Australian Infants Research Articles

Potential carrier priming effect in Australian infants after 7-valent pneumococcal conjugate vaccine introduction.

To investigate evidence of clinical protection in infants after one dose of 7-valent pneumococcal conjugate vaccine (7vPCV) owing to carrier priming. Using Australian National Notifiable Diseases Surveillance System data, we conducted a descriptive analysis of cases of vaccine type invasive pneumococcal disease (VT-IPD) during "catch-up" years, when 7vPCV was carrier primed by prior administration of DTPa vaccine. We compared the number of VT-IPD cases occurring 2-9 wk after a single dose of 7vPCV (carrier primed), with those < 2 wk post vaccination, when no protection from 7vPCV was expected yet. Further comparison was conducted to compare the occurrence of VT-IPD cases vs non-VT-IPD cases after a single carrier-primed dose of 7vPCV. We found four VT-IPD cases occurring < 2 wk after one carrier primed dose of 7vPCV while only one case occurred 2-9 wk later. Upon further comparison with the non-VT-IPD cases that occurred after one carrier primed dose of 7vPCV, two cases were detected within 2 wk, whereas seven occurred within 2-9 wk later; suggesting a substantial level of protection from VT-IPD occurring from 2 wk after carrier-primed dose of 7vPCV. This data suggest that infants may benefit from just one dose of 7vPCV, likely through enhanced immunity from carrier priming effect. If this is proven, an adjusted 2-dose schedule (where the first dose of PCV is not given until after DTPa) may be sufficient and more cost-effective.

Supporting breastfeeding In Local Communities (SILC) in Victoria, Australia: a cluster randomised controlled trial

ObjectivesBreastfeeding has significant health benefits for mothers and infants. Despite recommendations from the WHO, by 6 months of age 40% of Australian infants are receiving no breast milk. Increased early...

Iron intakes of Australian infants and toddlers: findings from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program.

Fe deficiency remains the most common nutritional deficiency worldwide and young children are at particular risk. Preventative food-based strategies require knowledge of current intakes, sources of Fe, and factors associated with low Fe intakes; yet few data are available for Australian children under 2 years. This study's objectives were to determine intakes and food sources of Fe for Australian infants and toddlers and identify non-dietary factors associated with Fe intake. Dietary, anthropometric and socio-demographic data from the Melbourne Infant Feeding, Activity and Nutrition Trial Program were analysed for 485 infants (mean age: 9·1 (sd 1·2) months) and 423 toddlers (mean age: 19·6 (sd 2·6) months) and their mothers. Dietary intakes were assessed via 24-h recalls over 3 non-consecutive days. Prevalence of inadequate Fe intake was estimated using the full probability approach. Associations between potential non-dietary predictors (sex, breast-feeding status, age when introduced to solid foods, maternal age, maternal education, maternal employment status and mother's country of birth) and Fe intakes were assessed using linear regression. Mean Fe intakes were 9·1 (sd 4·3) mg/d for infants and 6·6 (sd 2·4) mg/d for toddlers. Our results showed that 32·6 % of infants and 18·6 % of toddlers had inadequate Fe intake. Main food sources of Fe were Fe-fortified infant formula and cereals for infants and toddlers, respectively. Female sex and current breast-feeding were negatively associated with infant Fe intakes. Introduction to solid foods at or later than 6 months was negatively associated with Fe intake in toddlers. These data may facilitate food-based interventions to improve Australian children's Fe intake levels.

PneuMum: Impact from a randomised controlled trial of maternal 23-valent pneumococcal polysaccharide vaccination on middle ear disease amongst Indigenous infants, Northern Territory, Australia

