Impact of the national targeted Hepatitis A immunisation program in Australia: 2000–2014

In November 2005, hepatitis A vaccine was funded under the Australian National Immunisation Program for Aboriginal and Torres Strait Islander (Indigenous) children aged 12–24 months in the targeted jurisdictions of Queensland, South Australia, Western Australia and the Northern Territory.We reviewed the epidemiology of hepatitis A from 2000 to 2014 using data from the Australian National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database, and Australian Bureau of Statistics causes-of-death data. The impact of the national hepatitis A immunisation program was assessed by comparison of pre-vaccine (2000–2005) and post-vaccine time periods (2006–2014), by age group, Indigenous status and jurisdiction using incidence rate ratios (IRR) per 100,000 population and 95% confidence intervals (CI).The national pre-vaccine notification rate in Indigenous people was four times higher than the non-Indigenous rate, and declined from 8.41 per 100,000 (95% CI 5.03–11.79) pre-vaccine to 0.85 per 100,000 (95% CI 0.00–1.99) post-vaccine, becoming similar to the non-Indigenous rate. Notification and hospitalisation rates in Indigenous children aged <5 years from targeted jurisdictions declined in the post-vaccine period when compared to the pre-vaccine period (notifications: IRR = 0.07; 95% CI 0.04–0.13; hospitalisations: IRR = 0.04; 95% CI 0.01–0.16). As did notification rates in Indigenous people aged 5–19 (IRR = 0.08; 95% CI 0.05–0.13) and 20–49 years (IRR = 0.06; 95% CI 0.02–0.15) in targeted jurisdictions. For non-Indigenous people from targeted jurisdictions, notification rates decreased significantly in children aged <5 years (IRR 0.47; 95% CI 0.31–0.71), and significantly more overall (IRR = 0.43; 95% CI 0.39–0.47) compared to non-Indigenous people from non-targeted jurisdictions (IRR = 0.60; 95% CI 0.56–0.64).The national hepatitis A immunisation program has had a significant impact in the targeted population with relatively modest vaccine coverage, with evidence suggestive of substantial herd protection effects.     

Nursing home admission in elderly subjects with dementia: predictive factors and future challenges

ObjectivesThe aim of this study was to identify factors predictive of nursing home admission (NHA) over a period of 1 year among elderly subjects with dementia.MethodsThe study population was drawn from the SAFES cohort that was formed within a national research program into the recruitment of emergency departments in 9 teaching hospitals. Subjects were to have been hospitalized in a medical ward in the same hospital as the emergency department to which they were initially admitted. Subjects who experienced NHA before emergency department admission were excluded. Those with a confirmed diagnosis of dementia were considered in the present analysis. NHA has been defined as the incident admission into either a nursing home or other long term care facility within the follow-up period. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 1-year NHA.ResultsThe 425 subjects of the study were 86 ± 6 years old, and were mainly women (63%). NHA rate was 40% (n = 172). Four factors were identified to increase NHA risk: age 85 or older (hazard ratio [HR] = 1.5; 95% confidence interval [CI] = 1.1–2.1), inability to use the toilet (HR = 2.5; 95% CI = 1.5–4.2), balance disorders (HR = 1.5; 95% CI = 1.1–2.1), and living alone (HR = 1.5; 95% CI = 1.1–2.1). Three factors decreased this risk significantly: inability to transfer (HR = 0.5; 95% CI = 0.3–0.8), increased number of children (HR = 0.88; 95% CI = 0.96–0.99), and increased initial Mini-Mental State Examination score (HR = 0.97; 95% CI = 0.8–0.9).ConclusionNHA determinants in dementia are strongly linked to the patient’s own characteristics but also to his or her physical or social environment. Interventions should target both members of the dyad “patient-caregiver” because both are affected by the disease.     

