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In temperate countries, death rates increase in winter, but influenza epidemics often cause greater increases. The death rate time series that occurs without epidemic influenza can be called a seasonal baseline. Differentiating observed death rates from the seasonally oscillating baseline provides estimated influenza-associated death rates. During 2003-2009 in New South Wales, Australia, we used a Serfling approach with robust regression to estimate age-specific weekly baseline all-cause death rates. Total differences between weekly observed and baseline rates during May-September provided annual estimates of influenza-associated death rates. In 2009, which included our first wave of pandemic (H1N1) 2009, the all-age death rate was 6.0 (95% confidence interval 3.1-8.9) per 100,000 persons lower than baseline. In persons ?80 years of age, it was 131.6 (95% confidence interval 126.2-137.1) per 100,000 lower. This estimate is consistent with a pandemic virus causing mild illness in most persons infected and sparing older persons. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is a major cause of respiratory illness, with younger infants at greatest risk of hospitalisation. With the recent approval of a maternal RSV vaccine in Australia, it is timely to evaluate its potential costs and health benefits in Australia., Methods: We applied an integrated dynamic and economic evaluation model to estimate specific outcomes of RSV disease and the cost-effectiveness of a year-round maternal RSV vaccination program in Australia. Cost-effectiveness was estimated using the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained., Results: From a healthcare system perspective, the maternal vaccination program was estimated to be cost-effective at a vaccine price less than approximately 120 Australian dollars ($AU), assuming a willingness-to-pay (WTP) threshold of $AU 50,000/QALY gained. Most of the estimated cost-savings were from preventing RSV hospitalisations in infants aged <6 months. However, while 82% of the cost-savings were from preventing RSV hospitalisations in infants aged <6 months, only about 25% of the QALY gains were in this age group. The majority of the other QALY gains came via herd effects from prevention of death in older adults and to a lesser extent, prevention of nonmedically-attended illness in older teens and adults. When predicted cost-savings and QALY gains in those ≥6 months of age were excluded, the vaccine price required to meet the assumed WTP threshold fell to $AU 63., Conclusions: A maternal RSV vaccination program in Australia could provide value for money by reducing hospitalisations and associated costs among infants aged <6 months, depending on the vaccine price. We have provided evidence that herd effects beyond the target population may be an important consideration in assessing cost-effectiveness of maternal RSV vaccination., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Allen Nazareno reports financial support was provided by University of New South Wales School of Population Health. James Wood reports a relationship with Australian Technical Advisory Group that includes: board membership. Alexandra Hogan reports a relationship with World Health Organization Immunization and vaccines related implementation research advisory committee (IVIR-AC) that includes: board membership. Alexandra Hogan reports a relationship with National Health and Medical Research Council that includes: funding grants. David Muscatello reports a relationship with National Health and Medical Research Council that includes: funding grants. Anthony Newall reports a relationship with Center for Innovation and Value Research that includes: funding grants. Nusrat Homaira reports a relationship with Sanofi, Pfizer and Merck Sharp & Dohme Australia that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: Mortality surveillance was established in the state of Victoria just before the COVID-19 pandemic. Here, we describe the establishment of this surveillance system, justify the modelling approach selected, and provide examples of how the interpretation of changes in mortality rates during the pandemic was influenced by the model chosen., Methods: Registered deaths occurring in Victoria from 1 January 2015 to 31 December 2020 were sourced from the Victoria Death Index. Observed mortality rates were compared to a raw historical 5-year mean and to predicted means estimated from a seasonal robust regression. Differences between the observed mortality rate and the historical mean (∆MR) and excess mortality rate from the observed and predicted rates were assessed., Results: There were 20 375 COVID-19 cases notified in Victoria as of 31 December 2020, of whom 748 (3.7%) died. Victorians aged ≥ 85 years experienced the highest case fatality ratio (34%). Mean observed mortality rates in 2020 (MR: 11.6; 95% confidence interval [CI]: 11.4, 11.9) were slightly reduced when compared with the annual rate expected using the historical mean method (mean MR: 12.2; 95% CI: 12.1-12.3; ∆MR: -0.57; 95% CI: -0.77, -0.38), but not from the rate expected using the robust regression (estimated MR: 11.7; 95% prediction interval [PI]: 11.5, 11.9; EMR: -0.05; 95% CI: -0.26, 0.16). The two methods yielded opposing interpretations for some causes, including cardiovascular and cancer mortality., Discussion: Interpretation of how pandemic restrictions impacted mortality in Victoria in 2020 is influenced by the method of estimation. Time-series approaches are preferential because they account for population trends in mortality over time., Competing Interests: At the time this work was undertaken, LS, SGS, DH and SLR were employed at the Victorian Department of Health. SGS has consulted for CSL Seqirus, Pfizer, Moderna and EvoHealth. The other authors have no conflicts of interest to declare., ((c) 2025 The authors; licensee World Health Organization.)