BackgroundWe assessed maternal 23-valent pneumococcal polysaccharide (23vPPV) vaccine efficacy (VE) against middle ear disease and pneumococcal carriage amongst Australian Indigenous infants. MethodsIn an open label, allocation concealed, outcome-assessor blinded, community stratified, randomised controlled trial, healthy pregnant Indigenous women aged 17–39 years in the Northern Territory of Australia received the 23vPPV (1:1:1) at: 30–36 weeks gestation, birth, or were unvaccinated (ClinicalTrials.gov NCT00714064). Co-primary outcomes were the point prevalences of infant middle ear disease and 23vPPV-type carriage at age 7 months. ResultsThe consent rate was 50% (313/632). Among 227 eligible participants randomised, retention rates were 86% (66/77) controls; 89% (67/75) pregnancy vaccinees; 88% (66/75) birth vaccinees. At infant age 7 months, ear disease prevalence was: 71% (47/66) controls, 63% (42/67) pregnancy vaccinees, 76% (50/66) birth vaccinees; and 23vPPV-type carriage was: 26% (17/66) controls, 18% (12/67) pregnancy vaccinees, 18% (12/66) birth vaccinees. For pregnancy vaccinees, VE was 12% (95% CI −12% to 31%) against infant ear disease and 30% (95% CI −34% to 64%) against 23vPPV-type carriage. In a post-hoc analysis, VE against infant ear disease concurrent with carriage of 23vPPV or related types was 51% (95% CI −2% to 76%). There were no serious adverse effects following receipt of the 23vPPV in pregnancy or at birth. ConclusionsIn a high risk population, our study was unable to demonstrate efficacy of 23vPPV in pregnancy against the co-primary outcomes of either all-cause infant ear disease or 23vPPV-type nasopharyngeal carriage at age 7 months. Efficacy against ear disease concurrent with carriage of vaccine-related serotypes (a more specific outcome) suggests 23vPPV in pregnancy may complement childhood pneumococcal vaccination programs.

BUILDING A WORKFORCE COMPETENCY-BASED TRAINING PROGRAM IN INFANT/EARLY CHILDHOOD MENTAL HEALTH.

This article describes findings from a project conducted in Western Australia (Mental Health Commission WA, 2015) that investigated the education and training needs of the Infant/Early Childhood Mental Health (I/ECMH) workforce. We examined international training programs and models of delivery in infant mental health, including a review of the current training available in Australia. Data collected from over 60 interviews were analyzed, and a staged delivery model for I/ECMH training and supervision that aligned with the Michigan Association for Infant Mental Health (2014) Competency Guidelines was recommended. These findings led to the purchase of the Michigan Association for Infant Mental Health (2014) for use in Western Australia. In a very short time, use of the Michigan Competency Framework by the Australian Association for Infant Mental Health West Australian Branch Incorporated has begun to change the training and education opportunities for upskilling the infant and early childhood workforce in Western Australia. It has resulted in a map to guide and develop training in the I/ECMH field for individual practitioners and professionals as well as for workplaces that will ultimately benefit Western Australian infants, young children, and their families during the perinatal period and in the early years.

A study to prolong breastfeeding duration: design and rationale of the Parent Infant Feeding Initiative (PIFI) randomised controlled trial.

BackgroundVery few Australian infants are exclusively breastfed to 6 months as recommended by the World Health Organization. There is strong empirical evidence that fathers have a major impact on their partner’s decision to breastfeed and continuation of breastfeeding. Fathers want to participate in the breastfeeding decision making process and to know how they can support their partner to achieve their breastfeeding goals. The aim of the Parent Infant Feeding Initiative (PIFI) is to evaluate the effect on duration of any and exclusive breastfeeding of three breastfeeding promotion interventions of differing intensity and duration, targeted at couples but channelled through the male partner. The study will also undertake a cost-effectiveness evaluation of the interventions.Methods/designThe PIFI study is a factorial randomised controlled trial. Participants will be mothers and their male partners attending antenatal classes at selected public and private hospitals with maternity departments in Perth, Western Australia. Fathers will be randomly allocated to either the usual care control group (CG), one of two medium intensity (MI1 and MI2) interventions, or a high intensity (HI) intervention. MI1 will include a specialised antenatal breastfeeding education session for fathers with supporting print materials. MI2 will involve the delivery of an antenatal and postnatal social support intervention delivered via a smartphone application and HI will include both the specialised antenatal class and the social support intervention. Outcome data will be collected from couples at baseline and at six and 26 weeks postnatally. A total of 1600 couples will be recruited. This takes into account a 25 % attrition rate, and will detect at least a 10 % difference in the proportion of mothers breastfeeding between any two of the groups at 26 weeks at 80 % power and 5 % level of significance, using a Log-rank survival test. Multivariable survival and logistic regression analyses will be used to assess the effect of the treatment groups on the outcomes after adjusting for covariates.DiscussionThe PIFI study will be the first Australian study to provide Level II evidence of the impact on breastfeeding duration of a comprehensive, multi-level, male-partner-focused breastfeeding intervention. Unique features of the intervention include its large sample size, delivery of two of the interventions by mobile device technology, a rigorous assessment of intervention fidelity and a cost-effectiveness evaluation.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12614000605695. Registered 6 June 2014

Colonisation with Pneumocystis jirovecii in Australian infants

Colonisation with Pneumocystis jirovecii in Australian infants

Genetic and Environmental Factors Affecting TNF-α Responses in Relation to Sudden Infant Death Syndrome.

