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In 1977, the Soviet Union (Union of Soviet Socialist Republics [USSR]) notified the World Health Organization (WHO) about an outbreak of H1N1 influenza, which later spread to many countries. The H1N1 strain of 1977 reappeared after being absent from the world for over 20 years. This pandemic simultaneously spread to several cities in the USSR and China. Many theories have been postulated to account for the emergence of this pandemic, including natural and unnatural origins. The purpose of this study was to use the modified Grunow–Finke risk assessment tool (modified Grunow‐Finke tool [mGFT]) to investigate the origin of the 1977 H1N1 pandemic. Data was collected from WHO archives and published documents. The assessment of the pandemic's origin involved the utilization of a modified version of the original Grunow–Finke risk assessment tool (GFT). Using the mGFT, the final score was 37 out of 60 points (probability: 62%), indicating a high likelihood that the Russian influenza pandemic of 1977 was of unnatural origin. Several variables supported this finding, including the sudden re‐emergence of a previously extinct strain, a genetic signature of laboratory modification for vaccine development, and unusual epidemiology. Inter‐rater reliability was moderate to high. By applying the mGFT to the 1977 Russian influenza pandemic, we established a high probability that this pandemic was of unnatural origin. Although this is not definitive, it is consistent with the possibility that it originated from an incompletely attenuated live influenza vaccine. The mGFT is a useful risk analysis tool to evaluate the origin of epidemics. [ABSTRACT FROM AUTHOR]

The origin of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is contentious. Most studies have focused on a zoonotic origin, but definitive evidence such as an intermediary animal host is lacking. We used an established risk analysis tool for differentiating natural and unnatural epidemics, the modified Grunow–Finke assessment tool (mGFT) to study the origin of SARS‐COV‐2. The mGFT scores 11 criteria to provide a likelihood of natural or unnatural origin. Using published literature and publicly available sources of information, we applied the mGFT to the origin of SARS‐CoV‐2. The mGFT scored 41/60 points (68%), with high inter‐rater reliability (100%), indicating a greater likelihood of an unnatural than natural origin of SARS‐CoV‐2. This risk assessment cannot prove the origin of SARS‐CoV‐2 but shows that the possibility of a laboratory origin cannot be easily dismissed. [ABSTRACT FROM AUTHOR]

This study aimed to determine optimal mitigation strategies in the event of an aerosolized attack with Bacillus anthracis, a category A bioterrorism agent with a case fatality rate of nearly 100% if inhaled and untreated. To simulate the effect of an anthrax attack, we used a plume dispersion model for Sydney, Australia, accounting for weather conditions. We determined the radius of exposure in different sizes of attack scenarios by spore quantity released per second. Estimations of different spore concentrations were then used to calculate the exposed population to inform a Susceptible-Exposed-Infected-Recovered (SEIR) deterministic mathematical model. Results are shown as estimates of the total number of exposed and infected people, along with the burden of disease, to quantify the amount of vaccination and antibiotics doses needed for stockpiles. For the worst-case scenario, over 500,000 people could be exposed and over 300,000 infected. The number of deaths depends closely on timing to start postexposure prophylaxis. Vaccination used as a postexposure prophylaxis in conjunction with antibiotics is the most effective mitigation strategy to reduce deaths after an aerosolized attack and is more effective when the response starts early (2 days after release) and has high adherence, while it makes only a small difference when started late (after 10 days). [ABSTRACT FROM AUTHOR]