Background: Respiratory syncytial virus (RSV) is a leading cause of respiratory illness among infants. A maternal RSV vaccine that protects young infants has recently been approved for registration in Australia. We estimated the population benefits of a future year-round maternal RSV vaccination program in terms of prevented RSV infections and hospitalisations in Australia., Methods: We described RSV transmission using an age-structured compartmental model calibrated to Australian aggregated monthly RSV-coded hospitalisations in children aged <5 years. We accounted for mother and infant interactions in the model to capture herd effects more realistically. Using the model, we estimated the annual age-specific RSV infections and hospitalisations prevented for a range of assumptions for vaccine efficacy, coverage, and durability to estimate the future impact of year-round maternal RSV vaccination on infants and the wider population., Results: Assuming base case vaccine efficacy, 6 months duration of protection and 70% coverage, RSV hospitalisations were predicted to fall by 60% (from 3.0 to 1.2 per 100 persons) in infants aged <3 months and 40% (from 1.9 to 1.1 per 100 persons) in 3-5-month-olds. These benefits were primarily due to direct protection to infants of vaccinated mothers. This vaccine program was predicted to reduce the population-level RSV infection by about 4%. Coverage and duration assumptions were influential, with higher coverage leading to larger declines in infants <6 months, and increased duration of protection leading to additional declines in infection and hospitalisation risk in older infants aged 6-8 months., Conclusions: With vaccine uptake similar to that achieved for other maternal vaccines in Australia, a year-round RSV maternal vaccination program is predicted to approximately halve the number of RSV hospitalisations in infants younger than 6 months. There was a small herd effect predicted in the base case but potential for larger benefits if vaccine coverage or the duration of protection exceeds base case assumptions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Allen Nazareno reports financial support was provided by University of New South Wales School of Population Health. James Wood reports a relationship with Australian Technical Advisory Group on Immunisation that includes: board membership. Alexandra Hogan reports a relationship with World Health Organization Immunization and vaccines related implementation research advisory committee (IVIR-AC) that includes: board membership. Alexandra Hogan reports a relationship with National Health and Medical Research Council that includes: funding grants. David Muscatello reports a relationship with National Institute of Health and Medical Research Great West Regional Delegation that includes: funding grants. Anthony Newall reports a relationship with Center for Innovation and Value Research that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: COVID-19 and seasonal influenza are endemic causes of morbidity and mortality. This study aimed to compare the epidemiology of severe illness and risk of death among patients following emergency department (ED) presentation with either infection., Methods: De-identified, population-based, emergency department records in New South Wales, Australia, were probabilistically linked to population-level health outcome databases for the period 1 January 2015 to 28 February 2023. Included were patients allocated an ED diagnosis consistent with an acute respiratory infection. Logistic regression was used to examine the association of infecting virus with risk of a severe outcome (intensive care unit admission or death)., Results: Influenza infection was notified in 2335 and COVID-19 in 5053 patients with a severe outcome. The age distribution was similar for both viruses, except in <15-year-olds, where severe influenza was nearly three times more frequent. Overall, the odds of death among patients with COVID-19 was 1.65 (95% CI 1.43, 1.89) times higher than among those with influenza. This declined to 1.49 (95% CI 1.08, 2.06) times during the COVID-19 Omicron variant period., Conclusions: The Omicron variant arrived when background population COVID-19 vaccination coverage was >90%. Despite that, death was more frequent for COVID-19 than influenza., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Estimates of excess deaths provide critical intelligence on the impact of population health threats including seasonal respiratory infections, pandemics and environmental hazards. Timely estimates of excess deaths can inform the response to COVID-19. However, access to timely mortality data is challenging due to the time interval between the death occurring and the date the death is registered and available for analysis ('registration interval')., Development: Using data from the New South Wales, Australia, Births Deaths and Marriages Registry, we developed a Poisson regression model that estimated near-complete weekly counts, for a given week of death, from partially-complete death registration counts. A 10-weeks lag was considered, and a 2-year baseline of historical registration intervals was used to correct lag weeks., Application: Validation of estimated counts found that the root-mean-square error (as a percentage of mean observed near-complete registrations) was less than 7% for lag week 3, and <5% for lag weeks 4-9. We incorporated this method utilizing an existing rapid weekly mortality surveillance system. Counts corrected for registration interval replaced observed values for the most recent weeks. Excess death estimates, based on corrected counts, were within 1.2% of near-complete counts available 9 weeks from the end of the analysis period., Conclusions: This study demonstrates a method for estimating recent death counts to correct for registration intervals. Estimates obtained at a 3-week lag were acceptable, while those at greater than 3 weeks were optimal., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Epidemiological Association.)

The effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health., Purpose: Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40-69 years at recruitment during 2006-2010., Method: We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode., Results: At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42-1.49), 1.26 times (95% CI 1.22-1.30), 1.31 times (95% CI 1.26-1.36) and 1.16 times (95% CI 1.13-1.19) higher for the most deprived compared with the least deprived quantile., Conclusion: Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health., (© 2024. The Author(s).)

