons are made between universal infant varicella vaccination and the current measles immunization programme, and a review of current literature on age-specific complications of varicella and cost-benefit analyses of varicella vaccination. RESULTS: Universal infant vaccination will cause a greater proportion of varicella cases to occur in adults, including pregnant women, who are at greater risk of serious complications compared to children. Although economic costs resulting from lost time from work will fall dramatically, health costs may rise. CONCLUSIONS: Universal infant vaccination should only be considered if measles is first controlled, and then only if more information on duration of protection becomes available and combined measles-mumps-rubella-varicella vaccines are approved.
Austria↗
Control of infections in child care.
The control of infections in child-care centres involves vaccination of children and staff, attention to hygiene (particularly to handwashing), exclusion of children (and employees) while infectious and/or grouping of infectious children, separation of toilet-trained children from those in nappies, and judicious use of antimicrobial agents and vaccination during outbreaks. By reporting cases of infectious diseases in patients with child-care contact to public health authorities, doctors can assist in controlling such diseases in child care.
Child↗
Cost effectiveness of prevaccination screening of health care workers for immunity to measles, rubella and mumps.
OBJECTIVES: To determine the value of infection and vaccination histories as predictors of immunity to measles, rubella and mumps, and to compare the costs of various screening strategies with the cost of universal vaccination of health care workers. SETTING: Staff employed by a Sydney children's hospital. METHODS: Histories of measles, rubella and mumps infection or vaccination were compared with the results of serological testing to determine which historical statements had high positive predictive values (PPV) for immunity. Using this, we devised three prevaccination screening strategies and compared their costs with the cost of universal staff vaccination. RESULTS: Of 235 participants, 98.3% were serologically immune to measles, 96.6% to rubella and 83.0% to mumps. Historical statements indicating immunity with a PPV of more than 95% were histories of measles or of rubella vaccination, and personal recollection of mumps infection. Strategies using historical screening were cheaper than universal vaccination, which in turn was cheaper than using serological screening alone. CONCLUSIONS: Among health care workers at occupational risk of measles, rubella and mumps, the need for vaccination can be reduced by combining historical and serological screening. Where screening is felt to impose an administrative burden, a universal vaccination strategy costs 30%-50% more than strategies which use historical screening.
Adult↗
Communicable diseases in child care centres: effects on parental work absenteeism.
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Absenteeism↗
Infections in day care.
The number of preschool-aged children who attend day care has increased dramatically in recent years. Factors promoting spread of infections in this setting include crowding, lack of hygiene, high prevalence of early exploratory behaviors, and the likelihood of many susceptible children being in close contact. As a result, children attending day care experience a great number of episodes of respiratory and gastrointestinal illness than do other children. Moreover, the risk of a number of specific infections, including Haemophilus influenzae type b and hepatitis A, is increased by attendance in day care. Day-care staff are at increased risk of a number of infections, some of which, including cytomegalovirus and parvovirus B19, may have adverse consequences to a fetus. The presence of children in day care increases the risk of illness among staff and family members and may promote the circulation of infections in the community as a whole.
Adult↗
Child care for mildly sick children.
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Child Care↗