Dysregulation of the inflammatory responses has been suggested to contribute to the events leading to sudden infant deaths. Our objectives were (1) to analyze a single nucleotide polymorphism (SNP) associated with high levels of tumor necrosis factor-α (TNF-α) responses, TNF G-308A, in sudden infant death syndrome (SIDS) infants, SIDS and control parents, and ethnic groups with different incidences of SIDS; (2) the effects of two risk factors for SIDS, cigarette smoke and virus infection, on TNF-α responses; and (3) to assess effects of genotype, cigarette smoke, and gender on TNF-α responses to bacterial toxins identified in SIDS infants. TNF G-308A genotypes were determined by real-time polymerase chain reaction for SIDS infants from Australia, Germany, and Hungary; parents of SIDS infants and their controls; and populations with high (Aboriginal Australian), medium (Caucasian), and low (Bangladeshi) SIDS incidences. Leukocytes from Caucasian donors were stimulated in vitro with endotoxin or toxic shock syndrome toxin-1 (TSST-1). TNF-α responses were measured by L929 bioassay (IU/ml) and assessed in relation to genotype, smoking status, and gender. There was a significantly higher proportion of the minor allele AA genotype among Australian SIDS infants (6/24, 24%) compared to 3/62 (4.8%) controls (p = 0.03). There were no significant differences in TNF-α responses by TNF G-308A genotypes when assessed in relation to smoking status or gender. Given the rarity of the TNF G-308A A allele in Caucasian populations, the finding that 24% of the Australian SIDS infants tested had this genotype requires further investigation and cautious interpretation. Although non-smokers with the AA genotype had higher TNFα responses to both TSST-1 and endotoxin, there were too few subjects with this rare allele to obtain statistically valid results. No effects of genotype, smoking, or gender were observed for TNF-α responses to these toxins.

Dietary intake in Australian children aged 4-24 months: consumption of meat and meat alternatives.

Meat/meat alternatives (M/MA) are key sources of Fe, Zn and protein, but intake tends to be low in young children. Australian recommendations state that Fe-rich foods, including M/MA, should be the first complementary foods offered to infants. The present paper reports M/MA consumption of Australian infants and toddlers, compares intake with guidelines, and suggests strategies to enhance adherence to those guidelines. Mother-infant dyads recruited as part of the NOURISH and South Australian Infants Dietary Intake studies provided 3 d of intake data at three time points: Time 1 (T1) (n 482, mean age 5·5 (SD 1·1) months), Time 2 (T2) (n 600, mean age 14·0 (SD 1·2) months) and Time 3 (T3) (n 533, mean age 24 (SD 0·7) months). Of 170 infants consuming solids and aged greater than 6 months at T1, 50 (29%) consumed beef, lamb, veal (BLV) or pork on at least one of 3 d. Commercial infant foods containing BLV or poultry were the most common form of M/MA consumed at T1, whilst by T2 BLV mixed dishes (including pasta bolognaise) became more popular and remained so at T3. The processed M/MA increased in popularity over time, led by pork (including ham). The present study shows that M/MA are not being eaten by Australian infants or toddlers regularly enough; or in adequate quantities to meet recommendations; and that the form in which these foods are eaten can lead to smaller M/MA serve sizes and greater Na intake. Parents should be encouraged to offer M/MA in a recognisable form, as one of the first complementary foods, in order to increase acceptance at a later age.

Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome.