Background: The interpretation of relative vaccine effectiveness (rVE) of improved influenza vaccines is complex. Estimation of burden averted is useful to contextualise their potential impact across different seasons. For the population aged under 65 years in Australia, this study estimated the additional morbidity and mortality that could be averted using improved influenza vaccines., Methods: We used observed, season-specific (2015-2019) influenza notification and influenza-coded hospitalisation frequencies and published modelled estimates of influenza-associated hospitalisations and deaths that occurred under the prevailing influenza vaccination coverage scenario. After back-calculating to the estimated burden in the population without vaccination, we applied published standard influenza vaccine effectiveness and coverage estimates to calculate the burden potentially averted by standard and improved influenza vaccines. A plausible range of rVE values were used, assuming 50% coverage., Results: The percentage point difference in absolute vaccine effectiveness (VE) of an improved vaccine compared to a standard vaccine is directly proportional to its rVE and inversely proportional to the effectiveness of the standard vaccine. The incremental burden averted by an improved vaccine is a function of both its difference in absolute VE and the severity of the influenza season. Assuming an rVE of 15% with 50% coverage, the improved vaccine was estimated to additionally avert 1517 to 12,641 influenza notifications, 287 to 1311 influenza-coded hospitalisations and 9 to 33 modelled all-cause influenza deaths per year compared to the standard vaccine., Conclusions: Improved vaccines can have substantial clinical and population impact, particularly when the effectiveness of standard vaccines is low, and burden is high., (© 2024 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Background: The influenza mortality burden has remained substantial in the United States (US) despite relatively high levels of influenza vaccine uptake. This has led to questions regarding the effectiveness of the program against this outcome, particularly in the elderly. The aim of this evaluation was to develop and explore a new approach to estimating the population-level effect of influenza vaccination uptake on pneumonia and influenza (P&I) associated deaths., Methods: Using publicly available data we examined the association between state-level influenza vaccination and all-age P&I associated deaths in the US from the 2013-2014 influenza season to the 2018-2019 season. In the main model, we evaluated influenza vaccine uptake in all those age 6 months and older. We used a mixed-effects regression analysis with generalised least squares estimation to account for within state correlation in P&I mortality., Results: From 2013-2014 through 2018-2019, the total number of all-age P&I related deaths during the influenza seasons was 480,111. The mean overall cumulative influenza vaccine uptake (age 6 months and older) across the states and years considered was 46.7%, with higher uptake (64.8%) observed in those aged ≥ 65 years. We found that overall influenza vaccine uptake (6 months and older) had a statistically significant protective association with the P&I death rate. This translated to a 0.33 (95% CI: 0.20, 0.47) per 100,000 population reduction in P&I deaths in the influenza season per 1% increase in overall influenza vaccine uptake., Discussion: These results using a population-level statistical approach provide additional support for the overall effectiveness of the US influenza vaccination program. This reassurance is critical given the importance of ensuring confidence in this life saving program. Future research is needed to expand on our approach using more refined data., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: Compare two approaches to analyzing time series data-interrupted time series with segmented regression (ITS-SR) and Bayesian structural time series using the CausalImpact R package (BSTS-CI)-highlighting advantages, disadvantages, and implementation considerations., Study Design and Setting: We analyzed electronic health records using each approach to estimate the antibiotic prescribing reduction associated with an educational program delivered to Australian primary care physicians between 2012 and 2017. Two outcomes were considered: antibiotics for upper respiratory tract infections (URTIs) and antibiotics of specified formulations., Results: For URTI indication prescribing, average monthly prescriptions changes were estimated at -4,550; (95% confidence interval, -5,486 to -3,614) and -4,270; (95% credible interval, -5,934 to -2,626) for ITS-SR and BSTS-CI, respectively. Similarly for specified formulation prescribing, monthly average changes were estimated at -7,923; (95% confidence interval, -15,887 to 40) for ITS-SR and -20,269; (95% credible interval, -25,011 to -15,635) for BSTS-CI., Conclusion: Differing results between ITS-SR and BSTS-CI appear driven by divergent explanatory and outcome series trends. The BSTS-CI may be a suitable alternative to ITS-SR only if the explanatory series represent the secular trend of the outcome series before the intervention and are equally affected by exogenous or confounding factors. When appropriately applied, BSTS-CI provides an alternative to ITS with more readily interpretable Bayesian effect estimates., Competing Interests: Declaration of competing interest None of the authors have any conflicts to disclose., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Evidence on the effectiveness of influenza vaccine in preventing antibiotic prescriptions for influenza-like illness (ILI) in adults is limited., Methods: A primary care-based case-control study was conducted to estimate influenza vaccine effectiveness (VE) against influenza-like illness (ILI) and antibiotic prescribing for ILI in adults aged ≥40 years. Cases were patients diagnosed with ILI from 1 st June to 30 th September in each year, 2015-2018; a subset of those with ILI prescribed antibiotics was also defined. Controls were patients attending a practice who did not receive an ILI diagnosis. Generalised estimating equations were used to calculate adjusted VE overall, by age (<65 versus ≥65 years) and comorbidity status., Results: The number of ILI cases varied from 558 in 2018 to 2901 in 2017 and controls from 86618 in 2015 to 136763 in 2017. Over 4 years the pooled estimate of VE was 24% (95%CI, 11% to 34%) against ILI and 15% (95%CI, -3% to 29%) against antibiotic prescription for ILI. Influenza vaccine was effective in reducing ILI with an associated antibiotic prescriptions in patients aged <65 years (VE=23%, 95%CI, 3% to 38%) and if no comorbidities were recorded (VE=22%, 95%CI, 1% to 39%) but not in other subgroups., Conclusions: Influenza vaccine reduced the likelihood of antibiotic prescriptions for ILI in low-risk adults (40-64 years and those without comorbidities)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Background: Respiratory syncytial virus (RSV) and influenza are important causes of disease in children and adults. In Australia, information on the burden of RSV in adults is particularly limited., Methods: We used time series analysis to estimate respiratory, acute respiratory infection, pneumonia and influenza, and bronchiolitis hospitalisations attributable to RSV and influenza in Australia during 2009 through 2017. RSV and influenza-coded hospitalisations in &lt;5-year-olds were used as proxies for relative weekly viral activity., Results: From 2009 to 2017, the estimated all-age average annual rates of respiratory hospitalisations attributable to RSV and seasonal influenza (excluding 2009) were 54.8 (95% confidence interval [CI]: 20.1, 88.8) and 87.8 (95% CI: 74.5, 97.7) per 100,000, respectively. The highest estimated average annual RSV-attributable respiratory hospitalisation rate per 100,000 was 464.2 (95% CI: 285.9, 641.2) in &lt;5-year-olds. For seasonal influenza, it was 521.6 (95% CI: 420.9, 600.0) in persons aged ≥75 years. In ≥75-year-olds, modelled estimates were approximately eight and two times the coded estimates for RSV and seasonal influenza, respectively., Conclusions: RSV and influenza are major causes of hospitalisation in young children and older adults in Australia, with morbidity underestimated by hospital diagnosis codes., (© 2022 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Background: Little is known about global variation in early epidemic growth rates and effective reproduction numbers (R e ) of seasonal influenza. We aimed to estimate global variation in R e of influenza type A and B during a single period., Methods: Country influenza detection time series from September 2017 through January 2019 were obtained from an international database. Type A and B epidemics by country were selected on the basis of R e estimates for a five-week moving window, advanced by week. Associations of R e with absolute latitude, human development index, percent of the population aged <15 years, and percent of those living in rural areas in each country were assessed., Results: Time series were included for 119 of 169 available countries. There were 100 countries with influenza A and 79 with B epidemics. Median R e for both influenza A and B epidemics was 1.23 (ranges: A 1.10, 1.60; B 1.06, 1.58). R e of influenza B but not A was independently associated with absolute latitude, increasing by 0.022 (95% confidence interval 0.002, 0.043) per 10 degrees., Conclusion: The R e of influenza A and B were similar. Only the R e of influenza B was associated with country characteristics, which was increasing with distance from the equator. The approach may be suitable for continuous R e surveillance., Competing Interests: Conflict of interest The authors have no competing interest to declare., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

COVID-19 public health measures altered respiratory syncytial virus (RSV) epidemiology. We examined age-stratified trends in RSV-related disease in Australian children in 2020 compared with previous years., Competing Interests: FINANCIAL DISCLOSURES: The authors have indicated they have no financial relationships relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)