Optometrists have been advised to wear face masks during the COVID-19 pandemic. This study examined whether face masks were equally protective against transmission of microbes. The aim of the current study was to examine the ability of face masks to reduce transmission of microbes in aerosols and during speech. Different face masks, surgical, medical 3-ply and cloth masks with different layers were used. The masks were tested under the ASTM standard F2101–1 to measure their ability to reduce the transmission of aerosolised Staphylococcus aureus. Bacterial cells in different sized aerosols were captured on agar plates. The ability of masks to reduce the transmission of bacteria during speech over 30 cm was measured. Bacteria were captured in masks or on agar plates at a distance of 30 cm during the speech. All masks reduced the transmission of aerosolised S. aureus (p ≤ 0.007). The medical 3-ply and cloth masks with three layers reduced the transmission of S. aureus aerosols (3.3 μm) by 98% and surgical and seven-layer masks reduced this by 100%. An antibacterial silver mask showed significantly greater transmission of S. aureus in aerosols of 4.7 μm (16 ± 6 cells) and 3.3 μm (122 ± 66 cells) compared to all other masks (0–3 cells and 0–15 cells, respectively; p ≤ 0.016). Surgical and three-layer masks had significantly worse filtration of 1.1 μm aerosols than for other aerosol sizes. Wearing a mask reduced the transmission of bacteria during speech, but the inner surface of these masks became contaminated with 528–3060 bacterial cells. Face masks effectively reduce the transmission of microbes in laboratory tests. Face masks made with seven layers were very effective at stopping transmission of S. aureus in all aerosol particle sizes. However, face masks become rapidly contaminated during wear. If masks are to be re-used, they should be regularly replaced or appropriately washed. [ABSTRACT FROM AUTHOR]

The AstraZeneca ChAdOx1 nCoV-19 (AZD1222) vaccine is associated with Thrombosis with Thrombocytopenia Syndrome (TTS) in 3/100,000 vaccinations with high fatality rates reported in many countries. We conducted a risk–benefit analysis for Australians aged 18–59 years, comparing the risk of vaccination versus infection, and rate of TTS to other vaccines which prompted policy change following rare adverse events – rotavirus, smallpox and oral polio vaccines. COVID-19 deaths over 12 months range from 0 to 417 in current and future worst case scenarios. In the past 15 months 20 COVID-19 deaths occurred in people < 60 years compared to 890 deaths over 60 years. The estimated possible number of TTS cases is 347, with vaccine-related deaths ranging from 17 to 153 if 80% of adults 18–59 years are vaccinated. The reported rate of TTS is in the same range as rare but serious adverse events associated with other vaccines that have been subject to policy change. In Australia, the potential risks of the AZD1222 vaccine in younger adults, who are at low risk of dying from COVID-19, may outweigh the benefits. [ABSTRACT FROM AUTHOR]

