Topics

Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus infection. The most common complication of HZ is post-herpetic neuralgia (PHN), which is often debilitating and refractory to treatment.1 The incidence of both HZ and PHN increases markedly with age.2 In November 2016, a vaccine for HZ was included in Australia’s National Immunisation Program (NIP) for all people aged 70, together with a 5-year catch-up program for those aged 71–79 years.3 The vaccine is cost-effective for people aged 70–79, but is registered for vaccinating people from age 50.3

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1 National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead, Sydney, NSW
2 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
3 University of Sydney, Sydney, NSW

Correspondence: meru.sheel@health.nsw.gov.au

Acknowledgements:

This work was supported by the National Centre for Immunisation Research and Surveillance. Meru Sheel is a scholar in the Master of Philosophy in Applied Epidemiology program at the Australian National University.

Competing interests:

No relevant disclosures.

1. Cunningham AL, Breuer J, Dwyer DE, et al. The prevention and management of herpes zoster. Med J Aust 2008; 188: 171-176. <MJA full text>
2. MacIntyre R, Stein A, Harrison C, et al. Increasing trends of herpes zoster in Australia. PLoS One 2015; 10: e0125025.
3. Australian Government Department of Health. Zoster virus vaccine live; 0.65 mL injection, prefilled syringe; Zostavax^® [Pharmaceutical Benefits Advisory Committee public summary document]. Nov 2014. http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/psd/2014-11/files/zoster-vaccine-psd-11-2014.pdf (accessed Dec 2016).
4. Department of Health. National Immunisation Program Schedule (from 20 April 2015). Nov 2016. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/national-immunisation-program-schedule (accessed Dec 2016).
5. Australian Institute of Health and Welfare. Indigenous identification in hospital separations data: quality report (AIHW Cat. No. HSE 85; Health Services Series No. 35). Canberra: AIHW, 2010.
6. Liu B, Heywood AE, Reekie J, et al. Risk factors for herpes zoster in a large cohort of unvaccinated older adults: a prospective cohort study. Epidemiol Infect 2015; 143: 2871-2881.

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Research

Epidemiology of invasive meningococcal B disease in Australia, 1999–2015: priority populations for vaccination

Brett N Archer, Clayton K Chiu, Sanjay H Jayasinghe, Peter C Richmond, Jodie McVernon, Monica M Lahra, Ross M Andrews and Peter B McIntyre, on behalf of the Australian Technical Advisory Group on Immunisation (ATAGI) Meningococcal Working Party

Med J Aust 2017; 207 (9): . || doi: 10.5694/mja16.01340
Published online: 6 November 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Environment and public health

Abstract

Objectives: To describe trends in the age-specific incidence of serogroup B invasive meningococcal disease (IMD) in Australia, 1999–2015.

Design, setting, participants: Analysis in February 2017 of de-identified notification data from the Australian National Notifiable Diseases Surveillance System of all notifications of IMD in Australia with a recorded diagnosis date during 1999–2015.

Major outcomes: IMD notification rates in Australia, 1999–2015, by age, serogroup, Indigenous status, and region.

Results: The incidence of meningococcal serogroup B (MenB) disease declined progressively from 1.52 cases per 100 000 population in 2001 to 0.47 per 100 000 in 2015. During 2006–2015, MenB accounted for 81% of IMD cases with a known serogroup; its highest incidence was among infants under 12 months of age (11.1 [95% CI, 9.81–12.2] per 100 000), children aged 1–4 years (2.82 [95% CI, 2.52–3.15] per 100 000), and adolescents aged 15–19 years (2.40 [95% CI, 2.16–2.67] per 100 000). Among the 473 infants under 2 years of age with MenB, 43% were under 7 months and 69% under 12 months of age. The incidence of meningococcal serogroup C (MenC) disease prior to the introduction of the MenC vaccine in 2003 was much lower in infants than for MenB (2.60 cases per 100 000), the rate peaking in people aged 15–19 years (3.32 per 100 000); the overall case fatality rate was also higher (MenC, 8%; MenB, 4%). The incidence of MenB disease was significantly higher among Indigenous than non-Indigenous Australians during 2006–2015 (incidence rate ratio [IRR], 3.8; 95% CI, 3.3–4.5).