Introduction: In Australia, the 2017 and 2019 influenza seasons were severe. High-dose or adjuvanted vaccines were introduced for ≥65 year-olds in 2018., Aim: To compare influenza-associated mortality in 2017 and 2019 with the average for 2010-2019., Methods: We used time series modelling to obtain estimates of influenza-associated death rates for influenza A(H1N1)pdm09, A(H3N2) and B in Australia, in persons of all ages and <65, 65-74 and ≥75 years. Estimates were made for pneumonia and influenza (P&I, 2010-2018), respiratory (2010-2018), and all-cause outcomes (2010-2019)., Results: During 2010 through 2018 (and 2019 for all-cause), influenza was estimated to be associated with an annual average of 2.1 (95% confidence interval (CI) 1.9, 2.4), 4.0 (95% CI 3.4, 4.6), and 11.6 (95% CI 8.4, 15.0) P&I, respiratory and all-cause deaths per 100,000 population, respectively. Influenza A(H1N1)pdm09 was estimated to be associated with less than one quarter of influenza-associated P&I and respiratory deaths, while A(H3N2) and B were each estimated to contribute approximately equally to the remaining influenza-associated deaths. In 2017, the respective rates were 7.8 (95% CI 7.1, 8.4), 12.3 (95% CI 10.9, 13.6) and 26.0 (95% CI 20.8, 32.0) per 100,000. In 2019, the all-cause estimate was 20.8 (95% CI 14.9, 26.7) per 100,000., Conclusions: Seasonal influenza continues to be associated with substantial mortality in Australia, with at least double the average occurring in 2017. Age-specific monitoring of vaccine effectiveness is needed in Australia to understand higher mortality seasons., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to estimate delay-adjusted case fatality rates (CFRs) for COVID-19 in South Korea, and evaluate how these estimates have evolved over time throughout the epidemic., Methods: Public data from the Korea Centers for Disease Control and Prevention (KCDC) were used to estimate age- and sex-specific CFRs for COVID-19 in South Korea up to June 12, 2020. We applied statistical methods previously developed to adjust for the delay between diagnosis and death, and presented both delay-adjusted and crude (unadjusted) CFRs throughout the epidemic., Results: The overall estimated delay-adjusted CFR was 2.39% (3.05% for males and 1.92% for females). Within each age strata where deaths were reported, males were found to have significantly higher CFRs than females. The estimated CFRs increased substantially from age 60 years in males and from 70 years in females. Both the delay-adjusted and crude CFRs were found to have evolved substantially, particularly early in the epidemic, converging only from mid-April 2020., Conclusions: The CFRs for South Korea provide an estimate of mortality risk in a setting where case ascertainment is likely to be more complete. The evolution in CFRs throughout the epidemic highlights the need for caution when interpreting CFRs calculated at a given time point., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We aimed to examine the available evidence on the impact of overseas parental migration on healthcare seeking for common childhood illnesses and the nutritional status of children left-behind under five years of age. A systematic review of English language articles was conducted on PubMed, MEDLINE and EMBASE, supplemented by a manual search of grey literature and reference lists. There were no studies examining the association between overseas parental migration and healthcare seeking for common childhood illnesses. We found three cross-sectional surveys examining the association with an indicator of nutritional status. We observed mixed findings from the available studies. The results indicated that children left-behind may have positive, negative or null effects on their nutritional status. There was insufficient information available to draw conclusions on the magnitude and direction of the association between overseas parental migration and its effect on either healthcare seeking for common childhood illnesses or the nutritional status of left-behind children. The association, if any, may be context or country dependent. Prospective studies are needed to address this important knowledge gap.

Objective: To examine the impact of parental international migration on health care seeking for common childhood illnesses (diarrhoea, fever, and acute respiratory infections) and nutritional status (stunting, underweight and wasting) in young children in Nepal using the most recent nationally representative Multiple Indicator Cluster Survey., Study Design: Nationally representative cross-sectional survey., Methods: We used multiple logistic regression models to examine the association between parental international migration and the study outcomes adjusting for a range of potential confounders., Results: Of 5310 children, 23.5% had at least one parent living abroad. Health care for common childhood illnesses was sought for 52.1% (95% confidence interval [CI]: 45.0%-59.2%) and 47.0% (95% CI: 42.7%-51.1%) of children from migrant and non-migrant families, respectively. The prevalence of stunting, underweight and wasting among left-behind children were 35.3% (95% CI: 31.5%-39.1%), 28.3% (95% CI: 24.2%-32.2%) and 11.8% (95% CI: 8.8%-14.7%), respectively. In adjusted analyses, there were no statistically significant differences in health care seeking or nutritional status by parent's migration status., Conclusions: Despite large economic benefits to Nepal due to international labour migration, we did not observe any apparent differences in young left-behind children in terms of seeking health care for common childhood illnesses or prevalence of under-nutrition. Longitudinal studies are needed to accurately measure whether migration has any substantial temporal effect on the nutritional status of young children or seeking for health care., (Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: The Early Warning and Response System (EWARS) is Indonesia's national syndromic and early warning surveillance system for the rapid detection of infectious diseases and outbreaks. We evaluated EWARS in the remote West Papua province of Indonesia., Methods: Structured telephone interviews were conducted with 11 key informants from West Papuan health services. EWARS data were analysed for usefulness of reporting., Results: Most respondents reported that EWARS is important and useful in improving early detection of outbreaks. The system has led to increased disease control coordination among health jurisdictional levels in the province. However, respondents noted that the limited number of districts involved in the system affected representativeness, and some stated that only about 30-35% of districts in each regency were involved and trained in EWARS reporting, partly owing to lack of a mobile telephone network. Barriers to complete reporting and response to alerts included limited human and funding resources for surveillance, lack of epidemiological training, and technical limitations imposed by limited internet and mobile communication infrastructure in this remote region., Conclusion: Great progress has been made in integrating West Papua into a nationally consistent disease and outbreak detection system. Strategies for addressing barriers resulting from remoteness, constrained human, funding and laboratory resources, lack of training, and limited internet and communications infrastructure are needed if EWARS in West Papua is to advance., Competing Interests: Mersi K Manurung is employed by the Health Department of West Papua Province, where the study was conducted. To limit conflict of interest, interviews were conducted by an Indonesian-speaking coauthor, Sarce EN Reo, who is not employed by the Health Department of West Papua Province. All authors declare no other conflict of interest

Background: Children aged under 5 years are particularly vulnerable to influenza infection. In this study, we aim to estimate the number and incidence of influenza among young children and estimate the impact of childhood vaccination in different scenarios from 2013/14 to 2016/17 seasons., Methods: The number and incidence rate of influenza infections among children aged under 5 years in Beijing was estimated by scaling up observed surveillance data. Then, we used a susceptible-exposed-infected-recovery (SEIR) model to reproduce the weekly number of influenza infections estimated in Beijing during the study seasons, and to estimate the number and proportion of influenza-attributed medically attended acute respiratory infections (I-MAARI) averted by vaccination in each season. Finally, we evaluated the impact of alternative childhood vaccination programs with different coverage and speed of vaccine distribution., Results: The estimated average annual incidence of influenza in children aged under 5 years was 33.9% (95% confidence interval (CI): 27.5%, 47.2%) during the study period. With the actual coverage during the included seasons at around 2.9%, an average of 3.9% (95%CI: 3.5%, 4.4%) I-MAARI was reduced compared to a no-vaccination scenario. Reaching 20%, 40%, 50%, 60%, 80% and 100% vaccine coverage would lead to an overall I-MAARI reduction of 25.3%, 42.7%, 51.9%, 57.0%, 65.3% and 71.2%. At 20% coverage scenario, an average of 28.8% I-MAARI will be prevented if intensive vaccination implemented in 2 months since the vaccine released., Conclusion: In Beijing, the introduction of a program for vaccinating young children, even at relatively low vaccine coverage rates, would considerably reduce I-MAARI, particularly if the vaccines can be quickly delivered.