Incremental effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia hospitalisation among Australian Indigenous children: A record linkage study

BackgroundThe impact of pneumococcal conjugate vaccines (PCVs) on pneumonia in children is well-documented but data on 23-valent pneumococcal polysaccharide vaccine (PPV23) are lacking. Between 2001 and 2011, Indigenous children in Western Australia (WA) were recommended to receive PPV23 at 18–24 months of age following 3 doses of 7-valent PCV. We evaluated the incremental effectiveness of PPV23 against pneumonia hospitalisation.MethodsIndigenous children born in WA between 2001 and 2012 who received PCV dose 3 by 12 months of age were followed from 18 to 60 months of age for the first episode of pneumonia hospitalisation (all-cause and 3 subgroups: presumptive pneumococcal, other specified causes, and unspecified). We used Cox regression modelling to estimate hazard ratios (HRs) for pneumonia hospitalisation among children who had, versus had not, received PPV23 between 18 and 30 months of age after adjustment for confounders.Results11,120 children had 327 first episodes of all-cause pneumonia hospitalisation, with 15 (4.6%) coded as presumptive pneumococcal, 46 (14.1%) as other specified causes and 266 (81.3%) unspecified. No statistically significant reduction in all-cause pneumonia was seen with PPV23 (HR 1.11; 95% CI: 0.87–1.43), but the direction of the association differed for presumptive pneumococcal (HR 0.47; 95% CI: 0.16–1.35) and specified (HR 0.89; 95% CI: 0.49–1.62) from unspecified causes (HR 1.13; 95% CI: 0.86–1.49). During the baseline period before PPV23 vaccination (12–18 months), all-cause pneumonia risk was higher among PPV23-vaccinated than unvaccinated children (RR: 1.73; 95% CI: 1.30–2.28).ConclusionIn this high-risk population, no statistically significant incremental effect of a PPV23 booster at 18–30 months was observed against hospitalised all-cause pneumonia or the more specific outcome of presumptive pneumococcal pneumonia. Confounding by indication may explain the slight trend towards an increased risk against all-cause pneumonia. Larger studies with better control of confounding are needed to further inform PPV23 vaccination.     

Increased risk of adverse maternal and infant outcomes among women with renal disease

We conducted a retrospective population-based study to estimate the risk of adverse maternal and neonatal outcomes in women with a diagnosis of renal disease during pregnancy. One hundred and sixty-nine women with renal disease who gave birth to a singleton infant between 1987 and 1993 were identified through linked Washington State hospital discharge and birth certificate databases. For comparison, 506 women without renal disease matched for year of delivery were selected. Women with renal disease were at increased risk of pre-eclampsia [OR = 7.2, 95% CI 4.2–12.5], preterm labour [OR = 7.9, 95% CI 1.9–32.6], dysfunctional labour [OR = 3.6, 95% CI 1.1–11.5], and caesarean section [OR = 3.1, 95% CI 2.0–4.8]. They were also at increased risk of delivering infants who were small for gestational age [OR = 5.3, 95% CI 2.8–10.0], preterm [OR = 6.1, 95%CI 3.3–11.3], and had 5-minute Apgar scores of less than 7 [OR = 3.9, 95% CI 1.1–14.6]. These associations persisted in analyses restricted to women without chronic hypertension. Women with renal disease and their infants also had median hospital charges that were more than twice those of women without renal disease and were more likely to be hospitalised longer. These data demonstrate that, independent of chronic hypertension, women with underlying renal disease are at increased risk of adverse maternal and perinatal outcomes and use more resources than women without renal disease.     