Conclusions: Based on disease incidence at its current low endemic levels, priority at risk age/population groups for MenB vaccination include all children between 2 months and 5 years of age, Indigenous children under 10 years of age, and all adolescents aged 15–19 years. Given marked variation in meningococcal disease trends over time, close scrutiny of current epidemiologic data is essential.

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1 National Centre for Immunisation Research and Surveillance (NCIRS), Sydney, NSW
2 Sydney Medical School, University of Sydney, Sydney, NSW
3 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
4 University of Western Australia, Perth, WA
5 Princess Margaret Hospital for Children, Perth, WA
6 Victorian Infectious Diseases Reference Laboratory, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
7 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
8 Murdoch Children's Research Institute, Melbourne, VIC
9 Neisseria Reference Laboratory and WHO Collaborating Centre for Sexually Transmitted Diseases, Prince of Wales Hospital, Sydney, NSW
10 South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW
11 University of New South Wales, Sydney, NSW
12 Menzies School of Health Research, Charles Darwin University, Darwin, NT

Correspondence: peter.mcintyre@health.nsw.gov.au

Acknowledgements:

The members of the Australian Technical Advisory Group on Immunisation (ATAGI) Meningococcal Working Party (2013) and of ATAGI (2013–2014) were Ross Andrews (chair), Michael Nissen, Peter McIntyre, Peter Richmond, Jodie McVernon, Sue Campbell-Lloyd, Karen Peterson, Monica Lahra, Ann Koehler and Julie Leask. We acknowledge the Office of Health Protection (Australian Government, Department of Health and Ageing) and the National Neisseria Network, Australia for providing the data; and all jurisdictional representatives on the National Surveillance Committee (NSC) and the Communicable Diseases Network of Australia (CDNA) for advice on interpreting jurisdiction-specific features of the notified data.

Competing interests:

The views expressed in this article are those of its authors, and do not represent the official position of or recommendations by ATAGI or the Australian Government.