This study determined the influence of prematurity on the manifestation and treatment of neonatal abstinence syndrome (NAS). This was a medical record review of Australian infants exposed to opiates in 2004 and 2007. Finnegan scores were obtained for 215 of 361 (59%) preterm infants under 37-week gestation and 694 of 1178 (59%) term infants. The mean and standard deviation (SD) gestational ages were 34 (3) and 38 (3) weeks for preterm and term infants, respectively. Maternal daily methadone doses were similar for the preterm and term infants with a mean (SD) of 79mg (39) versus 72mg (38) (p=0.06). Maximum Finnegan scores were significantly lower in preterm infants (10 versus 11, p=0.01), scores were positively correlated with gestation and fewer preterm infants were medicated for NAS (40% versus 48% p=0.05). Maximum median daily and interquartile range morphine doses were lower for preterm than term infants (0.5mg/kg/day (0.3-0.6) versus 0.5mg/kg/day (0.4-0.7), p=0.02). Preterm infants were just as likely to be monitored for withdrawal as term infants, but their Finnegan scores were lower and fewer preterm infants were treated for NAS. Whether this indicates decreased NAS severity or physiological immaturity is uncertain. Other means of evaluating NAS in preterm infants are warranted, especially long-term outcomes.

Group B streptococcal disease and genotypes in Australian infants.

Estimate the incidence, risk factors and clinical features of group B streptococcal (GBS) disease in Australian infants and compare bacterial genotypes between infant disease and maternal carriage. The Australian Paediatric Surveillance Unit conducted a study of invasive GBS disease in infants aged 0-90 days between July 2005 and June 2008. Clinical data were obtained by questionnaire. GBS isolates from affected infants and antenatal carriers were referred for genotyping. One hundred fifty confirmed cases were reported: 88 early-onset (EOD; 0-6 days) and 62 late-onset disease (LOD). Based on review of selected laboratory records, they represented ∼1/3 of all cases. Estimated national EOD and LOD rates were 0.38 and 0.19/1000 live births, respectively. Admission to intensive care was common (44%), and 7% of infants died. One or more obstetric indications for intrapartum antibiotic prophylaxis (IAP) were identified in 51% of mothers; 53% of mothers were screened for GBS carriage, and screening was positive in 45%; only 25% of women with clinical or microbiological risk factors were given IAP (no significant differences between EOD and LOD groups). Distribution of GBS genotypes differed significantly between invasive and vaginal isolates: virulent serosubtype III-2/sequence type 17 was strongly associated with LOD but uncommon among EOD and vaginal isolates. Estimated GBS disease rates remain relatively low despite poor predictive values of clinical and microbiological criteria for, and compliance with, IAP. Clinical and microbiological epidemiology of LOD differs significantly from that of EOD. Further reduction in infant morbidity and mortality from GBS disease will require new strategies.

Australian and New Zealand Indigenous mothers' report respect for smoking bans in homes.

There is limited data about the reasons behind residential rules to reduce environmental tobacco smoke (ETS) exposure or the establishment or enforcement of such rules in Indigenous populations. We aimed to gain an understanding of smokefree rules around Australian and New Zealand (NZ) Indigenous infants. This was a qualitative study nested within a randomised controlled trial that aimed to test the efficacy of a family-centred tobacco control programme about environmental tobacco smoke (ETS) to improve the respiratory health of Indigenous infants in Australia and New Zealand. Qualitative semi-structured interviews were conducted with 26 Indigenous mothers of infants in Australia (n=7) and NZ (n=19). We asked about the presence of smokefree rules, who set the rules, how the rules were set and enforced, and presence of smokefree rules in participants' wider social circle. Interviews were audiotaped, transcribed, and inductively analysed to identify key themes. Sixty-nine percent of mothers had partners, 77% smoked and all reported some presence of smokefree rules for house and car. Three main themes were identified: strategies to minimise exposure to ETS, establishing smokefree rules in homes and cars, and, adherence and enforcement of smokefree rules. Several strategies were identified to limit children's exposure to ETS, including rules to limit exposure to third-hand smoke. Mothers extended their smokefree rules to apply to other people's houses or cars, and reported that their family and social circles also had smokefree rules. The main reason for having smokefree rules was for the health of their children. Rules were most commonly set by the mother, often jointly with their partner. Few mothers reported challenges or problems with other people adhering to the smokefree rules. Women tried very hard to, and believed that they were effective in, protecting their children from the harmful effects of ETS exposure. In this context, health professionals need to emphasise smoking cessation in parents, so that children are maximally protected from ETS exposure.

A prospective study of the introduction of complementary foods in contemporary Australian infants: What, when and why?