Purpose: The burden of influenza on primary health-care services is not well established in tropical countries, where there are no clearly defined influenza seasons. We aimed to estimate the association between influenza infection activity and polyclinic attendance rates for upper respiratory tract infections (URTIs) in the Singapore population., Methods: We used generalized additive time series models to estimate the association between the proportion of respiratory tests positive for influenza infection in Singapore reported to the World Health Organization every week, and the population rate of polyclinic attendances in Singapore for physician-diagnosed URTI, which includes influenza-like illness (ILI), for six years from 2012 through 2017. Where data were available, we controlled for other infections that can cause fever or respiratory symptoms., Results: Influenza, dengue fever and chickenpox (varicella) were positively associated with acute URTI polyclinic attendances. The estimated URTI polyclinic attendance rates attributable to influenza, dengue fever and chickenpox were 618.9 (95% confidence interval [CI]: 501.6-736.3), 153.3 (95% CI: 16.5-290.2) and 1751.5 (95% CI: 1246.3-2256.8) per 100 000 population per year, respectively., Conclusion: Influenza poses a considerable burden on primary health-care services in Singapore. However, a substantial number of polyclinic attendances due to febrile infections such as dengue fever and chickenpox appear to be recorded as URTI in the polyclinic database. These associations require further investigation., ((c) 2020 The authors; licensee World Health Organization.)

Background: Influenza continues to cause seasonal epidemics and pandemics in humans. The burden of influenza is underestimated by traditional laboratory-based surveillance, and modelled estimates are required for influenza-attributable morbidity and mortality. We aimed to estimate the influenza-attributable hospitalisation in Australia, by influenza type., Methods: A generalised-additive regression model was used to estimate type- and age-specific influenza-attributable hospitalisation rates per 100,000 population by principal diagnosis in Australia, from 2001 through 2013. Weekly counts of laboratory-confirmed influenza notifications and by type, influenza A and B were used as covariates in the model. Main principal diagnosis categories of interest were influenza and pneumonia and respiratory admissions. A smoothing spline was used to control for unmeasured time varying factors. Results for 2009, in which the pandemic influenza A(H1N1)pdm09 virus circulated, were not included in annual averages and are reported separately., Results: During the study period, the estimated annual average, all-age, annual respiratory hospitalisation rates attributable to seasonal influenza type A, B and total influenza were 45.4 (95% CI: 34.9, 55.9), 32.6 (95% CI: 22.8, 42.4), and 76.9 (95% CI: 73.6, 80.2) per 100,000 population, respectively. During 2009, the estimated total pandemic influenza-attributable, all-age, respiratory hospitalisation rate was 56.1 (95% CI: 47.4, 64.9) per 100,000. Older adults (≥85 years of age) experienced the highest influenza-attributable hospitalisation rates for both seasonal and 2009 pandemic influenza. Collinearity between influenza A and B time series in some years limited the ability of the model to resolve differences in influenza attribution between the two virus types., Conclusion: Both seasonal and pandemic influenza caused considerable morbidity in Australia during the years studied, particularly among older adults. The pandemic hospitalisation rate in 2009 was lower than the average overall annual rate for seasonal influenza, but young to middle aged adults experience a hospitalisation rate similar to that of severe seasonal influenza., Competing Interests: CRM has had funding or in-kind support for investigator-driven research, and sat on advisory boards for Seqirus, Sanofi and Pfizer in the past 5 years. These funds did not go toward the present study. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Although oil-in-water adjuvants improve pandemic influenza vaccine efficacy, AS03 versus MF59 adjuvant comparisons in A(H1N1)pdm09 pandemic vaccines are lacking., Methods: We conducted an indirect-comparison meta-analysis extracting published data from randomised controlled trials in literature databases (01/01/2009-09/09/2018), evaluating immunogenicity and safety of AS03- or MF59-adjuvanted vaccines. We conducted comparisons of log-transformed haemagglutination inhibition geometric mean titre ratio (GMTR; primary outcome) of different regimens of each adjuvant versus unadjuvanted counterparts. Then via test of subgroup differences, we indirectly compared different AS03 versus MF59 regimens., Results: We identified 22 publications with 10,734 participants. In adults, AS03-adjuvanted vaccines (3.75 µg haemagglutinin) achieved superior GMTR versus unadjuvanted vaccines (all four comparisons); MD = 0.56 (95%CI 0.33 to 0.80, p < 0.001) to 1.18 (95%CI 0.72 to 1.65, p < 0.001). MF59 (full-dose)-adjuvanted vaccines (7.5 µg haemagglutinin) were superior to unadjuvanted vaccines (three of four comparisons); MD = 0.47 (95%CI 0.19 to 0.75, p = 0.001) to 0.80 (95%CI 0.44 to 1.16, p < 0.001). Adult indirect comparisons favoured AS03 over MF59 (six of eight comparisons; p < 0.001 to p = 0.088). Paediatric indirect comparisons favoured MF59-adjuvanted vaccines (two of seven comparisons; p = 0.011, 0.079). However, unadjuvanted control group seroconversion rate was lower in MF59 than AS03 studies (p < 0.001 to p = 0.097). There was substantial heterogeneity, and adult AS03 studies had lower risk of bias., Conclusions: Despite limited studies, in adults, AS03-adjuvanted vaccines allow antigen sparing versus MF59-adjuvanted and unadjuvanted vaccines, with similar immunogenicity, but higher risk of pain and fatigue (secondary outcomes) than unadjuvanted vaccines. In children, adjuvanted vaccines are also superior, but the better adjuvant is uncertain., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Surveillance of influenza epidemics is a priority for risk assessment and pandemic preparedness, yet representation of their spatiotemporal intensity remains limited. Using the epidemic of influenza type A in 2016 in Australia, we demonstrated a simple but statistically sound adaptive method of mapping epidemic evolution over space and time. Weekly counts of persons with laboratory confirmed influenza type A infections in Australia in 2016 were analysed by official national statistical region. Weekly standardised epidemic intensity was represented by a standard score (z-score) calculated using the standard deviation of below-median counts in the previous 52 weeks. A geographic information system (GIS) was used to present the epidemic progression. There were 79,628 notifications of influenza A infections included. Of these, 79,218 (99.5%) were allocated to a geographical area. The GIS maps indicated areas of elevated epidemic intensity across Australia by week and area that were consistent with the observed start, peak and decline of the epidemic when compared with counts aggregated at the state and territory level. This simple, adaptable approach could improve local level epidemic intelligence in a variety of settings and for other diseases. It may also facilitate increased understanding of geographic epidemic dynamics.

