ABSTRACT AusVaxSafety (Australia’s active safety surveillance system) used SMS/email delivered surveys to actively solicit the short-term (within first 3 days after vaccination) adverse event profile of mRNA COVID-19 vaccines in children (aged 5–15 years) by age, dose, brand and pre-existing comorbidity. 392,268 survey responses for children aged 5–15 who received a COVID-19 vaccine between July 2021–May 2022 (211,994 following BNT162b2 10mcg in children aged 5–11 years, 173,329 following BNT162b2 30mcg and 6,945 following mRNA-1273 100mcg in adolescents aged 12–15 years) were analysed. Adverse event rates were higher following dose 2 and 3 compared to dose 1 after all vaccines and highest following dose 2 of mRNA-1273 in 12–15 years. Fever was low in the youngest children (5 years old, any dose; 1,090/26,181 (4%)). Medical review rates remained low (0.3% overall) and impact on daily activities was also low (7% overall). No self-reported cases of myocarditis or pericarditis were identified. Ongoing active safety surveillance of lower dose mRNA vaccines in children under 5 years old is required to better understand safety as the vaccines roll out into this population age-group.
Nicholas Wood, Laura López, Catherine Glover et al.
BACKGROUND: Telehealth and telemonitoring is an emerging area of study in people with cystic fibrosis (CF), with the potential of increasing access to care, and minimising infection control risks to patients without compromising their health outcomes. To date, limited evidence is available to support the use of telehealth in paediatric population with CF in a clinical setting. This study aims to investigate the utility of a multimodal telehealth-based outpatient physiotherapy service and assess its effect on quality of life, functional exercise capacity, hospital admission and intravenous antibiotic requirements, lung function, processes of care, participation in activities of daily living, and health economics associated with operating an innovative service. METHOD: This single centre, prospective, parallel, randomised, controlled, non-inferiority trial aims to recruit 110 children with CF between the ages 8 to 18 years of age. Participants will be randomised to the Usual Outpatient Physiotherapy Service group (Usual OPS) or the telehealth intervention group (CyFiT OPS). Quality of life, participation in activity of daily living, functional exercise capacity and patient perception of care will be examined every six months using the Cystic Fibrosis Questionnaire-Revised (CFQ-R), Children's Assessment of Participation and Enjoyment (CAPE), Preferences for Activities of Children (PAC) questionnaire, Modified Shuttle Test-25 (MST25), and Measure of Process of Care (MPOC-20) questionnaire. Physiological measurements collected during routine clinical visits such as spirometry, body weight and height, information will be retrospectively retrieved via a chart review at the end of the study. DISCUSSION: We anticipate that this multi-modal telehealth service will deliver a comparable service to traditional face-to-face models. An alternative to existing outpatient physiotherapy services may potentially increase patient options for access to care and patient-orientated outcomes such as quality of life. If deemed appropriate, the new model of care can be integrated into clinical practice immediately. TRIAL REGISTRATION: This trial is registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12617001035314 ) last updated 17th July 2018.
Ray Lei Lang, Christine J. Wilson, Kellie A. Stockton et al.
Female Genital Mutilation (FGM) is a universal issue which affects girls in Africa, the Middle East, Asia and South America, and immigrant communities in Western Europe, North America, Australia and New Zealand. FGM is a cultural practice in approximately 29 countries in Africa, affecting over 140 million girls. FGM is practiced as a rite of passage, where girls are initiated into womanhood. This practice is promoted as a means for incorporation, thus ascribing personhood, and belonging for girls to their communities. African scholars hold conflicting positions about FGM, with some arguing that it is essential for relational fullness and harmony. While others believe FGM is unjustified because of the health and social risks associated with the practice. We argue, applying sustainable social harmony and Gyekye's views on cultural revitalization, that FGM is morally unjustified and should be prohibited. We believe the claims that FGM fosters harmony, a value of Ubuntu, are fallacious, and this perceived harmony is pretentious and unsustainable. We claim that FGM is inauthentic, unjust and steeped in patriarchal underpinnings that are unsustainable, thus it is a disharmonious practice. Cultural practices that are disharmonious should be refined and pruned and must be dynamic and responsive to current realities.
Abstract In Australia assaulting another person is a criminal offence. It occurs when one person strikes another person, applying force of any kind either directly or indirectly, without the person's consent. There is an exception. Children are specifically denied legal protection from intentional assaults when it is rebranded as corporal punishment. Successive governments have failed to act to provide children with the same protection from assault as adults despite repeated calls by the United Nations Committee on the Rights of the Child to prohibit corporal punishment in all settings, and the robust body of evidence of the substantial harm it causes (Gershoff & Grogan‐Kaylor, 2016). This glaring inconsistency in the law, should cause us to question how far we have evolved in our attitudes and treatment of children. In particular just how deeply ingrained are attitudes and prejudices about children that rationalise or justify acts and omissions that harm them, and fail to protect their rights (Childism: Confronting Prejudice Against Children, Yale University Press, 2013). This paper will examine past and contemporary attitudes to children and the narrative that helps explains why policy makers and the community tolerate the use of physical force against children, and why a new narrative is needed.
