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doi:10.1111/jpc.12282
ORIGINAL ARTICLE
Paediatric Active Enhanced Disease Surveillance: A new surveillance system for Australia Yvonne Zurynski,1,4 Peter McIntyre,2,3,4 Robert Booy,2,3,4 and Elizabeth J Elliott,1,3,4 on behalf of the PAEDS Investigators Group* 1
Australian Paediatric Surveillance Unit, 2National Centre for Immunisation Research and Surveillance, Kids Research Institute, 3The Sydney Children’s Hospitals Network (Randwick and Westmead) and 4The Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
Aim: The Paediatric Active Enhanced Disease Surveillance (PAEDS) is described. PAEDS is active in four tertiary children’s hospitals in four states of Australia and aims to address gaps in surveillance for severe vaccine-preventable diseases and adverse events following immunisation. Methods: From August 2007 to December 2010, surveillance nurses actively identified and recruited children admitted with: acute flaccid paralysis, varicella infection, intussusception, seizures in infants and pandemic influenza (June–October 2009). Details of presentation, medical and immunisation history, outcome and laboratory results were collected. Completeness of ascertainment was estimated through audits of International Classification of Diseases 10th edition-coded medical records where possible. Results: Seven hundred thirty-three cases matching case definition criteria for the four conditions were recruited. In addition, 601 cases of influenza were recruited during the 2009 pandemic. PAEDS enhanced acute flaccid paralysis surveillance by the Australian Paediatric Surveillance Unit; the World Health Organization surveillance target was met when Australian Paediatric Surveillance Unit and PAEDS cases were combined. Among 133 children hospitalised for varicella, only 16 were vaccinated; samples of vesicle scrapings were collected in 57% for genotyping. Of 122 infants presenting with seizures, only six (12%) had received a vaccine in the last 7 days. Intussusception was more frequent among infants receiving their first dose of either of the rotavirus vaccines. Results informed policy and education for parents and health professionals. Preliminary audits of medical records suggest excellent ascertainment through PAEDS. Conclusions: PAEDS provides important, previously unavailable data to inform public health policy, clinical practice and community confidence. It has potential to respond quickly during outbreaks and epidemics. Key words:
child; immunisation; infectious disease; surveillance system.
Correspondence: Associate Professor Yvonne Zurynski, Australian Paediatric Surveillance Unit, Kids Research Institute, The Sydney Children’s Hospitals Network (Westmead), Locked Bag 4001, Westmead, NSW 2145, Australia. Fax: +61 2 9845 3082; email:
[email protected] Conflict of interest: The authors have no conflicts of interest. *PAEDS Investigators Group: Dr Nicholas Wood, National Centre for Immunisation Research & Surveillance, The Sydney Children’s Hospitals Network (Randwick and Westmead), Sydney. A/Prof Kristine Macartney, National Centre for Immunisation Research & Surveillance, The Sydney Children’s Hospitals Network (Randwick and Westmead), Sydney. Dr Tom Snelling, National Centre for Immunisation Research & Surveillance, The Sydney Children’s Hospitals Network (Randwick and Westmead), Sydney. A/Prof Jim Buttery, Immunisation Centre for Clinical Research Excellence, Infectious Diseases Unit, Murdoch Children’s Research Institute, and The Royal Children’s Hospital, Melbourne. Dr Jenny Royle, Immunisation Service, The Royal Children’s Hospital, Melbourne. Dr Nigel Crawford, The Royal Children’s Hospital; SAFEVIC, Murdoch Children’s Research Institute; and Department of Paediatrics, University of Melbourne, Melbourne. A/Prof Michael Gold, Discipline of Paediatrics, University of Adelaide and Women’s and Children’s Hospital, Adelaide. A/Prof Helen Marshall, Director, Vaccinology & Immunology Research Trials Unit, Adelaide, Women’s & Children’s Hospital, Adelaide and the University of Adelaide, Adelaide. A/Prof Peter Richmond, School of Paediatrics and Child Health, University of Western Australia, and Princess Margaret Hospital for Children, Perth. Dr Christopher Blyth, School of Paediatrics and Child Health, University of Western Australia, and Princess Margaret Hospital for Children, Perth. A/Prof Michael Nissen, Queensland Paediatric Infectious Diseases Laboratory; Children’s Medical Research Institute, Royal Children’s Hospital; and School of Medicine, The University of Queensland, Brisbane. Accepted for publication 23 December 2012.
Journal of Paediatrics and Child Health (2013) © 2013 The Authors Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
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A new surveillance system for Australia
Y Zurynski et al.
What is already known on this topic
What this paper adds
1 Timely, detailed information on hospital admissions for vaccinepreventable diseases or potential adverse events following immunisation is needed to support policy. 2 There are no surveillance systems that allow for the collection of biological samples, vaccination history and detailed clinical data simultaneously for the same child. 3 Data on potential severe adverse reactions following immunisation leading to hospitalisation are not readily available.
1 Hospital-based surveillance using specialist nurses to actively and prospectively identify relevant cases is feasible in Australia and provides previously unavailable data to support public health policy. 2 Paediatric Active Enhanced Disease Surveillance demonstrated its capability to respond to outbreaks by providing a unique, prospectively collected data set on hospitalisations due to influenza during the 2009 pandemic. 3 Paediatric Active Enhanced Disease Surveillance is capable of providing detailed data about potential adverse events following immunisation and produced the first data set in the world to identify an increased risk of intussusception after receipt of the new generation rotavirus vaccines.
Although excellent national laboratory and public health surveillance systems are currently operating in Australia, very few provide timely, detailed clinical data or the opportunity for simultaneous collection of biological samples.1 To address this gap, in 2007, the Australian Paediatric Surveillance Unit (APSU) and the National Centre for Immunisation Research and Surveillance (NCIRS) developed a hospital-based active surveillance system: Paediatric Active Enhanced Disease Surveillance (PAEDS). PAEDS is modelled on the Canadian Immunisation Monitoring Program Active (IMPAct) system that commenced in 1993, with the primary aim of ascertaining data on potential severe adverse events following immunisation (AEFI).2 IMPAct has progressively expanded to include all 12 tertiary paediatric centres in Canada where nurse monitors actively scan hospital records for target conditions. Such active case finding ensures high ascertainment, timely acquisition of clinical data and facilitates collection of relevant biological samples.3 This model is well suited to Australia. Similar to Canada, Australia has a geographically dispersed population, but the majority of children with serious illnesses are referred and admitted to large paediatric hospitals, ensuring opportunity for high ascertainment of relevant cases. The PAEDS network is funded by the Australian Department of Health and Aging (DoHA). This core funding was supplemented until March 2012 by the APSU National Health and Medical Research Council (NHMRC) Enabling Grant (no.402784). Since 2011, each participating state health department has also provided funding for PAEDS activities. We assessed the utility and potential value of PAEDS for the surveillance of vaccine-preventable diseases (VPDs) and AEFI, which are sufficiently severe to result in hospitalisation and difficult to adequately capture through passive surveillance mechanisms. One of the major drivers for the PAEDS initiative was a long-term problem in reaching adequate reporting and stool collection rates of acute flaccid paralysis (AFP).4 In order to maintain polio-free certification by the World Health Organization (WHO), Australia must reach a surveillance target of at least one AFP case per 100 000 children aged