Objectives: Annual seasonal influenza vaccine manufacturing cycles align with temperate country seasonality in each hemisphere, yet influenza seasonality is poorly defined for many countries. The study introduces a novel and universal approach to defining and classifying seasonality that can be used to classify any country's influenza vaccine cycle alignment., Methods: Countries reporting to the World Health Organization's FluNet influenza virology database in 90% of weeks during 2011 through 2017 were included. A smoothed, standardised, average proportion of influenza occurring in each week of the year was used to determine degree of seasonality based on the range of average weekly variation. The proportion of activity occurring May through October was used to align influenza activity with a hemisphere's vaccine manufacturing cycle., Results: From 84 included countries, there were 2,239,208 positive influenza results, of which 26% were influenza type B. Degree of seasonality was moderately positively correlated with absolute value of latitude (r = 0.69, p < 0.0001). Latitude was strongly negatively correlated with the proportion of influenza occurring during May through October (r = -0.83, p < 0.0001). Thirteen countries (12% of the included global population), mainly in tropical zones, had influenza occurrence aligned with the opposite hemisphere's influenza vaccine manufacturing cycle. In tropical zones, concordance in the degree of seasonality and vaccine cycle alignment within regions and between adjacent countries was limited. In temperate zones, on average, influenza B peaked four weeks later than A., Conclusions: Influenza activity in many countries aligns with the vaccine manufacturing cycle of the opposite hemisphere. In tropical regions, there is limited scope for grouping countries for vaccine distribution and administration., (Copyright © 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Background: The benefit of school-based influenza vaccination policy has not been fully addressed in Beijing., Objectives: To evaluate the benefit of school-based influenza vaccination policy launched in Beijing., Methods: Using existing surveillance and immunization data, we developed a dynamic transmission model to assess the impact of influenza vaccination in school-going children. The outcome was defined as the averted number of medically attended influenza illnesses and the prevented disease fraction to all children aged 5-14 years for the 2013/14, 2014/15, and 2015/16 seasons., Results: We estimated that during the three consecutive influenza seasons, the averted number of medically attended influenza illnesses among children aged 5-14 years was around 104 000 (95% CI: 101 000-106 000), 23 000 (95% CI: 22 000-23 000), and 21 000 (95% CI: 21 000-22 000), respectively. Corresponding prevented fractions to all children aged 5-14 years were 76.3%, 38.5%, and 43.9%., Conclusions: In Beijing, school-based vaccinations reduced a substantial number of medically attended influenza illnesses despite seasonal variation in the prevented fraction. This is strong supportive evidence for the continuation of school-based vaccination programs to reduce the influenza burden in this age group., (© 2018 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)

We analyzed surveillance data for 2 sentinel hospitals to estimate the influenza-associated severe acute respiratory infection hospitalization rate in Beijing, China. The rate was 39 and 37 per 100,000 persons during the 2014-15 and 2015-16 influenza seasons, respectively. Rates were highest for children <5 years of age.

Background: Studies conducted during the 2009 influenza A (H1N1) pandemic found that obesity increases the risk of severe influenza including hospitalization and death. In this study, we examined the relationship of BMI with having laboratory-confirmed seasonal influenza and influenza-related respiratory hospitalization., Methods: We linked a cohort of 246,494 adults aged ≥45 years with data on BMI to subsequent laboratory-confirmed influenza notifications and cause-specific hospitalizations from 2006 to 2015. Cox-proportional hazard models were used to estimate the risk of incident laboratory-confirmed influenza and influenza-related respiratory hospitalizations according to BMI, adjusting for age, sex and other covariates., Results: After 1,840,408 person-years of follow-up, 1891 participants had laboratory-confirmed influenza notifications (crude rate 10.3/10,000 person-years) of whom 623 were hospitalized for a respiratory illness. Compared to those with healthy BMI (22.5 to <25.0 kg/m 2) , influenza incidence was respectively 27% (adjusted HR [aHR]: 1.27, 95% CI: 1.10-1.46) and 69% (aHR: 1.69, 1.24-2.29) greater among obese (BMI: 30 to <40 kg/m 2) and very obese adults (40 to <50 kg/m 2) . The equivalent aHRs for hospitalization were 1.57 (95% CI: 1.22-2.01) and 4.81 (95% CI: 3.23-7.17). For every 5-unit BMI increase above 22.5 kg/m 2 , there was a 15% (aHR: 1.15, 95% CI: 1.09-1.22) increase in risk of having a diagnosis of influenza and 42% increase in hospitalization (aHR: 1.42, 95% CI: 1.30-1.60). These trends did not differ between the pandemic year (2009) and other years., Conclusions: Our results suggest that obese adults have a similar risk of hospitalization for seasonal influenza as adults with cardiovascular disease and diabetes, and should therefore  be equally prioritized for funded interventions such as targeted immunization programs.

Background: In 2010, influenza, influenza-like illness (ILI) and acute respiratory infection (ARI) surveillance was established by the government of Burkina Faso. We provide preliminary descriptive results from this surveillance activity., Methods: The study period was 2013 through 2015. Two primary healthcare facilities in Bobo-Dioulasso district reported ILI in outpatients. Influenza virology, using reverse transcription-polymerase chain reaction (rRT-PCR), was available for a proportion of ILI patients. One hospital, in the capital Ouagadougou, reported ARI in both outpatients and inpatients (hospitalized). Inpatients admitted with ARI were considered severe ARI (SARI). We estimated the proportion of primary care outpatient visits that were ILI, and the proportion of those that were due to influenza, by age. We estimated the proportion of hospital outpatient visits that were ARI and the proportion of those that were SARI, by age., Results: Among combined outpatient visits in the Bobo-Dioulasso facilities, 19.6% were for ILI. One half (49.9%) of outpatient visits in infants and 30.9% in 1-4 year-olds were ILI. Among ILI outpatient visits 14.8% were due to influenza virus and, of these, 58.5% were type A and 41.5% type B. At the Ouagadougou hospital, 6.7% of outpatient visits were ARI, and 22.3% of those were SARI. The highest proportions of ARI were among infants (19.8%) and 1-4 year-olds (16.0%). The proportion of ARI that was SARI was highest among ≥15 year-olds (31.5%) followed by 1-4 year-olds (22.4%). Overall, 4.1% of SARI patients died., Conclusions: These preliminary data indicate the importance of respiratory infections among health care attendances in Burkina Faso, and influenza may be an important contributor to these.