1. Halperin SA, Bettinger JA, Greenwood B, et al. The changing and dynamic epidemiology of meningococcal disease. Vaccine 2012; 30 Suppl 2: B26-B36.
2. Jafri RZ, Ali A, Messonnier NE, et al. Global epidemiology of invasive meningococcal disease. Popul Health Metr 2013; 11: 17.
3. Lahra MM, Enriquez RP. Australian meningococcal surveillance programme annual report, 2015. Commun Dis Intell 2016; 40: E503-E511.
4. Sadarangani M, Scheifele DW, Halperin SA, et al. Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study. Clin Infect Dis 2015; 60: e27-e35.
5. Viner RM, Booy R, Johnson H, et al. Outcomes of invasive meningococcal serogroup B disease in children and adolescents (MOSAIC): a case-control study. Lancet Neurol 2013; 11: 774-783.
6. Wang B, Afzali HHA, Marshall H. The inpatient costs and hospital service use associated with invasive meningococcal disease in South Australian children. Vaccine 2014; 32: 4791-4798.
7. Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases in Australia, 2005 to 2007. Commun Dis Intell Q Rep 2010; 34 Suppl: S1-S167.
8. Lawrence G, Wang H, Lahra M, et al. Meningococcal disease epidemiology in Australia 10 years after implementation of a national conjugate meningococcal C immunization programme. Epidemiol Infect 2016; 144: 2382-2391.
9. Australian Government, Department of Health. Australian Technical Advisory Group on Immunisation (ATAGI) statement. Advice for immunisation providers regarding the use of Bexsero (March 2014). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/atagi-advice-bexsero (accessed May 2015).
10. Australian Government, Department of Health. Multicomponent meningococcal group B vaccine, 0.5 mL, injection, prefilled syringe, Bexsero^® — November 2013 [public summary document]. Pharmaceutical Benefits Scheme; updated Mar 2016. http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2013-11/meningococcal-vaccine (accessed June 2016).
11. Pharmaceutical Benefits Scheme (PBS). Recommendations made by the PBAC July 2015: subsequent decisions not to recommend. Pharmaceutical Benefits Scheme; updated Dec 2015. http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2015-07/web-outcomes-july-2015-subsequent-decision-not-to-recommend.pdf (accessed June 2016).
12. Marshall H, Clarke M, Sullivan T. Parental and community acceptance of the benefits and risks associated with meningococcal B vaccines. Vaccine 2014; 32: 338-344.
13. Australian Government, Department of Health. Meningococcal disease (invasive) surveillance case definition — V1.4. Updated Jan 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-nndss-casedefs-cd_mening.htm (accessed Jan 2014).
14. Gibson A, Jorm L, McIntyre P. Using linked birth, notification, hospital and mortality data to examine false-positive meningococcal disease reporting and adjust disease incidence estimates for children in New South Wales, Australia. Epidemiol Infect 2015; 143: 2570-2579.
15. Australian Bureau of Statistics. 3101.0. Australian demographic statistics, Jun 2016. Updated 15 Dec 2016. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3101.0 (accessed Mar 2017).
16. Australian Bureau of Statistics. 3238.0. Estimates and projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026. Updated Apr 2014. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3238.0 (accessed May 2015).
17. Naidu L, Chiu C, Habig A, et al. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2006–2010. Commun Dis Intell Q Rep 2013; 37 (Suppl): S1-S95.
18. Borrow R, Abad R, Trotter C, et al. Effectiveness of meningococcal serogroup C vaccine programmes. Vaccine 2013; 31: 4477-4486.
19. Andrews SM, Pollard AJ. A vaccine against serogroup B Neisseria meningitidis: dealing with uncertainty. Lancet Infect Dis 2014; 14: 426-434.
20. Vesikari T, Esposito S, Prymula R, et al. Immunogenicity and safety of an investigational multicomponent, recombinant, meningococcal serogroup B vaccine (4CMenB) administered concomitantly with routine infant and child vaccinations: results of two randomised trials. Lancet 2013; 381: 825-835.
21. Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62 (RR-2): 1-28.
22. MacNeil JR, Bennett N, Farley MM, et al. Epidemiology of infant meningococcal disease in the United States, 2006–2012. Pediatrics 2015; 135: e305-e311.
23. Public Health England. Invasive meningococcal disease (laboratory reports in England): 2015/2016 annual data by epidemiological year. Health Protection Report: Weekly Report [online] 2016; 10(37). https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/563949/hpr3716_imd-ann.pdf (accessed July 2017).
24. Pollard AJ, Riordan A, Ramsay M. Group B meningococcal vaccine: recommendations for UK use. Lancet 2014; 383: 1103-1104.
25. Parikh SR, Andrews NJ, Beebeejaun K, et al. Effectiveness and impact of a reduced infant schedule of 4CMenB vaccine against group B meningococcal disease in England: a national observational cohort study. Lancet 2016; 388: 2775-2782.
26. Martin NV, Ong KS, Howden BP, et al. Rise in invasive serogroup W meningococcal disease in Australia 2013–2015. Commun Dis Intell 2016; 40: E454-E459.
27. Government of South Australia, University of Adelaide. B part of it [website]. Updated 28 Nov 2016. http://www.bpartofit.com.au (accessed Mar 2017).
28. Novartis Vaccines and Diagnostics. Bexsero^® suspension for injection [product information]. 2013; updated July 2017. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2013-PI-02131-1 (accessed Mar 2017).
29. Poolman JT, Richmond P. Multivalent meningococcal serogroup B vaccines: challenges in predicting protection and measuring effectiveness. Expert Rev Vaccines 2015; 14: 1277-1287.
30. Patel MS. Australia’s century of meningococcal disease: development and the changing ecology of an accidental pathogen. Med J Aust 2007; 186: 136-141. <MJA full text>
31. Hart JT. The inverse care law. Lancet 1971; 297: 405-412.
32. National Centre for Immunisation Research and Surveillance. Meningococcal disease. Meningococcal vaccines for Australians: information for immunisation providers [fact sheet]. Mar 2017. http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf (accessed Aug 2017).