Relative effectiveness of COVID-19 vaccination with 3 compared to 2 doses against SARS-CoV-2 B.1.1.529 (Omicron) among an Australian population with low prior rates of SARS-CoV-2 infection

BackgroundWe estimate effectiveness of 3 versus 2 vaccine doses against SARS-CoV-2 B.1.1.529 Omicron in a mostly infection-naiive but highly vaccinated Australian population.MethodsCohort study of adults aged 40+ years resident in Sydney followed from 1 January 2022 for SARS-CoV-2 infection and COVID-19 hospitalisation or death using linked immunisation, disease notification and hospitalisation registers. Adjusted hazard ratios (aHR) and corresponding relative vaccine effectiveness (rVE) were estimated comparing 3 to 2 vaccine dose recipients by time since dose receipt, vaccine brand, and prior infection. Absolute risk reductions and numbers needed to boost by age groups were calculated.Results2,053,123 infection-naiive individuals (mean age 59 years) were followed for 327,272 person-years for infection and 224,269 person-years for severe outcomes (hospitalisation/death). There were 175,849 infections and 4113 hospitalisations/deaths. Compared to individuals receiving dose 2 within the last 3 months, rVE in dose 3 recipients was 7% (95% CI 5–9%) against infection and 65% (95%CI 61–69%) against hospitalisation/death. Almost all dose 3 recipients had an mRNA vaccine; there was little difference in dose 3 rVE by primary course vaccine brand (ChAdOx1 versus BNT162b2). Over the 6-week follow-up, we estimated one hospitalisation/death was avoided for every 192 adults aged ≥70 years boosted with dose 3 in the infection-naiive cohort. The aHR for hospitalisation/death from Omicron was 0.12 (95 %CI 0.07–0.23) for 2-dose recipients with a prior Delta infection compared with 2-dose recipients with no prior infection.ConclusionsReceipt of a third COVID-19 vaccine dose in adults aged 40 years and above significantly reduced hospitalisations and deaths from SARS-CoV-2 Omicron infections in a primarily infection-naiive population.     

Bicycle helmet campaigns and head injuries among children. Does poverty matter?

Objectives   To assess the impact of a community-based bicycle helmet programme aimed at children aged 5–12 years (about 140 000) from poor and well-off municipalities.
Methods   A quasi-experimental design, including a control group, was used. Changes in the risk of bicycle-related head injuries leading to hospitalization were measured, using rates ratios.
Results   Reductions in bicycle-related head injuries were registered in both categories of municipalities. Compared with the pre-programme period, the protective effect of the programme during the post-programme period was as significant among children from poor municipalities (RR 0.45; 95% CI 0.26–0.78) as among those from richer municipalities (RR 0.55; 95% CI 0.41–0.75).
Conclusion   Population-based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.     

Vaccination status and sequence of vaccinations as risk factors for hospitalisation among outpatients in a high mortality country

Background

Most developing countries are implementing the WHO immunisation programme. Although vaccines reach most children, many modifications of the recommended schedule are observed in practice. We investigated the association between vaccination status and risk of hospitalisation in Guinea-Bissau.

Methods

From May 2003 to May 2004, all consultations of children less than five years of age at the outpatient clinic of the paediatric ward at the national hospital in Bissau were registered. For each consultation, information was collected about the child's name, sex, age and socio-cultural conditions, as well as diagnosis and whether the child was hospitalised. Information about vaccinations was also registered from the child's vaccination card. We analysed the association between vaccination status and risk of hospitalisation in age intervals according to the pre-dominant vaccines. We particularly emphasised the comparison of those who had received the recommended vaccination for the age groups and those who were delayed and only had the previous vaccinations. We also examined those who had received the vaccines out of sequence.

Results

Information about vaccinations was available for 11,949 outpatient children of whom 2219 (19%) were hospitalised. Among children less than 3 months of age, unvaccinated children compared to BCG children had as expected a higher risk of hospitalisation; controlled for important determinants of hospitalisation, the hospitalisation risk ratio (HRR) was 1.99 (95% CI 1.37-2.89). In contrast, there was no difference in the HRR for children aged 1 ½ -8 months who were delayed and had only received BCG compared to those who as recommended had received diphtheria-tetanus-pertussis (DTP) vaccine after BCG (HRR = 1.10 (0.77-1.59)). In the age interval 9-17 months of age, children who were delayed and had only received DTP had significantly higher risk of hospitalisation compared with children who as recommended had measles vaccine (MV) as the most recent vaccination (HRR = 1.39 (1.16-1.66)). Having received DTP after MV (HRR = 1.60 (1.15-2.24)) or MV and DTP simultaneously (HRR = 1.51 (1.16-1.97)) was also associated with higher risk than MV only as most recent vaccination. In contrast, the children aged 18-59 months who as recommended had received a DTP booster after MV did not have lower risk of hospitalisations compared with children who were delayed and had received only MV (RR = 0.90 (0.75-1.07)). After 9 months of age, there was a significant difference in the female-male HRR for children who had MV (HRR = 0.85 (0.72-1.00)) or DTP (HRR = 1.08 (0.96-1.22)) as most recent vaccination (p = 0.02, test of interaction).