Each winter, around 2,000 whānau in Aotearoa New Zealand (NZ) have their lives affected by infant hospitalisation for respiratory syncytial virus (RSV) complications. RSV is the leading cause of lower respiratory tract infection (bronchiolitis) leading to hospitalisation in infants, with the greatest burden in the first months after birth. Māori and Pacific infants are disproportionately affected. Material hardship, household crowding, and cold, damp housing contribute to RSV prevalence and severity. Effective immunisations against RSV are now available in the form of long-acting monoclonal antibodies (nirsevimab or clesrivomab) given to newborns and maternal RSV vaccination during pregnancy (RSVpreF (Abrysvo)). They are widely used internationally, creating an opportunity for NZ to significantly reduce hospitalisations, ease winter health system pressure, and improve equity. RSV immunisation represents a high‑impact and economically efficient strategy that justifies rapid policy approval and implementation in NZ.
Hazel Dobinson, MacDonald, Claire, Jutta van den Boom et al.
BACKGROUND: Patients with Inflammatory Bowel Disease (IBD) are at increased risk of serious infections, including vaccine preventable diseases. Current evidence suggests uptake of additional recommended special risk vaccinations is low. Identification of IBD patients prior to commencing immunosuppressive therapy allows for optimisation of vaccination, including timely administration of live-attenuated and additional recommended vaccines, such as influenza and pneumococcal vaccines. METHODS: Paediatric patients (0-18 years) seen at the tertiary Royal Children's Hospital, Melbourne, Australia, with a recent diagnosis of IBD were referred by the Gastroenterology Unit to our Specialist Immunisation Clinic (SIC) for assessment and provision of routine and special risk vaccines. Data was collected via a standardised REDCap questionnaire completed in or post attendance at the SIC and included serology results where available. RESULTS: Sixty-nine paediatric patients were recruited to the study between 2014 and 2017. Median age at IBD diagnosis was 11.25 years (IQR 4.64 years), with median time between diagnosis and SIC review of 0.88 years (IQR 2.84 years). At initial review 84.1% (58/69) of patients were up to date with vaccines on the Australian National Immunisation Program (NIP) schedule. Of those who were tested, serological evidence of immunity was demonstrated in 38.3% (23/60) of patients for Hepatitis B, 66.7% (36/54) for measles, 51.9% (28/54) for rubella and 41.9% (26/62) for Varicella Zoster Virus. Prior to SIC review 47.8% (33/69) had additional vaccinations and 92.8% (64/69) had vaccinations administered in the 12 months following SIC assessment. The Pneumococcal conjugate vaccine (76.8%, 53/69) was the most commonly administered vaccine after SIC review, followed by influenza vaccine (69.6%, 48/69). Within 12 months of SIC review 43.5% (30/69) of patients had completed the schedule and were up-to-date as recommended by the SIC. CONCLUSIONS: Children with IBD and other special risk groups can benefit from early referral to a SIC team to ensure optimal administration of routine and additionally recommended vaccines, especially live and additional special risk vaccines. The value of optimising immunisations could also be applied to other special risk groups, including adult IBD cohorts, particularly those commencing newer biologic immunosuppressive medications.
Timothy J Ford, Margie H Danchin, Alissa McMinn et al.
BACKGROUND: SAEFVIC is the Victorian surveillance system for adverse events following immunisation (AEFI). It enhances passive surveillance by also providing clinical support and education to vaccinees and immunisation providers. This report summarises surveillance, clinical and vaccine pharmacovigilance activities of SAEFVIC in 2018. METHODS: A retrospective observational cohort study of AEFI reports received by SAEFVIC in 2018, compared with previous years since 2008. Data were categorised by vaccinee demographics of age, sex, pregnancy and Indigenous status, vaccines administered and AEFI reactions reported. Age cohorts were defined as infant (0-12 months); young child (1-4 years); school-aged (5-17 years); adult (18-64 years); and older person (65+ years). Proportional reporting ratios were calculated for signal investigation of serious adverse neurological events with all vaccines and with influenza vaccines. Clinical support services and educational activities are described. RESULTS: SAEFVIC received 1730 AEFI reports (26.8 per 100,000 population), with 9.3% considered serious. Nineteen percent (n = 329) attended clinical review. Annual AEFI reporting trends increased for infants, children and older persons, but were stable for school-aged and adult cohorts. Females comprised 55% of all reports and over 80% of reports among adults. There were 17 reports of AEFI in pregnant women and 12 (0.7%) in persons identifying as Indigenous Australians. A possible signal regarding serious adverse neurological events (SANE) was detected, but was not supported by signal validation testing. A clinical investigation is ongoing. Two deaths were reported coincident to immunisation with no evidence of causal association. CONCLUSION: SAEFVIC continues to provide robust AEFI surveillance supporting vaccine safety monitoring in Victoria and Australia, with new signal detection and validation methodologies strengthening capabilities.
Hazel J Clothier, Jock Lawrie, Georgina Lewis et al.
