Search

International audience; Together with influenza, the non-influenza RNA respiratory viruses (NIRVs), which include respiratory syncytial virus, parainfluenza viruses, coronavirus, rhinovirus, and human metapneumovirus, represent a considerable global health burden, as recognised by WHO's Battle against Respiratory Viruses initiative. By contrast with influenza viruses, little is known about the contemporaneous global diversity of these viruses, and the relevance of such for development of pharmaceutical interventions. Although far less advanced than for influenza, antiviral drugs and vaccines are in different stages of development for several of these viruses, but no interventions have been licensed. This scarcity of global genetic data represents a substantial knowledge gap and impediment to the eventual licensing of new antiviral drugs and vaccines for NIRVs. Enhanced genetic surveillance will assist and boost research and development into new antiviral drugs and vaccines for these viruses. Additionally, understanding the global diversity of respiratory viruses is also part of emerging disease preparedness, because non-human coronaviruses and paramyxoviruses have been listed as priority concerns in a recent WHO research and development blueprint initiative for emerging infectious diseases. In this Personal View, we explain further the rationale for expanding the genetic database of NIRVs and emphasise the need for greater investment in this area of research.

Measles that develops in previously vaccinated cases has been reported to be associated with modified disease, although severity has usually been assessed by the presence or absence of symptoms. To date no studies have attempted to subjectively grade the severity of the clinical features.To investigate both the objective and subjective severity of measles in vaccinated and unvaccinated cases in the context of a community outbreak.A retrospective observational cohort study conducted in Christchurch in 2009 using notified data compared the presentation of measles in 14 confirmed cases that had received at least one MMR (measles, mumps, rubella) vaccination and 14 age-matched unvaccinated confirmed cases. Additional details on the subjective and objective severity of the illness were obtained from parents/guardians using a standardised telephone questionnaire.The vaccinated group had significantly fewer clinical features on presentation (p=0.01, RR=1.3, 95% CI 1.1-1.6) and a less severe illness objectively, as measured by height and duration of fever, the number of days needing medication other than paracetamol and days required in bed. Unvaccinated cases were 2.8 times more likely to have more severe clinical features than vaccinated cases (OR=2.8, 95% CI 1.5-5.0). Unvaccinated cases were 3.0 times more likely to develop IgM antibody (RR=3.0, 95% CI 0.9-9.3).Previously vaccinated children who develop measles are likely to have less severe disease and serology results that may be inconclusive, particularly for IgM antibody if tested in the first few days after the rash onset.

To determine the incidence rates of community-acquired pneumonia and pneumococcal pneumonia requiring hospitalisation among Maori and non-Maori, an observational study was conducted in Christchurch and Hamilton. Self-reported data were collected using an interviewer-administered questionnaire. Routine clinical, radiological, and microbiological techniques were used apart from the BinaxNow pneumococcal antigen test for diagnosis of this infection. Census data was used to determine the denominator for statistical analyses. The pneumonia rate overall was 3.03 times higher among Maori than non-Maori (p0.001). Differences were significant for each 10-year age group from age 45-74 years (p0.05). The rate of pneumococcal pneumonia was 3.23 fold higher for Maori than non-Maori (p0.001), but it did not reach statistical significance in the age-related comparisons. These ethnic disparities are of major concern, and policy planners should consider further interventions to improve the efficacy of current anti-smoking campaigns and to undertake studies of conjugate pneumococcal vaccines for Maori.

To identify knowledge, attitudes, and beliefs influencing influenza-immunisation coverage in people aged 65 years and over in New ZealandA postal survey of general practitioners (GPs) and practice nurses (PNs) was carried out during 2001-2002 in four regions of New Zealand (Northland, Waikato, Bay of Plenty, and Christchurch) with low or high influenza-immunisation coverage, based on 2000 data. A telephone survey of people aged 65 and over was also carried out in each region. Both surveys assessed knowledge and attitudes about influenza and influenza vaccination, including barriers to vaccination and personal vaccination status.GPs, PNs, and people aged 65 and over were generally well-informed about influenza, its complications, and the effectiveness of influenza immunisation. Some misinformation, however, is still prevalent in people 65 and over, and these beliefs discourage some older people from being immunised.Influenza vaccination coverage among high-risk groups in New Zealand is suboptimal. Overseas studies have shown that patient attitudes and beliefs influence influenza vaccination uptake, and our findings support this. While levels of awareness about influenza and the role of vaccination in its control are high, this study suggests a need for information specifically targeted towards younger age groups about the benefits of vaccination in healthy older adults.