Conclusion

Following the recommended vaccination schedule for BCG and MV is associated with a reduced risk of hospitalisation but this is not the case for DTP and booster DTP. Receiving DTP simultaneously with MV or after MV is associated with increased risk of hospitalisation. Vaccines have sex-differential effects on the risk of hospitalisation.     

Intentional self‐harm and assault hospitalisations and treatment cost of children in Australia over a 10‐year period

Objective: To examine the magnitude, 10‐year temporal trends and treatment cost of intentional injury hospitalisations of children aged ≤16 years in Australia. Method: A retrospective examination of linked hospitalisation and mortality data for children aged ≤16 years during 1 July 2001 to 30 June 2012 with self‐harm or assault injuries. Negative binomial regression examined temporal trends. Results: There were 18,223 self‐harm and 13,877 assault hospitalisations, with a treatment cost of $64 million and $60.6 million, respectively. The self‐harm hospitalisation rate was 59.8 per 100,000 population (95%CI 58.96–60.71) with no annual decrease. The assault hospitalisation rate was 29.9 per 100,000 population (95%CI 29.39–30.39) with a 4.2% annual decrease (95%CI ?6.14– ?2.31, p<0.0001). Poisoning was the most common method of self‐harm. Other maltreatment syndromes were common for children ≤5 years of age. Assault by bodily force was common for children aged 6–16 years. Conclusions: Health professionals can play a key role in identifying and preventing the recurrence of intentional injury. Psychosocial care and access to support services are essential for self‐harmers. Parental education interventions to reduce assaults of children and training in conflict de‐escalation to reduce child peer‐assaults are recommended. Implications for public health: Australia needs a whole‐of‐government and community approach to prevent intentional injury.     

The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies

Background/aim:  Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor.
Methods:  Eight databases (1985–2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data.
Results:  Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls.
Cohort:  Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97–1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03–1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59–2.71) and institutional (OR = 1.77; 95% CI: 1.66–1.89) settings.
Conclusions:  Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.     

Clustering of Cardiovascular Disease Risk Factors and Health-Related Quality of Life among US Adults

Objective:  To assess the association of clusters of multiple cardiovascular disease (CVD) risk factors with health-related quality of life (HRQOL) among US adults aged 18 years or older in 2003.
Methods:  Data from the 2003 Behavioral Risk Factor Surveillance System were analyzed. The four HRQOL questions developed by the Centers for Disease Control and Prevention were used. The CVD risk factors included diabetes, hypertension, high cholesterol, obesity, and current smoking.
Results:  The adjusted odds ratios of having four or more CVD risk factors were 14.0 (95% confidence interval [CI] 12.4–16.0) for poor or fair health, 6.4 (95% CI 5.6–7.3) for 14 or more physically unhealthy days, 4.8 (95% CI 4.2–5.6) for 14 or more mentally unhealthy days, and 8.0 (95% CI6.8–9.3) for 14 or more impaired activity days compared to having none of the five risk factors. A greater number of CVD risk factors was significantly associated with an increasing likelihood of having poor or fair health ( P ₁ < 0.0001 for linear trend, P ₂ < 0.0001 for quadratic trend), 14 or more physically unhealthy days ( P ₁ < 0.0001, P ₂ < 0.0001), 14 or more mentally unhealthy days ( P ₁ < 0.0001, P ₂ = 0.02), and 14 or more impaired activity days ( P ₁ < 0.0001, P ₂ < 0.0001).
Conclusions:  A greater number of multiple CVD risk factors may be associated with more detrimental impairment of HRQOL. Preventing or reducing the clustering of multiple CVD risk factors to improve HRQOL is needed among adults.     