Aims: The persistence of atrial fibrillation (AF) has been associated with differential clinical outcomes, with studies showing that persistent and permanent AF results in increased morbidity and mortality when compared to the paroxysmal subtype. Given the established prognostic implications of AF subtype, we sought to discern the clinical and structural cardiac parameters associated with persistent/ permanent AF. Materials and methods: Consecutive patients admitted to our institution between January 2013 and January 2018 with a primary diagnosis of non‐valvular AF who underwent comprehensive transthoracic echocardiography were retrospectively appraised. Assessment of clinical and echocardiographic parameters was undertaken and compared according to AF subtype. Results: Of 1010 patients, 665 (mean age 66.8 ± 13.5 years, 53% men) had comprehensive transthoracic echocardiography on index admission and were included in the primary analysis. The majority of patients (n = 468; 70%) had paroxysmal AF while 197 (30%) had persistent/ permanent AF. Multivariable logistic regression analysis showed that heart failure (adjusted OR 3.135; 95% CI 2.099 to 4.682, P <.001), right atrial (RA) area ≥18 cm2 (adjusted OR 2.147; 95% CI 1.413 to 3.261, P <.001) and left atrial emptying fraction (LAEF) ≤34% (adjusted OR 2.959; 95% CI 1.991 to 4.398, P <.001) were independent predictors of persistent /permanent AF. Conclusions: The presence of heart failure, increased RA size and impaired LA function were associated with persistent/ permanent AF. These clinical and cardiac structural risk markers of AF persistence may identify a target population for early intervention to prevent adverse cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Graphene derivatives have the capability of forming chemical bonding with fabrics and show the potential to be used in smart textiles. However, the challenge is to fabricate highly conductive multifunctional fabric with good washing durability. Herein, reduced graphene oxide (RGO) and silver (Ag)/copper (Cu) nanoparticles (NPs)‐coated durable electroconductive silk fabric is fabricated by facile dip and dry method using 3‐glycidyloxypropyl trimethoxy silane as coupling agent (CA). Results show that RGO and NPs‐coated fabrics not only demonstrate low surface resistance but also excellent electrothermal property, UV shielding, enhanced thermal stability, and outstanding hydrophobicity consistently in the following order: pure silk < silk‐RGO < silk‐CA‐RGO < silk‐CA‐RGO‐Ag < silk‐CA‐RGO‐Cu. The addition of CA and NPs is found to have a significant impact on performance and washing durability. Cu incorporated samples (silk‐CA‐RGO‐Cu) show a very low value of surface resistance (3.15 kΩ sq−1) and even after washing 20 times, the resistance (6.76 kΩ sq−1) is observed to be lower than unwashed non‐Cu incorporated samples. Moreover, silk‐CA‐RGO‐Cu also has the highest UV resistance, Joule heating, hydrophobicity, and thermal stability among all samples, which makes it well suited for numerous potential applications including protective clothing, health monitoring, motion sensing, and sports clothing. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to measure the awareness, acceptability and perceptions of current issues in biosecurity posed by infectious diseases dual-use research of concern (DURC) in the community. DURC is conducted today in many locations around the world for the benefit of humanity but may also cause harm through either a laboratory accident or deliberate misuse. Most DURC is approved by animal ethics committees, which do not typically consider harm to humans. Given the unique characteristics of contagion and the potential for epidemics and pandemics, the community is an important stakeholder in DURC. Design: Self-administered web-based cross-sectional survey. Participants: Participants over the age of 18 in Australia and 21 in the USA were included in the survey. A total of 604 participants completed the study. The results of 52 participants were excluded due to potential biases about DURC stemming from their employment as medical researchers, infectious diseases researchers or law enforcement professionals, leaving 552 participants. Of those, 274 respondents resided in Australia and 278 in the USA. Outcomes: Baseline awareness, acceptability and perceptions of current issues surrounding DURC. Changes in perception from baseline were measured after provision of information about DURC. Results: Presurvey, 77% of respondents were unaware of DURC and 64% found it unacceptable or were unsure. Two-thirds of respondents did not change their views. The baseline perception of high risk for laboratory accidents (29%) and deliberate bioterrorism (34%) was low but increased with increasing provision of information (42% and 44% respectively, p<0.001), with men more accepting of DURC (OR=1.79, 95% CI 1.25 to 2.57, p=0.002). Postsurvey, higher education predicted lower risk perception of laboratory accidents (OR=0.56, 95% CI 0.34 to 0.93, p=0.02) and bioterrorism (OR=0.48, 95% CI 0.29 to 0.80, p=0.004). Conclusion: The community is an important stakeholder in infectious diseases DURC but has a low awareness of this kind of research. Only a minority support DURC, and this proportion decreased with increasing provision of knowledge. There were differences of opinion between age groups, gender and education levels. The community should be informed and engaged in decisions about DURC. [ABSTRACT FROM AUTHOR]

Successful identification of unnatural epidemics relies on a sensitive risk assessment tool designed for the differentiation between unnatural and natural epidemics. The Grunow–Finke tool (GFT), which has been the most widely used, however, has low sensitivity in such differentiation. We aimed to recalibrate the GFT and improve the performance in detection of unnatural epidemics. The comparator was the original GFT and its application in 11 historical outbreaks, including eight confirmed unnatural outbreaks and three natural outbreaks. Three steps were involved: (i) removing criteria, (ii) changing weighting factors, and (iii) adding and refining criteria. We created a series of alternative models to examine the changes on the parameter likelihood of unnatural outbreaks until we found a model that correctly identified all the unnatural outbreaks and natural ones. Finally, the recalibrated GFT was tested and validated with data from an unnatural and natural outbreak, respectively. A total of 238 models were tested. Through the removal of criteria, increasing or decreasing weighting factors of other criteria, adding a new criterion titled "special insights," and setting a new threshold for likelihood, we increased the sensitivity of the GFT from 38% to 100%, and retained the specificity at 100% in detecting unnatural epidemics. Using test data from an unnatural and a natural outbreak, the recalibrated GFT correctly classified their etiology. The recalibrated GFT could be integrated into routine outbreak investigation by public health institutions and agencies responsible for biosecurity. [ABSTRACT FROM AUTHOR]