Background: Seasonal influenza is responsible for a large disease and economic burden. Despite the expanding recommendation of influenza vaccination, influenza has continued to be a major public health concern in the United States (U.S.). To evaluate influenza prevention strategies it is important that policy makers have current estimates of the economic burden of influenza., Objective: To provide an updated estimate of the average annual economic burden of seasonal influenza in the U.S. population in the presence of vaccination efforts., Methods: We evaluated estimates of age-specific influenza-attributable outcomes (ill-non medically attended, office-based outpatient visit, emergency department visits, hospitalizations and death) and associated productivity loss. Health outcome rates were applied to the 2015 U.S. population and multiplied by the relevant estimated unit costs for each outcome. We evaluated both direct healthcare costs and indirect costs (absenteeism from paid employment) reporting results from both a healthcare system and societal perspective. Results were presented in five age groups (<5 years, 5-17 years, 18-49 years, 50-64 years and ≥65 years of age)., Results: The estimated average annual total economic burden of influenza to the healthcare system and society was $11.2 billion ($6.3-$25.3 billion). Direct medical costs were estimated to be $3.2 billion ($1.5-$11.7 billion) and indirect costs $8.0 billion ($4.8-$13.6 billion). These total costs were based on the estimated average numbers of (1) ill-non medically attended patients (21.6 million), (2) office-based outpatient visits (3.7 million), (3) emergency department visit (0.65 million) (4) hospitalizations (247.0 thousand), (5) deaths (36.3 thousand) and (6) days of productivity lost (20.1 million)., Conclusions: This study provides an updated estimate of the total economic burden of influenza in the U.S. Although we found a lower total cost than previously estimated, our results confirm that influenza is responsible for a substantial economic burden in the U.S., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000-500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999-2015., Methods: We estimated country-specific influenza-associated respiratory excess mortality rates (EMR) for 33 countries using time series log-linear regression models with vital death records and influenza surveillance data. To extrapolate estimates to countries without data, we divided countries into three analytic divisions for three age groups (<65 years, 65-74 years, and ≥75 years) using WHO Global Health Estimate (GHE) respiratory infection mortality rates. We calculated mortality rate ratios (MRR) to account for differences in risk of influenza death across countries by comparing GHE respiratory infection mortality rates from countries without EMR estimates with those with estimates. To calculate death estimates for individual countries within each age-specific analytic division, we multiplied randomly selected mean annual EMRs by the country's MRR and population. Global 95% credible interval (CrI) estimates were obtained from the posterior distribution of the sum of country-specific estimates to represent the range of possible influenza-associated deaths in a season or year. We calculated influenza-associated deaths for children younger than 5 years for 92 countries with high rates of mortality due to respiratory infection using the same methods., Findings: EMR-contributing countries represented 57% of the global population. The estimated mean annual influenza-associated respiratory EMR ranged from 0·1 to 6·4 per 100 000 individuals for people younger than 65 years, 2·9 to 44·0 per 100 000 individuals for people aged between 65 and 74 years, and 17·9 to 223·5 per 100 000 for people older than 75 years. We estimated that 291 243-645 832 seasonal influenza-associated respiratory deaths (4·0-8·8 per 100 000 individuals) occur annually. The highest mortality rates were estimated in sub-Saharan Africa (2·8-16·5 per 100 000 individuals), southeast Asia (3·5-9·2 per 100 000 individuals), and among people aged 75 years or older (51·3-99·4 per 100 000 individuals). For 92 countries, we estimated that among children younger than 5 years, 9243-105 690 influenza-associated respiratory deaths occur annually., Interpretation: These global influenza-associated respiratory mortality estimates are higher than previously reported, suggesting that previous estimates might have underestimated disease burden. The contribution of non-respiratory causes of death to global influenza-associated mortality should be investigated., Funding: None., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: Influenza outbreaks cause overcrowding in EDs. We aimed to quantify the impact of influenza on the National Emergency Access Targets and premature patient departure in New South Wales, Australia., Methods: This was a retrospective observational study of 11 million presentations to 115 hospitals during 2010-2014, using routinely collected administrative records. A time series generalised additive regression model was used to assess the correlation between weekly influenza activity and the weekly proportion of patients leaving the ED in >4 h and the proportion that departed before commencing or completing treatment ('did not wait'), after controlling for background winter and holiday effects., Results: During 2011-2014, peak annual circulating influenza was associated with the peak weekly proportion of presentations that left in >4 h. The maximum estimated absolute weekly change in that proportion was 3.88 (95% confidence interval 3.02-4.74) percentage points in 2014. For presentations that did not wait, influenza circulation was associated with statistically significant increases in all years, with a maximum weekly value of 2.68 (95% confidence interval 2.31-3.06) percentage points in 2012., Conclusions: Circulating influenza was associated with sustained increases and peaks in delayed patient throughput and premature patient departures. Influenza surveillance information may assist with development of health system and hospital workforce planning and bed management activities., (© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Background: Regression modeling methods are commonly used to estimate influenza-associated mortality using covariates such as laboratory-confirmed influenza activity in the population as a proxy of influenza incidence., Objective: We examined the choices of influenza proxies that can be used from influenza laboratory surveillance data and their impact on influenza-associated mortality estimates., Method: Semiparametric generalized additive models with a smoothing spline were applied on national mortality data from South Africa and influenza surveillance data as covariates to obtain influenza-associated mortality estimates from respiratory causes from 2009 to 2013. Proxies examined included alternative ways of expressing influenza laboratory surveillance data such as weekly or yearly proportion or rate of positive samples, using influenza subtypes, or total influenza data and expressing the data as influenza season-specific or across all seasons., Result: Based on model fit, weekly proportion and influenza subtype-specific proxy formulation provided the best fit. The choice of proxies used gave large differences to mortality estimates, but the 95% confidence interval of these estimates overlaps., Conclusion: Regardless of proxy chosen, mortality estimates produced may be broadly consistent and not statistically significant for public health practice., (© 2017 The Authors. Influenza and Other Respiratory Viruses. Published by John Wiley & Sons Ltd.)

Introduction: Influenza's impact on health and health care is underestimated by influenza diagnoses recorded in health-care databases. We aimed to estimate total and non-admitted influenza-attributable hospital Emergency Department (ED) demand in New South Wales (NSW), Australia., Methods: We used generalized additive time series models to estimate the association between weekly counts of laboratory-confirmed influenza infections and weekly rates of total and non-admitted respiratory, infection, cardiovascular and all-cause ED visits in NSW, Australia for the period 2010 through 2014. Visit categories were based on the coded ED diagnosis or the free-text presenting problem if no diagnosis was recorded., Results: The estimated all-age, annual influenza-attributable respiratory, infection, cardiovascular and all-cause visit rates/100 000 population/year were, respectively, 120.6 (99.9% confidence interval [CI] 102.3 to 138.8), 79.7 (99.9% CI: 70.6 to 88.9), 14.0 (99.9% CI: 6.8 to 21.3) and 309.0 (99.9% CI: 208.0 to 410.1). Among respiratory visits, influenza-attributable rates were highest among < 5-year-olds and ≥ 85-year-olds. For infection and all-cause visits, rates were highest among children; cardiovascular rates did not vary significantly by age. Annual rates varied substantially by year and age group, and statistically significant associations were absent in several years or age groups. Of the respiratory visits, 73.4% did not require admission. The non-admitted proportion was higher for the other clinical categories. Around 1 in 100 total visits and more than 1 in 10 respiratory or infection visits were associated with influenza., Discussion: Influenza is associated with a substantial and annually varying burden of hospital-attended illness in NSW.