The nutritional intake supplied by enteral formulae used in older children (aged 7–12 years) on home tube feeds

Background:  In the UK, patients aged 6–12 years contribute more than one-third of children on home enteral tube feeds (HETF). Many enteral feeds are given to this age group. The present study aimed to investigate the formula with the best nutritional composition for children aged 7–12 years on HETF by comparing the nutrient intake of three feed types; a paediatric feed (PF) for 1–6 year olds, an adult feed (AF), and a feed for children (OCF) aged 7–12 years.
Methods:  Twenty-five HETF children aged 7–14 years (median 10 years) were given a 6.3 kJ mL⁻¹ enteral feed designed for 7–12 year olds (or weighing 21–45 kg) for 9 months. Nutrient intakes on the 7–12-year-old feed were compared with baseline feed (paediatric n  = 10; or adult n  = 15).
Results:  At baseline, the PF failed to meet 100% of the reference nutrient intake (RNI) for three of 19 (16%) of the nutrients studied, whereas AF provided in excess of 250% of the RNI for six of 19 (32%) of the nutrients. During the trial, the nutrients on the OCF were two of 19 (11%) <100% and four of 19 (21%) >250% of the RNI. Only seven of 10 (70%) children on a PF met at least 100% of the UK RNI for calcium, compared to 17 of 19 (89%) on the OCF.
Conclusions:  It is important to offer older children an enteral feed that provides an optimal level of nutrients to meet their nutritional requirements. Feeds designed for 7–12-year-old children more closely meet nutrient requirements than paediatric or adult formulae, but require further modification to fully meet the nutritional needs of this group.     

2010年与2020年沈阳市3~6岁儿童睡眠时间与超重肥胖的变化及相互关系

  目的  描述2010年和2020年沈阳市3~6岁儿童超重肥胖变化情况,探讨睡眠时间与超重肥胖之间的关系,为今后开展儿童肥胖防制工作提供参考依据。  方法  采用方便抽样方法,2020年在沈阳市抽取6所幼儿园,在知情同意情况下,对全体儿童进行身高和体重测量,同时对家长进行问卷调查。比较2010年在同一区10所幼儿园儿童的身高体重数据及调查问卷中所需要的内容,统计分析10年间儿童睡眠时间和超重肥胖的变化情况并探讨睡眠时间对儿童超重肥胖发生的影响。  结果  2020年参与调查的3~6岁儿童共623人。2010年共574名3~6岁儿童的调查问卷被采用。与2010年比较,2020年3~6岁儿童的年龄和性别差异均无统计学意义(均有P＞0.05);2020年儿童身高、体重以及BMI均明显增加(均有P＜0.05)。2020年儿童肥胖检出率(14.9%)明显高于2010年(10.5%,P＜0.05)。多因素logistic回归分析模型分析结果显示,2010年睡眠时间＜8 h组的儿童超重检出率是正常儿童的2.51倍(95% CI: 1.22~5.19),其肥胖检出率是正常儿童的2.78倍(95% CI: 1.17~6.23)。2020年睡眠时间8~9 h组的儿童超重检出率是正常儿童的2.71倍(95% CI: 1.34~5.48),其肥胖检出率是正常儿童的2.25倍(95% CI: 1.09~4.67)。  结论  2010―2020年,沈阳市3~6岁儿童的超重肥胖率呈明显增加趋势。2010年儿童睡眠时间＜8 h和2020年睡眠时间在8~9 h的儿童超重肥胖的风险增加。     