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Ethics and law

The right to know versus the right to privacy: donor anonymity and the Assisted Reproductive Treatment Amendment Act 2016 (Vic)

Xavier Symons

Med J Aust 2017; 207 (9): . || doi: 10.5694/mja17.00259
Published online: 6 November 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Ethics and law

Recent Victorian legislation is ethically defensible but will need to be closely monitored

On 1 March 2017, the Assisted Reproductive Treatment Amendment Act 2016 (Vic) came into effect, allowing for the retrospective release of anonymous donor information to donor-conceived children.1 The legislation, an Australian first, allows donor children to know the name, date of birth, ethnicity, physical characteristics, genetic conditions and donor code of their donor parents, even where anonymity has been requested. Donor children can access information about their biological parents through a new “one-door-in” service to be provided by the Victorian Assisted Reproductive Treatment Authority (VARTA), which is now managing the state’s central donor registry and providing information and support to donor-conceived people, parents, donors and their relatives. The donors affected by the legislation are those who donated before 1 January 1998; anonymous donation ceased in Victoria after that date.

Institute for Ethics and Society, University of Notre Dame Australia, Sydney, NSW

Correspondence: xavier.symons@nd.edu.au

Competing interests:

No relevant disclosures.

1. Parliament of Victoria. Assisted Reproductive Treatment Amendment Act 2016 (No. 6 of 2016). http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/51dea49770555ea6ca256da4001b90cd/A1554C040E11C661CA257F69000A4A50/$FILE/16-006aa%20authorised.pdf (accessed Sept 2017).
2. Victoria’s changes to laws on tracing sperm and egg donors a sensible evolution [editorial]. The Age (Melbourne) 2017; 2 Mar. http://www.theage.com.au/comment/the-ageeditorial/victoriaschanges-to-laws-on-tracing-sperm-and-egg-donors-a-sensible-evolution-20170302-guowdh.html (accessed Sept 2017).
3. Pennings G. How to kill gamete donation: retrospective legislation and donor anonymity. Hum Reprod 2012; 27: 2881-2885.
4. Fyfe M. When sperm-donor children come calling. Sydney Morning Herald 2015; 3 Sept. http://www.smh.com.au/good-weekend/when-spermdonor-children-come-calling-20150902-gjd76r.html (accessed Mar 2017).
5. Kirkham M, Bourne K, Fisher J, et al. Gamete donors’ expectations and experiences of contact with their donor offspring. Hum Reprod 2014; 29: 731-736.
6. Bruce N. On the importance of genetic knowledge. Child Soc 1990; 4: 183-196.
7. Marko Harrigan M, Dieter S, Leinwohl J, Marrin L. “It’s just who I am … I have brown hair. I have a mysterious father”: an exploration of donor-conceived offspring’s identity construction. J Fam Commun 2015; 15: 75-93.
8. Golombok S, Blake L, Casey P, et al. Children born through reproductive donation: a longitudinal study of psychological adjustment. J Child Psychol Psychiatry 2013; 54: 653-660.
9. Mahlstedt P, LaBounty K, Kennedy W. The views of adult offspring of sperm donation: essential feedback for the development of ethical guidelines within the practice of assisted reproductive technology in the United States. Fertil Steril 2010; 93: 2236-2246.
10. Hammarberg K, Johnson L, Bourne K, et al. Proposed legislative change mandating retrospective release of identifying information: consultation with donors and Government response. Hum Reprod 2014 Feb; 29: 286-292.
11. Paul M, Berger R. Topic avoidance and family functioning in families conceived with donor insemination. Hum Reprod 2007; 22: 2566-2571.
12. Scheib JE, Riordan M, Rubin S. Adolescents with open-identity sperm donors: reports from 12–17 year olds. Hum Reprod 2005; 20: 239-252.
13. Benetar D. The unbearable lightness of bringing into being. J Appl Philos 1999; 16: 173-180.
14. Australian Law Reform Commission. Traditional rights and freedoms – encroachments by Commonwealth laws. Final report. (ALRC Report No. 29). Sydney: ALRC, 2016. https://www.alrc.gov.au/sites/default/files/pdfs/publications/alrc_129_final_report_.pdf (accessed Sept 2017).
15. Nordquist P. The drive for openness in donor conception: conception: disclosure and the trouble with real life. Int J Law Policy Family 2014; 28: 321-338.