OBJECTIVES: To quantify developmental vulnerability at age 5 by child protection contacts before school in two Australian states. METHODS: All children with birth, child protection and/or 2009, 2012, 2015 and 2018 Australian Early Development Census (AEDC) data in New South Wales (NSW) and South Australia (SA) were grouped according to child protection contact before school: no contact, child protection reports, screened-in reports, investigations, substantiations and out-of-home care (OOHC). The outcome was developmental vulnerability on ≥1 AEDC domains or medically diagnosed conditions with support needs at school entry. RESULTS: 56 650 (14.2%) NSW children and 12 617 (15.6%) SA children had ≥1 child protection contact before school. Developmental vulnerability on ≥1 domains or medically diagnosed conditions was lowest in the no child protection group (NSW, 21-22%; SA, 24-25%), with progressively higher risk in the child protection report (NSW, 35%; SA, 41-46%) through to the OOHC (NSW, 50-54%; SA, 59-66%) groups in all AEDC years. Developmental risk was higher among children aged <2 years at first contact and those with more reports. Children with only one child protection report before school had approximately 65% higher developmental risk than the no child protection group in both states. CONCLUSIONS: A single child protection report before school was an early indicator of higher developmental risk at age 5, with higher developmental risks among children with earlier, more serious and frequent child protection contacts. Beyond child safety screening, child protection reports represent an opportunity to mobilise early health and social support for children with developmental support needs.
Kathleen Falster, Rhiannon Megan Pilkington, Tasnia Ahmed et al.
IntroductionThe WA Child Development Atlas (CDA) is a unique resource that generates geographic profiles of the development, health and well-being of WA children. The CDA has been developed at the Telethon Kids Institute with funding from the Ian Potter and Minderoo Foundations and in partnership with government agencies and service providers. Objectives and ApproachVisualisation of data within geographic boundaries helps to build a picture of ‘place’. This informs better decision making and underpins the development of evidence-based policy and service planning that acknowledges the differing needs of communities. The CDA is an online, interactive mapping tool that utilises geographic information system (GIS) technologies to identify spatial patterns in population-level child and youth development indicators. Data are sourced from core health, social, and linked administrative datasets, from 1990 onwards. Aggregated, de-identified data on children and young people (0-24 years) and their parents are mapped within geographic boundaries across WA. The CDA was piloted to ensure it is useful and relevant to a diversity of stakeholders. Extensive community consultation has been undertaken at all stages of the project. The CDA has been received favourably by consumers, government organisations, communities and researchers, with significant support for public launch. ResultsThe CDA is a freely available, confidential and secure resource. Features of the CDA include: it is online and interactive (no software is required), area profiles, downloadable charts, tables and summary statistics, map panning and zooming. The Atlas has been used to generate community profiles and empowers all the people of WA with enhanced knowledge and understanding of the development of children. Conclusion / ImplicationsThe CDA has built capacity to use spatial information, assisting agencies who make decisions relevant to child development and to facilitate cross-agency collaboration. It is an important and valuable resource utilising disparate data sources with significant public benefit.
The diagnosis of Autism Spectrum Disorder is rising globally, and as a long-life condition associated with high support needs, parents of Autistic children experience greater parenting stress and lower quality of life than parents raising typically developing children. However, while research has investigated the relationship between the severity of child autism symptoms and parenting stress, studies into comorbid conditions that likewise impair child function are not as common and often focus on a small subset of conditions. The aim of the current study was to estimate the frequency of the five most common comorbidities reported in the autism literature (Anxiety, ADHD, Intellectual Disability, Gastrointestinal Issues, Sleep Disorder) and relate them to parenting stress and health-related quality of life (HRQOL). Using an internet-based survey, parent reports of their Autistic child’s comorbid conditions and the impact these have on their child’s function, parenting stress, and parental HRQOL were obtained from 453 parents residing in New Zealand. A global measure of parenting stress was obtained using the 18-item Parenting Stress Scale, while HRQOL ratings were obtained using the 36-Item Short Form Survey (SF-36). While many parents indicated the presence of comorbid conditions in their Autistic child, a substantial proportion were not formally diagnosed. A Linear Mixed-Effects Model indicated that child anxiety, Intellectual Disability, and ADHD had the greatest impact on both child and parent, however, subsequent multivariate analyses clarified that sleep disorder and Gastrointestinal Issues had the largest effect on parental stress and HRQOL, followed by ADHD. This result was robust irrespective of whether parents were asked if the comorbidity was present (vs. absent), diagnosed (vs. undiagnosed), or when related to child (i.e., functional) and parent (i.e., stress) impact. Evidence that child sleep disorder, Gastrointestinal Issues, and ADHD are most detrimental to parental well-being indicate that interventions targeting these comorbidities should be prioritised. Coupled with increased child function as a direct result of intervention, better parental outcomes should increase child well-being and family quality of life, indicating that future research into the diagnostic barriers associated with comorbid conditions would be useful. • Autism can co-occur with a number of comorbid conditions, though for a multitude of reasons these may go undiagnosed. • This study found that anxiety, ADHD, and sleep dysfunction were the most commonly represented comorbidities. • The greater the impact on child function, the more a comorbid condition contributes to parent stress. • Sleep and gastrointestinal disorders, followed by ADHD, had the greatest impact on child function and parenting stress.