Violence against women by their intimate partner and common mental disorders

The World Health Organization considers gender violence a cause of anxiety, depression and suicidal thoughts among women. This study investigated the association between violence committed against women by their intimate partners, defined by psychologically, physically and sexually abusive acts, and common mental disorders, assessed by using the Self Reporting Questionnaire (SRQ-20). A population-based household survey was carried out among women aged 15–49 years in two sites: São Paulo, the largest Brazilian city, and Zona da Mata of Pernambuco, a region with both urban and rural areas in the Northeast of the country. A large proportion of women reported violence (50.7%). The most frequent forms were psychological violence alone (18.8%) or accompanied by physical violence (16.0%). The prevalence of mental disorders was 49.0% among women who reported any type of violence and 19.6% among those who did not report violence (p < 0.0001). After adjustment for demographic and socioeconomic characteristics, the nature of the relationship, stressful life events and social support, all the forms of violence studied, with the exception of sexual violence alone or accompanied by either physical or psychological violence (p = 0.09), were significantly associated with mental disorders: physical violence alone (OR 1.91; CI 95% 1.2–3.0), psychological violence alone (OR 2.00; CI 95% 1.5–2.6), sexual violence alone or accompanied by either physical or psychological violence (OR 1.80; CI 95% 0.9–3.6), both psychological and physical violence (OR 2.56; CI 95% 1.9–3.5) and all three forms of violence (OR 2.68; CI 95% 1.8–4.0).This is the first population-based study on the association between intimate partner violence and mental health in Brazil. It contributes to the existing body of research and confirms that violence, frequently experienced by women in the country, is associated with mental disorders. Policies and strategies aimed at reducing gender-based violence are necessary for preventing and reducing anxiety and depression among women.     

Non-specific benefit of seasonal influenza vaccine on respiratory syncytial virus-hospitalisations in children: An instrumental variable approach using population-based data

BackgroundSeasonal influenza vaccine is effective against influenza hospitalisations, but little is known about non-specific effects of the vaccine on other respiratory pathogens with similar seasonal patterns. We aimed to assess the causal impact of seasonal influenza vaccine on laboratory-confirmed hospitalisations for respiratory syncytial virus (RSV) in children using an instrumental variable (IV) strategy.MethodsWe used probabilistically linked population-based data on childhood immunisations, births, deaths, hospitalisations, perinatal factors, and microbiology test results (2000–2013) of all Western Australian (WA) children born 2000–2012, observed longitudinally until the earliest of 7 years of age or 31 December 2013. We exploited a unique natural experiment created from the WA’s state-funded preschool influenza vaccination policy commencing in 2008 and used this as an instrument for children’s seasonal influenza vaccination status. We estimated a system of two simultaneous probit equations: determinants of influenza vaccine uptake, and determinants of RSV-confirmed hospitalisation.ResultsInfluenza vaccine coverage was low prior to 2008 but increased to 36 % in children aged 6–23 months in 2009. The majority (90 %) of RSV-hospitalisations occurred in children <2 years. Receipt of influenza vaccine reduced RSV-hospitalisations, especially in those <2 years with a rate reduction of 2.27 per 1000 (95 % CI: −3.26; −1.28), and a smaller rate reduction of 0.53 per 1000 (95 % CI: −1.04; −0.02) in those 2–7 years. Over the 5-year period (2008–2013), the state-funded preschool-influenza vaccine program resulted in 1,193 fewer RSV-hospitalisations. Of these, 793 (67 %) were in young children <2 years.ConclusionsTo our knowledge, this is the first analysis utilising an IV estimation strategy on a population level to assess the causal impact of seasonal influenza vaccine on risk of RSV-hospitalisations. We estimated a small protective effect that warrants further investigation.     