Planning for a re-emergent epidemic of smallpox requires surge capacity of space, resources and personnel within health systems. There are many uncertainties in such a scenario, including likelihood and size of an attack, speed of response and health system capacity. We used a model for smallpox transmission to determine requirements for hospital beds, contact tracing and health workers (HCWs) in Sydney, Australia, during a modelled epidemic of smallpox. Sensitivity analysis was done on attack size, speed of response and proportion of case isolation and contact tracing. We estimated 100638 clinical HCWs and 14595 public hospital beds in Sydney. Rapid response, case isolation and contact tracing are influential on epidemic size, with case isolation more influential than contact tracing. With 95% of cases isolated, outbreak control can be achieved within 100 days even with only 50% of contacts traced. However, if case isolation and contact tracing both fall to 50%, epidemic control is lost. With a smaller initial attack and a response commencing 20 days after the attack, health system impacts are modest. The requirement for hospital beds will vary from up to 4% to 100% of all available beds in best and worst case scenarios. If the response is delayed, or if the attack infects 10000 people, all available beds will be exceeded within 40 days, with corresponding surge requirements for clinical health care workers (HCWs). We estimated there are 330 public health workers in Sydney with up to 940,350 contacts to be traced. At least 3 million respirators will be needed for the first 100 days. To ensure adequate health system capacity, rapid response, high rates of case isolation, excellent contact tracing and vaccination, and protection of HCWs should be a priority. Surge capacity must be planned. Failures in any of these could cause health system failure, with inadequate beds, quarantine spaces, personnel, PPE and inability to manage other acute health conditions. [ABSTRACT FROM AUTHOR]

Objectives The aim of this survey was to investigate parental vaccination attitudes and responses to vaccine-related media messages from political and medical leaders. Design This was a cross-sectional study using a semiquantitative questionnaire. Data were analysed using descriptive statistics, X² tests and logistic regression. Setting Data were collected from a web-based questionnaire distributed in Australia by a market research company in May of 2017. Participants 411 participants with at least one child under 5 were included in this study. The sample was designed to be representative of Australia in terms of gender and state of residence. Primary and secondary outcome measures The primary outcome measures were parental attitudes towards childhood immunisation before and after viewing vaccine-related messages from political and medical leaders, including Donald Trump (USA), Pauline Hanson (Australia) and Michael Gannon (Australia). Parents were classified as having 'susceptible' (not fixed) or 'fixed' (positive or negative) views towards vaccination based on a series of questions. Results Parents with fixed vaccination views constituted 23.8% (n=98) of the total sample; 21.7% (n=89) were pro-vaccination and 2.2% (n=9) were anti-vaccination. The remaining 76.2% of participants were classified as having susceptible views towards vaccination. Susceptible parents were more likely to report a change in their willingness to vaccinate after watching vaccine-related messages compared with fixed-view parents, regardless of whether the messaging was positive or negative (Trump OR 2.54, 95% CI (1.29 to 5.00); Hanson OR 2.64, 95% CI (1.26 to 5.52); Gannon OR 2.64, 95% CI (1.26 to 5.52)). Susceptible parents were more likely than fixed-view parents to report increased vaccine hesitancy after viewing negative vaccine messages (Trump OR 2.14, 95% CI (1.11 to 4.14), Hanson OR 2.34, 95% CI (1.21 to 4.50)). Conclusions The findings suggest that most parents including the vaccinating majorty are susceptible to vaccine messaging from political and medical leaders. Categorising parents as 'fixed-view' or 'susceptible' can be a useful strategy for designing and implementing future vaccine promotion interventions. [ABSTRACT FROM AUTHOR]