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Medical education
Snapshot

Sinusitis complicated by frontal bone osteomyelitis in a young patient

Roza Nastovska and Lyn-Li Lim

Med J Aust 2017; 207 (9): . || doi: 10.5694/mja16.01434
Published online: 6 November 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Otorhinolaryngologic diseases

Respiratory tract diseases

A 15-year-old male presented with acute left forehead swelling (Figure, A, arrow) and tenderness following a one-month history of worsening headache secondary to extensive frontal sinusitis. Imaging showed a scalp abscess, frontal bone osteomyelitis and underlying resolving sinusitis (Figure, B, arrow). Management included abscess drainage and bilateral endoscopic sinus surgery. Streptococcus anginosus was isolated and he completed a 6-week course of intravenous benzylpenicillin.

Eastern Health, Melbourne, VIC

Correspondence: roza.nastovska@gmail.com

Acknowledgements:

We thank Jillian Lau for her contribution to the clinical case, editing of early drafts and contribution of clinical photography.

Competing interests:

No relevant disclosures.

1. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas and Bennett’s principles and practice of infectious diseases. 8th ed. Elsevier: 2014.

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Research

The increasing importance of community-acquired methicillin-resistant Staphylococcus aureus infections

Jason W Agostino, John K Ferguson, Keith Eastwood and Martyn D Kirk

Med J Aust 2017; 207 (9): . || doi: 10.5694/mja17.00089
Published online: 30 October 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Indigenous health

Environment and public health

Abstract

Objectives: To identify groups at risk of methicillin-resistant Staphylococcus aureus (MRSA) infection, patterns of antimicrobial resistance, and the proportion of patients with MRSA infections but no history of recent hospitalisation.

Design, setting and participants: Case series of 39 231 patients with S. aureus isolates from specimens processed by the Hunter New England Local Health District (HNELHD) public pathology provider during 2008–2014.

Main outcome measures: Proportion of MRSA infections among people with S. aureus isolates; antimicrobial susceptibility of MRSA isolates; origin of MRSA infections (community- or health care-associated); demographic factors associated with community-associated MRSA infections.

Results: There were 71 736 S. aureus-positive specimens during the study period and MRSA was isolated from 19.3% of first positive specimens. Most patients (56.9%) from whom MRSA was isolated had not been admitted to a public hospital in the past year. Multiple regression identified that patients with community-associated MRSA were more likely to be younger (under 40), Indigenous Australians (odds ratio [OR], 2.6; 95% CI, 2.3–2.8), or a resident of an aged care facility (OR, 4.7; 95% CI, 3.8–5.8). The proportion of MRSA isolates that included the dominant multi-resistant strain (AUS-2/3-like) declined from 29.6% to 3.4% during the study period (P < 0.001), as did the rates of hospital origin MRSA in two of the major hospitals in the region.

Conclusions: The prevalence of MRSA in the HNELHD region decreased during the study period, and was predominantly acquired in the community, particularly by young people, Indigenous Australians, and residents of aged care facilities. While the dominance of the multi-resistant strain decreased, new strategies for controlling infections in the community are needed to reduce the prevalence of non-multi-resistant strains.

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1 Australian National University Medical School, Australian National University, Canberra, ACT
2 John Hunter Hospital, Newcastle, NSW
3 University of Newcastle, Newcastle, NSW
4 NSW Health Pathology, Newcastle, NSW
5 Hunter New England Health, Newcastle, NSW
6 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT

Correspondence: jason.agostino@anu.edu.au

Competing interests:

No relevant disclosures.