To accurately establish the extent to which breastfeeding exclusivity and duration and the introduction of foods other than breast milk are congruous with Australian infant feeding guidelines among a cohort of primiparous women and their infants in Australia. The Feeding Queensland Babies Study is primarily a questionnaire-based prospective birth cohort study of infant feeding attitudes and behaviours but also collected significant data on feeding patterns in infancy. These data were extracted from the demographic questionnaire and from questionnaires administered at 4 and 6 months of infant age. Participants were healthy primiparous Australian women aged between 18 and 40 years, recruited by convenience sampling in Queensland, Australia. Data were collected by self-administered questionnaire both online and on paper between October 2010 and September 2011. Breastfeeding initiation in this cohort is high; however, by 4 months of age, 15.4% of mothers had completely ceased any breastfeeding, 28.7% of infants had been given formula and 18.5% had been introduced to baby cereal. By 6 months of age, 98.4% of infants had been introduced to non-milk foods, most commonly at a rate of one new food every 4 to 5 days. Contemporary prospective data on infant feeding have value in describing trends that may influence the health outcomes of a generation of Australian children. Even in this group of relatively well-educated Australian women, premature cessation of breastfeeding and the early introduction of foods other than breast milk to infants demonstrate behaviours not congruous with evidence-based guidelines.

Characteristics of infants with positional abnormal head shapes and their physiotherapy service at an Australian community health facility

Characteristics of infants with positional abnormal head shapes and their physiotherapy service at an Australian community health facility Amy Leung,1 Pauline Watter,2 John Gavranich31Department of Physiotherapy, Royal Children&#39;s Hospital, 2Physiotherapy Division, School of Health Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia; 3Child and Family Health Services, West Moreton Health Service District, Queensland, AustraliaPurpose: There is limited biographic information regarding infants presenting with abnormal head shape in Australia and little discussion of the effect of different cutoff values for diagnosis of plagiocephaly. This study aimed to 1) describe the biographic characteristics of infants with positional abnormal head shapes referred for physiotherapy management; 2) explore their access to physiotherapy services and intervention outcomes; and 3) explore the impact of using different modified Cranial Vault Asymmetry Index (mCVAI) cutoff points in plagiocephaly classification.Patients and methods: This retrospective community health record audit included the total cohort of infants referred over concerns about abnormal head shape to a pediatric physiotherapy service at a community health center in Australia from January 2004 to December 2007 (N=126 valid cases). Data retrieved included: demographic data; birth history; positioning; initial physiotherapy assessment; and factors associated with physiotherapy intervention and outcomes.Results: Of the 126 charts (65 males), 106 infants (84.1%) presented with plagiocephaly, ten (7.9%) with brachycephaly, and ten (7.9%) with combined deformities. Most biographic data from this study were similar to those reported in the literature. The mean age &plusmn; standard deviation (SD) of infants at referral was 11.29&plusmn;7.84 weeks, with about 4-weeks wait for assessment. For the plagiocephalic group, there was significant reduction in mCVAI mean value from assessment (-5.44%&plusmn;2.95%) to discharge (-4.41%&plusmn;2.66%) (t[df=60] =-5.396; 95% confidence interval [CI]: -1.66%, -0.76%; P&lt;0.001) and significant change in the Argenta Clinical Classification categories (P&lt;0.001) after physiotherapy intervention. There was a reduction of approximately 10% in infants classified with significant plagiocephaly when the mCVAI cutoff point increased by 1%.Conclusion: Characteristics of Australian infants presenting with plagiocephaly, brachycephaly, and combined conditions were similar to other reports. Infants with positional head deformities can benefit from physiotherapy intervention. The cutoff point of mCVAI at -6% is proposed to be appropriate for the provision of ongoing physiotherapy service.Keywords: plagiocephaly, brachycephaly, modified cranial vault asymmetry index, cutoff point

Wideband absorbance in Australian Aboriginal and Caucasian neonates.