Variola virus is at risk of re-emergence either through accidental release, bioterrorism, or synthetic biology. The use of phylogenetics and phylogeography to support epidemic field response is expected to grow as sequencing technology becomes miniaturized, cheap, and ubiquitous. In this study, we aimed to explore the use of common VARV diagnostic targets hemagglutinin (HA), cytokine response modifier B (CrmB), and A-type inclusion protein (ATI) for phylogenetic characterization as well as the representativeness of modelling strategies in phylogeography to support epidemic response should smallpox re-emerge. We used Bayesian discrete-trait phylogeography using the most complete data set currently available of whole genome (n = 51) and partially sequenced (n = 20) VARV isolates. We show that multilocus models combining HA, ATI, and CrmB genes may represent a useful heuristic to differentiate between VARV Major and subclades of VARV Minor which have been associated with variable case-fatality rates. Where whole genome sequencing is unavailable, phylogeography models of HA, ATI, and CrmB may provide preliminary but uncertain estimates of transmission, while supplementing whole genome models with additional isolates sequenced only for HA can improve sample representativeness, maintaining similar support for transmission relative to whole genome models. We have also provided empirical evidence delineating historic international VARV transmission using phylogeography. Due to the persistent threat of re-emergence, our results provide important research for smallpox epidemic preparedness in the posteradication era as recommended by the World Health Organisation. [ABSTRACT FROM AUTHOR]

Objective: To understand the global outbreak surveillance needs of stakeholders involved in epidemic response in selected countries and areas in the Asia–Pacific region in order to inform development of an epidemic observatory, Epi-watch. Methods: We designed an online, semi-structured stakeholder questionnaire to collect information on global outbreak surveillance sources and limitations from participants who use epidemic intelligence and outbreak alert services in their work in government and nongovernment organizations in the Asia–Pacific region. Results: All respondents agreed that it was important to remain up to date with global outbreaks. The main reason cited for following global outbreak news was as an early warning for serious epidemics. Mainstream media and specialist Internet sources such as the World Health Organization (n = 54/91; 59%), the Program for Monitoring Emerging Diseases (ProMED)-mail (n = 45/91; 49%) and the United States Centers for Disease Control and Prevention (n = 31/91; 34%) were the most common sources for global outbreak news; rapid intelligence services such as HealthMap were less common (n = 9/91; 10%). Only 51% (n = 46/91) of respondents thought that their sources of outbreak news were timely and sufficient for their needs. Conclusion: For those who work in epidemic response, epidemic intelligence is important and widely used. Stakeholders are less aware of and less frequently use rapid sources such as HealthMap and rely more on validated but less timely traditional sources of disease surveillance. Users identified a need for more timely and reliable epidemic intelligence. [ABSTRACT FROM AUTHOR]

Objective We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials ( RCTs). Methods The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory-confirmed viral respiratory infection, influenza A or B, laboratory-confirmed bacterial colonisation and pathogens grouped by mode of transmission. Results Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory-confirmed bacterial colonisation ( RR 0.33, 95% CI 0.21-0.51), laboratory-confirmed viral infections ( RR 0.46, 95% CI 0.23-0.91) and droplet-transmitted infections ( RR 0.26, 95% CI 0.16-0.42) were significantly lower in the continuous N95 arm. Laboratory-confirmed influenza was also lowest in the continuous N95 arm ( RR 0.34, 95% CI 0.10-1.11), but the difference was not statistically significant. Rates of laboratory-confirmed bacterial colonisation ( RR 0.54, 95% CI 0.33-0.87) and droplet-transmitted infections ( RR 0.43, 95% CI 0.25-0.72) were also lower in the targeted N95 arm, but not in medical mask arm. Conclusion The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as 'airborne precautions,' provide superior protection for droplet-transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines. [ABSTRACT FROM AUTHOR]

Rationale: Medical masks are commonly used by sick individuals with influenza-like illness (ILI) to prevent spread of infections to others, but clinical efficacy data are absent. Objective: Determine whether medical mask use by sick individuals with ILI protects well contacts from related respiratory infections. Setting: 6 major hospitals in 2 districts of Beijing, China. Design: Cluster randomised controlled trial. Participants: 245 index cases with ILI. Intervention: Index cases with ILI were randomly allocated to medical mask (n=123) and control arms (n=122). Since 43 index cases in the control arm also used a mask during the study period, an as-treated post hoc analysis was performed by comparing outcomes among household members of index cases who used a mask (mask group) with household members of index cases who did not use a mask (no-mask group). Main outcome measure: Primary outcomes measured in household members were clinical respiratory illness, ILI and laboratory-confirmed viral respiratory infection. Results: In an intention-to-treat analysis, rates of clinical respiratory illness (relative risk (RR) 0.61, 95% CI 0.18 to 2.13), ILI (RR 0.32, 95% CI 0.03 to 3.13) and laboratory-confirmed viral infections (RR 0.97, 95% CI 0.06 to 15.54) were consistently lower in the mask arm compared with control, although not statistically significant. A post hoc comparison between the mask versus no-mask groups showed a protective effect against clinical respiratory illness, but not against ILI and laboratory-confirmed viral respiratory infections. Conclusions: The study indicates a potential benefit of medical masks for source control, but is limited by small sample size and low secondary attack rates. Larger trials are needed to confirm efficacy of medical masks as source control. [ABSTRACT FROM AUTHOR]