Vaccination is the best available way to prevent influenza infections and related complications. Little information is available on vaccination policy in the world's most populous country, China. In China, influenza vaccine is not included in the national immunization programme. Citizens seek the vaccine on their own. Since 2007, Beijing, ahead of most cities in China, has offered free influenza vaccine for seniors aged at least 60 years and for primary and middle school students. There has been limited evaluation of the policy. We introduce and evaluate the government-funded influenza immunization policy in Beijing. Available data showed that the policy greatly increased the vaccine uptake rate in the population qualifying for free vaccination. Evidence of impact in a single influenza season on all high-risk populations was unclear. We suggest that further evaluation over multiple influenza seasons and in each high-risk group are required to inform future policy development in Beijing.

Infectious disease dynamic modeling can support outbreak emergency responses. We conducted a workshop to canvas the needs of stakeholders in Australia for practical, real-time modeling tools for infectious disease emergencies. The workshop was attended by 29 participants who represented government, defense, general practice, and academia stakeholders. We found that modeling is underused in Australia and its potential is poorly understood by practitioners involved in epidemic responses. The development of better modeling tools is desired. Ideal modeling tools for operational use would be easy to use, clearly indicate underlying parameterization and assumptions, and assist with policy and decision making.

Background: Influenza B is characterised by two antigenic lineages: B/Victoria and B/Yamagata. These lineages circulate together with influenza A during influenza seasons, with varying incidence from year to year and by geographic region., Objective: To determine the epidemiology of influenza B relative to influenza A in Australia., Methods: Laboratory-confirmed influenza notifications between 2001 and 2014 in Australia were obtained from the Australian National Notifiable Diseases Surveillance System., Results: A total of 278 485 laboratory-confirmed influenza cases were notified during the study period, comprising influenza A (82.2%), B (17.1%) and 'other and untyped' (0.7%). The proportion of notifications that were influenza B was highest in five- to nine-year-olds (27.5%) and lowest in persons aged 85 years and over (11.5%). Of all B notifications with lineage determined, 77.1% were B/Victoria and 22.9% were B/Yamagata infections. Mismatches between the dominant B lineage in a season and the trivalent vaccine B lineage occurred in over one-third of seasons during the study years. In general, influenza B notifications peaked later than influenza A notifications., Conclusion: The proportion of circulating influenza B in Australia during 2001-2014 was slightly lower than the global average and was dominated by B/Victoria. Compared with influenza A, influenza B infection was more common among older children and young adults and less common in the very elderly. Influenza B lineage mismatch with the trivalent vaccine occurred about one-third of the time., (© 2016 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)

Introduction and Aims: Acute harm from heavy drinking episodes is an increasing focus of public health policy, but capturing timely data on acute harms in the population is challenging. This study aimed to evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms., Design and Methods: We selected a random sample of 1000 ED presentations assigned an ED diagnosis code for alcohol harms (the 'alcohol syndrome') in the New South Wales, Australia, automatic syndromic surveillance system. The sample was selected from 68 public hospitals during 2014. Nursing triage free-text fields were independently reviewed to confirm alcohol consumption and classify each presentation into either an 'acute' or 'chronic' harm. Positive predictive value (PPV) for acute harm was calculated, and predictors of acute harm presentations were estimated using logistic regression., Results: The PPV of the alcohol syndrome for acute alcohol harm was 53.5%. Independent predictors of acute harm were ambulance arrival [adjusted odds ratio (aOR) = 3.4, 95% confidence interval (CI) 2.4-4.7], younger age (12-24 vs. 25-39 years: aOR = 3.4, 95% CI 2.2-5.3), not being admitted (aOR 2.2, 95% CI 1.5-3.2) and arriving between 10 pm and 5.59 am (aOR 2.1, 95% CI 1.5-2.8). PPV among 12 to 24-year-olds was 82%., Discussion and Conclusions: The alcohol syndrome provides moderate precision as an indicator of acute alcohol harms presenting to the ED. Precision for monitoring acute harm in the population is improved by filtering the syndrome by the strongest independent predictors of acute alcohol harm presentations. [Whitlam G, Dinh M, Rodgers C, Muscatello DJ, McGuire R, Ryan T, Thackway S. Diagnosis-based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level? Drug Alcohol Rev 2016;35:693-701]., (© 2016 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: A quadrivalent influenza vaccine (QIV) includes two A strains (A/H1N1, A/H3N2) and two B lineages (B/Victoria, B/Yamagata). The presence of both B lineages eliminate potential B lineage mismatch of trivalent influenza vaccine (TIV) with the circulating strain., Methods: Electronic database searches of Medline, Embase, Cochrane Central Register of Controlled Trials (CCRCT), Scopus and Web of Science were conducted for articles published until June 30, 2015 inclusive. Articles were limited to randomised controlled trials (RCTs) in adults using inactivated intramuscular vaccine and published in English language only. Summary estimates of immunogenicity (by seroprotection and seroconversion rates) and adverse events outcomes were compared between QIV and TIV, using a risk ratio (RR). Studies were pooled using inverse variance weights with a random effect model and the I(2) statistic was used to estimate heterogeneity., Results: A total of five RCTs were included in the meta-analysis. For immunogenicity outcomes, QIV had similar efficacy for the three common strains; A/H1N1, A/H3N2 and the B lineage included in the TIV. QIV also showed superior efficacy for the B lineage not included in the TIV; pooled seroprotection RR of 1.14 (95%CI: 1.03-1.25, p=0.008) and seroconversion RR of 1.78 (95%CI: 1.24-2.55, p=0.002) for B/Victoria, and pooled seroprotection RR of 1.12 (95%CI: 1.02-1.22, p=0.01) and seroconversion RR of 2.11 (95%CI: 1.51-2.95, p<0.001) for B/Yamagata, respectively. No significant differences were found between QIV and TIV for aggregated local and systemic adverse events within 7days post-vaccination. There were no vaccine-related serious adverse events reported for either QIV or TIV. Compared to TIV, injection-site pain was more common for QIV, with a pooled RR of 1.18 (95%CI: 1.03-1.35, p=0.02)., Conclusion: In adults, inactivated QIV was as immunogenic as seasonal TIV, with equivalent efficacy against the shared three strains included in TIV, and a superior immunogenicity against the non-TIV B lineage., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)