1. Brennan L, Lilliebridge RA, Cheng AC, et al. Community-associated methicillin-resistant Staphylococcus aureus carriage in hospitalized patients in tropical northern Australia. J Hosp Infect 2013; 83: 205-211.
2. Munckhof WJ, Nimmo GR, Schooneveldt JM, et al. Nasal carriage of Staphylococcus aureus, including community-associated methicillin-resistant strains, in Queensland adults. Clin Microbiol Infect 2009; 15: 149-155.
3. Coombs G, Daley D. Australian Staphylococcal Sepsis Outcome Program (ASSOP) 2015: final report. Perth: Australian Group on Antimicrobial Resistance, 2016. http://www.agargroup.org/files/July.2016.ASSOP%202015%20Final%20Report%202016%20(1).pdf (accessed Mar 2017).
4. Coombs GW, Daley DA, Thin Lee Y, et al. Australian Group on Antimicrobial Resistance Australian Staphylococcus aureus Sepsis Outcome Programme annual report, 2014. Commun Dis Intell Q Rep 2016; 40: E244-E254.
5. Nimmo GR, Bergh H, Nakos J, et al. Replacement of healthcare-associated MRSA by community-associated MRSA in Queensland: confirmation by genotyping. J Infect 2013; 67: 439-447.
6. Tong SY, Varrone L, Chatfield MD, et al. Progressive increase in community-associated methicillin-resistant Staphylococcus aureus in Indigenous populations in northern Australia from 1993 to 2012. Epidemiol Infect 2015; 143: 1519-1523.
7. Daley D, Coombs G, Nimmo G, et al. Staphylococcus aureus programme 2012. Community survey: antimicrobial susceptibility report. Australian Group on Antimicrobial Resistance (AGAR), 2013. http://www.agargroup.org/files/Staphylococcus%20aureus%20Programme%202012%20Susceptibility%20Report.pdf (accessed Mar 2017).
8. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus, 2011 [Active Bacterial Core surveillance report]. Nov 2012. https://www.cdc.gov/abcs/reports-findings/survreports/mrsa11.pdf (accessed Jan 2017).
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11. Clinical and Laboratory Standards Institute. Analysis and presentation of cumulative antimicrobial susceptibility test data: approved guideline (CLSI document M39-A4). 4th edition. Wayne (PA): CLSI, 2014.
12. Grayson ML, Russo PL, Cruickshank M, et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med J Aust 2011; 195: 615-619. <MJA full text>
13. Lawes T, Lopez-Lozano JM, Nebot CA, et al. Effects of national antibiotic stewardship and infection control strategies on hospital-associated and community-associated meticillin-resistant Staphylococcus aureus infections across a region of Scotland: a non-linear time-series study. Lancet Infect Dis 2015; 15: 1438-1449.
14. World Health Organization. Antimicrobial resistance global report on surveillance. Geneva: WHO, 2014. http://www.who.int/drugresistance/documents/surveillancereport/en/ (accessed Mar 2017).
15. Australian Government Department of Health, Department of Agriculture. Responding to the threat of antimicrobial resistance. Australia’s first national antimicrobial resistance strategy 2015–2019. Canberra: Department of Health, Department of Agriculture, 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/1803C433C71415CACA257C8400121B1F/$File/amr-strategy-2015-2019.pdf (accessed Mar 2017).
16. Duguid M, Cruickshank M (editors). Antimicrobial stewardship in Australian hospitals. Sydney: Australian Commission on Safety and Quality in Health Care, 2011. https://www.safetyandquality.gov.au/wp-content/uploads/2011/01/Antimicrobial-stewardship-in-Australian-Hospitals-2011.pdf (accessed Mar 2017).
17. Turnidge J, Baggoley C, Schipp M, Martin R. Resistance sans frontières: containing antimicrobial resistance nationally and globally. Med J Aust 2016; 204: 207-208. <MJA full text>
18. Munckhof WJ, Nimmo GR, Carney J, et al. Methicillin-susceptible, non-multiresistant methicillin-resistant and multiresistant methicillin-resistant Staphylococcus aureus infections: a clinical, epidemiological and microbiological comparative study. Eur J Clin Microbiol Infect Dis 2008; 27: 355-364.
19. Jeremiah CJ, Kandiah JP, Spelman DW, et al. Differing epidemiology of two major healthcare-associated meticillin-resistant Staphylococcus aureus clones. J Hosp Infect 2016; 92: 183-190.
20. Antibiotic Reference Group. Therapeutic guidelines: antibiotic, version 15. Melbourne: Therapeutic Guidelines Limited, 2014. https://tgldcdp.tg.org.au/guideLine?guidelinePage=Antibiotic&frompage=etgcomplete (accessed Mar 2017).
21. Bowen AC, Tong SY, Andrews RM, et al. Short-course oral co-trimoxazole versus intramuscular benzathine benzylpenicillin for impetigo in a highly endemic region: an open-label, randomised, controlled, non-inferiority trial. Lancet 2014; 384: 2132-2140.