Background: In Australia, a Goods and Services Tax (GST) introduced in 2000 led to a decline in the price of ready-to-drink (RTD) beverages relative to other alcohol products. The 2008 RTD ("alcopops") tax increased RTD prices. The objective of this study was to estimate the change in incidence of Emergency Department (ED) presentations for acute alcohol problems associated with each tax. Methods: Segmented regression analyses were performed on age and sex-specific time series of monthly presentation rates for acute alcohol problems to 39 hospital emergency departments across New South Wales, Australia over 15 years, 1997 to 2011. Indicator variables represented the introduction of each tax. Retail liquor turnover controlled for large-scale economic factors such as the global financial crisis that may have influenced demand. Under-age (15-17 years) and legal age (18 years and over) drinkers were included. Results: The GST was associated with a statistically significant increase in ED presentations for acute alcohol problems among 18-24 year old females (0.14/100 000/month, 95% CI 0.05-0.22). The subsequent alcopops tax was associated with a statistically significant decrease in males 15-50 years, and females 15-65 years, particularly in 18-24 year old females (-0.37/100 000/month, 95% CI -0.45 to -0.29). An increase in retail turnover of liquor was positively and statistically significantly associated with ED presentations for acute alcohol problems across all age and sex strata. Conclusions: Reduced tax on RTDs was associated with increasing ED presentations for acute alcohol problems among young women. The alcopops tax was associated with declining presentations in young to middle-aged persons of both sexes, including under-age drinkers. [ABSTRACT FROM AUTHOR]

Background: Currently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines. Methods: Policies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected. Results: Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks. Conclusion: Currently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should jointly evaluate the available evidence, prioritize research to inform evidence gaps, and develop consistent policy on masks and respirator use in the health care setting [ABSTRACT FROM AUTHOR]

Chow and colleagues confirmed that cardiovascular events contribute to influenza-associated morbidity and mortality. The editorialist discusses why clinicians should consider influenza vaccination routine secondary prevention for cardiovascular morbidity and mortality. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the major cause of hospitalisation and death globally. Infections exacerbate cardiovascular events among cardiac patients, contributing to all-cause mortality. Vaccination is a cheap and effective intervention that can prevent infection. In Australia, influenza, pneumococcal and herpes zoster vaccines are recommended and funded for high-risk adults such as cardiac patients. There is high prevalence of high-risk adults in Western Sydney. This study investigates the uptake of influenza, pneumococcal and herpes zoster vaccines in patients admitted with heart failure and atrial fibrillation in a tertiary hospital in Western Sydney and factors associated with the uptake of the vaccines. Consecutive patients' hospitalised between 2014 and 2018 with heart failure or atrial fibrillation as principal diagnoses were identified. Information on patients' social demographic, clinical and vaccination status was collected and described using descriptive analysis. Univariate and multivariate analyses were conducted to determine factors associated with the uptake of the vaccines. Low uptake for pneumococcal (40–45 %) and herpes zoster (15 %) vaccines were found. Prevalence of influenza vaccination was lower among participants younger than 65 (51–72 %) than in older ones (78–96 %). Australia-born participants were more likely to receive pneumococcal vaccine than those born overseas (OR 2.02, 95 % CI 1.05–3.89). Participants 65 years or older and those with comorbidities such as hypertension, COPD and chronic renal impairment were more likely to receive the vaccines. Multidisciplinary strategies are needed to improve access to vaccination, community knowledge, community engagement, and healthcare provider support to provide appropriate care to migrants and younger cardiac patients and reduce morbidity and mortality in this high-risk group. [ABSTRACT FROM AUTHOR]