Low birthweight and risk of mild mental retardation by ages 5 and 9 to 11

Summary. This prospective analysis assessed the risk of mild mental retardation (MMR) associated with low birthweight (LBW) in the Child Health and Development Studies. Scores of 50–70 on the Raven Progressive Matrices, a relatively culture-free test of cognitive functioning, were used to categorise MMR. At the age of 5,13.8% of the 195 children with birthweights less than 2500 g (LBW) were MMR, whilst 4.2% of the 2293 children with normal birthweights (>2955 grams) were MMR. After adjusting for confounders (maternal age, race, education, prenatal alcohol use, maternal conditions, and congenital anomalies), the relative risk of MMR for LBW was 3.4 (95% CI 1.2–5.4). For children aged 9–11, 7.7% of 194 LBW children were MMR, compared with 6.2% of the 2546 with normal birthweights; the adjusted relative risk for LBW was 1.2 (95% CI 0.7–2.0). Although a strong association between LBW and MMR was observed for both blacks and non-blacks at the age of 5, the association between birthweight and MMR was apparent only for blacks in the cohort of children aged 9–11. These findings suggest that race, a marker for environmental factors which were not measured in this study, may modify the LBW and MMR relationship.     

Changes in the prevalence of asthma, eczema and hay fever in pre-pubertal children: a 40-year perspective

Surveys of primary schools children in Aberdeen carried out in 1964, 1989, 1994 and 1999 suggested a slowing of the increase in parent-reported wheeze between 1994 and 1999. To assess whether this pattern had continued, questionnaires were distributed to 5712 children aged 7–12 years in the same schools in 2004. A total of 3271 (57.3%) completed questionnaires were returned. As in earlier surveys the results were divided into those for younger children (school years 3–4; age 7–9 years) and older children (school years 5–7; age 9–12 years).
Compared with 1999, the 2004 results showed a decrease in the proportion of children with wheeze in the last 3 years from 30.1% to 23.3% ( P  < 0.001) in the younger group and from 27.6% to 25.1% ( P  = 0.052) in the older group. There was no significant change in the lifetime prevalence of asthma in either the younger or the older group, but the lifetime prevalence of eczema and hay fever increased by around 10% in both the younger and older groups (all P  < 0.001). The differences in the time trends for the different conditions suggest that the causal factors for wheeze and asthma differ from those for other allergic diseases of childhood.     

Monitoring of community-acquired pneumonia hospitalisations before the introduction of pneumococcal conjugate vaccine into Polish National Immunisation Programme (2009–2016): A nationwide retrospective database analysis

PurposeCommunity-acquired pneumonia (CAP) is a common infection with significant morbidity and mortality. In January 2017, Poland introduced pneumococcal conjugate vaccine (PCV) into their national immunisation programme to protect children against invasive pneumococcal disease. This study was designed to investigate pneumonia-related hospitalisation rates and trends from 2009 to 2016 prior to the introduction of nationally funded PCV vaccination.MethodsUsing national public statistic data available from the National Institute of Public Health – National Institute of Hygiene, annual hospitalisation rates for pneumonia were analysed, categorised by aetiology and age (<2, 2–3, 4–5, 6–19, 20–59, 60+ years). Trends over time were assessed, as well as in-hospital mortality.ResultsThe overall hospitalisation rate due to pneumonia varied between 325.9 and 372.2/100,000 population. Higher rates of hospitalisation were seen in older adults and children ≤5 years. Trends were observed when analysing hospitalisations by pneumonia aetiology within age groups: between 2009 and 2016, Streptococcus pneumoniae hospitalisations significantly increased for children aged <2, 2–3, and 4–5 years, from 5.3 to 12.4, 5.2 to 8.2, and 1.9 to 4.6/100,000 population respectively. Whereas hospitalisations due to Haemophilus influenzae pneumonia decreased significantly from 7.8 to 1.8 and 4.8 to 1.9/100,000 children aged <2 and 2–3 years respectively. The numbers of in-hospital deaths increased from 5578 in 2009 to 8149 in 2016, with >85% of deaths in the 60+ age group.ConclusionsThis is the first national study of pneumonia hospitalisations in Poland, providing the baseline data from which to investigate the impact of the change in vaccination policy on pneumonia hospitalisations in Poland.