Despite the high prevalence of otitis media in Australian Aboriginal infants and children, the conductive mechanism of the outer and middle ear of Aboriginal neonates remains unclear. Differences in characteristics of the conductive pathway (outer and middle ear) between Aboriginal and Caucasian neonates have not been systematically investigated by using wideband acoustic immittance measures. The objective of this study was to compare wideband absorbance (WBA) in Australian Aboriginal and Caucasian neonates who passed or failed a screening test battery containing high-frequency tympanometry and distortion product otoacoustic emissions (DPOAEs). A cross-sectional study design was used. The mean WBA as a function of frequency was compared between Aboriginal and non-Aboriginal neonates who passed or failed the test battery. A total of 59 ears from 32 Aboriginal neonates (mean age, 51.9 h; standard deviation [SD], 18.2 h; range, 22-86 h) and 281 ears from 158 Caucasian neonates (mean age, 42.4 h; SD, 23.0 h; range, 8.1-152 h) who passed or failed 1000-Hz tympanometry and DPOAEs were included in the study. WBA results were analyzed by using descriptive statistics and t tests with Bonferroni adjustment. An analysis of variance with repeated measures was applied to the data. Aboriginal and Caucasian neonates had almost identical pass rates of 61%, as determined by the test battery. Despite the apparently equal pass rates, the mean WBA of Aboriginal neonates who passed the test battery was significantly lower than that of their Caucasian counterparts at frequencies between 0.4 and 2 kHz. The mean WBA of Aboriginal neonates who failed the test battery was significantly lower than that of their Caucasian counterparts who also failed the test battery at frequencies between 1.5 and 3 kHz. Both Aboriginal and Caucasian neonates who failed the test battery had significantly lower WBA values than their counterparts who passed the test battery. This study provided convincing evidence that Aboriginal neonates had significantly lower WBA values than their Caucasian counterparts, although both groups had equal pass rates, as determined by the test battery. Although the two ethnic groups showed significant differences in WBA, the factors contributing to such differences remain undetermined. Further research is warranted to determine the factors that might account for the difference in WBA between the two ethnic groups.

Comparison of Anti-pneumococcal Antibodies in Cord Blood From Australian Indigenous and Gambian Neonates and the Implications for Otitis Media

Australian indigenous infants experience the highest incidence of chronic suppurative and acute otitis media in the world with many babies developing disease in the early postnatal period. Streptococcus pneumoniae is the major cause of otitis media in this population. Infants are protected against bacterial disease in the first months of life by passive transfer of maternal antibody across the placenta during the late stages of gestation. We hypothesized that reduced passive immunity may contribute to increased disease risk in this population. We compared the concentrations and function of serotype-specific IgG in cord serum from Australian indigenous neonates and Gambian neonates, the latter experiences a similar socioeconomic status to Australian indigenous neonates. Serotype-specific IgG, IgG1 and IgG2 were measured using a modified 3rd generation enzyme linked immunosorbent assay based on World Health Organization recommendations. Antibody avidity was measured using a modified sodium thiocyanate elution method. Australian indigenous neonates had significantly increased levels of serotype-specific IgG compared with Gambian populations for 6 of 12 serotypes (P < 0.02). There was no significant difference in antibody function, as measured by antibody avidity, between the 2 groups. An increased risk for otitis media in Australian indigenous neonates is not primarily determined by specific antibody titers against pneumococcal bacteria. Further investigation into the possible roles of the innate immune response and Eustachian tube dysfunction in the development of chronic otitis media amongst Australian indigenous infants is warranted.

Impact of pneumococcal polysaccharide vaccine in people aged 65 years or older

To evaluate the impact and effectiveness of the 23-valent polysaccharide pneumococcal vaccine (23vPPV) in ≥ 65-year-old Australians in the context of concurrent 7-valent pneumococcal conjugate vaccine (7vPCV) use in infants. Ecological analysis of trends in invasive pneumococcal disease (IPD) notification rates and vaccine effectiveness estimation using the screening method, using data on Australians aged ≥ 65 years (23vPPV funded) and 50-64 years (23vPPV not funded). National 23vPPV program for people aged ≥ 65 years and national 7vPCV program for infants, both commencing in 2005. IPD incidence rate ratios, 2002-2004 to 2010-2011, and 23vPPV effectiveness against 23vPPV-type IPD. The proportion of people aged ≥ 65 years who were vaccinated within the previous 5 years in jurisdictions excluding Victoria ranged from 41% to 64% over the study period, with no clear trend over time. Incidence rate ratios in the ≥ 65-year age group were 0.11 (95% CI, 0.09-0.14) for 7vPCV serotypes, 1.64 (95% CI, 1.41-1.91) for 23vPPV-non-7vPCV serotypes and 2.07 (95% CI, 1.67-2.57) for non-23vPPV serotypes. The incidence rate ratio for total IPD was 0.65 (95% CI, 0.59-0.71) for people aged ≥ 65 years, and 0.80 (0.71-0.90) for people aged 50-64 years. The estimate of 23vPPV effectiveness was 61.1% (95% CI, 55.1%-66.9%). The greater reduction in IPD among ≥ 65-year-olds compared with 50-64-year-olds did not reach statistical significance. However, vaccine effectiveness was significant. Greater reductions in IPD in ≥ 65-year-olds would be expected from the indirect effects of using 13-valent pneumococcal conjugate vaccine in infants (introduced for Australian infants in 2011) and an increase in 23vPPV coverage.

S7 Evolution of lung function during the first two years of life in infants with cystic fibrosis diagnosed by newborn screening

Background In contrast to findings from the Australian AREST-CF study1 infants with cystic fibrosis (CF) diagnosed by newborn screening (NBS) participating in the London CF Collaboration (LCFC) study2 were found to have relatively mild lung disease by 1 year of age when compared to healthy controls. Hypothesis In NBS CF infants, lung function remains stable to 2 years. Methods Lung clearance index (LCI), plethysmographic functional residual capacity (FRC) and forced expiratory volume (FEV 0.5 ) from the raised volume technique were measured in NBS CF infants and healthy controls at 3months (3m), 1year (1y) and 2 years (2y). Results were expressed as z-scores using equipment-specific equations to adjust for age, sex and body size. Results To date, 55 CF and 28 control infants have been assessed on all 3 occasions. The mildly elevated LCI and FRC in CF infants identified by 3m when compared with controls remained stable thereafter. The significant reduction in FEV 0.5 (mean difference (95% CI) -1.26 (-1.73; -0.79) z score) among CF infants at 3m had improved by 1y (see Figure 1). From 1 to 2 years all 3 measurements remained stable with no significant changes in average z-scores for either the CF or control infants. On average, LCI, FRC and FEV 0.5 only changed by 0.02, 0.16 and 0.06 z-scores respectively amongst CF children between 1 2 years, similar to that observed in controls. Mean (95%CI) group differences (CF-HC) in change of LCI, FRC and FEV 0.5 between 1 2y were 0.02 (-0.61; 0.66), p = 0.94;-0.05 (-0.61; 0.51), p = 0.86; and 0.32 (-0.27; 0.90) p = 0.29, respectively. Conclusions This is the first study to demonstrate stable lung function to 2y in NBS CF infants managed on standard CF therapy. These results suggest that in many of these infants novel treatments could be deferred beyond infancy when objective outcomes are more easily measured. References Pillarisetti et al. AJRCCM 2011 Hoo et al Thorax 2012.

An age-specific urine flow model to estimate daily bisphenol A exposure in Australian children

Background. Environmental chemical exposures are of particular concern when they occur during periods of critical development. Children experience different exposures to chemicals than adults, and may have different sensitivity to chemicals than adults, due to differences in behaviour and/or physiology. Although biomonitoring has been identified as the ‘gold standard’ for assessing these chemical exposures, it is more challenging for infants and children than for adults due to difficulties with obtaining consent, sampling techniques and sample volume. Compared with other matrices such as blood, urine is easier to collect and less invasive. Aims. The aims of this study were to (1) develop a model to provide an age-specific estimate of average urine flow, adjusted to bodyweight for children &lt;5 years, and (2) apply the model to an existing dataset to estimate daily exposure. Methods. Daily urinary flow per kilogram bodyweight was calculated for each participant in the National Health and Nutrition Examination Survey 2009-2010 survey cycle, and the arithmetic mean calculated for age and sex strata. As the data set was limited to individuals ?6 years, urinary flow data for infants and children (&lt;15 years) were identified from other sources in the literature. Results. Under steady-state assumption the model was applied to pooled urine samples of Australian infants to estimate daily exposures to bisphenol A. The results ranged from 26.2-18200 ng/kg-d for young children (&gt;0-&lt;5 years), and 20.1-165 ng/kg-d for adults (?15-&lt;75 years), with significantly higher mean for infants compared to adults (107 and 47 ng/kg-d, respectively). Conclusions. The variation of urinary flow with age indicates that daily exposure and excretion rates can differ across age, even when the measured concentrations are similar. This means that volume-based measures of concentration for environmental chemicals may significantly underestimate actual exposures for young age groups relative to older age groups.

Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery.

BackgroundRemote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings.MethodsA mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004–2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians’ perspectives on barriers to effective remote health service delivery.ResultsData from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians’ to impact upon the quality of service delivery.ConclusionAmong Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians’ adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.