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Perspectives

The kids are OK: it is discrimination not same-sex parents that harms children

Ken W Knight*, Sarah EM Stephenson*, Sue West*, Martin B Delatycki, Cheryl A Jones, Melissa H Little, George C Patton, Susan M Sawyer, S Rachel Skinner, Michelle M Telfer, Melissa Wake, Kathryn N North and Frank Oberklaid

Med J Aust 2017; 207 (9): . || doi: 10.5694/mja17.00943
Published online: 23 October 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Sexual health

Pediatric medicine

Social determinants of health

An update on the evidence, and implications for the medical community

The current public debate about same-sex marriage raises a number of significant issues for medical professionals and researchers in Australia. Misinformation is circulating in the public domain that children and adolescents with same-sex parents are at risk of poorer health and wellbeing than other children. An increased public health risk exists as a result of homophobic campaign messages for the entire lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) community, including a mental health risk for same-sex couples, their children, and young people who identify as LGBTIQ+.

1 Murdoch Childrens Research Institute, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 Royal Children's Hospital, Melbourne, VIC
4 Victorian Clinical Genetics Services, Melbourne, VIC
5 Children's Hospital at Westmead, Sydney, NSW
6 Liggins Institute, University of Auckland, Auckland, NZ

Correspondence: frank.oberklaid@rch.org.au

* Joint first authors

Competing interests:

No relevant disclosures.

1. Columbia Law School. What does the scholarly research say about the wellbeing of children with gay or lesbian parents? http://whatweknow.law.columbia.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-wellbeing-of-children-with-gay-or-lesbian-parents (accessed Sept 2017).
2. Manning WD, Fettro MN, Lamidi E. Child well-being in same-sex parent families: review of research prepared for American Sociological Association Amicus Brief. Popul Res Policy Rev 2014; 33: 485-502.
3. Dempsey D. Same-sex parented families in Australia. Melbourne: Australian Institute of Family Studies, 2013. https://aifs.gov.au/cfca/publications/same-sex-parented-families-australia (accessed Sept 2017).
4. Qu L, Knight K, Higgins D. Same-sex couple families in Australia 2016. Melbourne: Australian Institute of Family Studies, 2016. https://aifs.gov.au/publications/same-sex-couple-families-australia (accessed Sept 2017).
5. Biblarz TJ, Stacey J. How does the gender of parents matter? J Marriage Fam 2010; 72: 3-22.
6. Carlson MJ, Corcoran ME. Family structure and children’s behavioral and cognitive outcomes. J Marriage Fam 2001; 63: 779-792.
7. Golombok S. Parenting: what really matters. London: Routledge, 2000.
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11. Crowl A, Ahn S, Baker J. A meta-analysis of developmental outcomes for children of same-sex and heterosexual parents. J GLBT Fam Stud 2008; 4: 385-407.
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Narrative review

Reducing antibiotic prescribing in Australian general practice: time for a national strategy

Christopher B Del Mar, Anna Mae Scott, Paul P Glasziou, Tammy Hoffmann, Mieke L van Driel, Elaine Beller, Susan M Phillips and Jonathan Dartnell

Med J Aust 2017; 207 (9): . || doi: 10.5694/mja17.00574
Published online: 23 October 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Pharmaceutical preparations

Respiratory tract diseases

General medicine

Summary

In Australia, the antibiotic resistance crisis may be partly alleviated by reducing antibiotic use in general practice, which has relatively high prescribing rates — antibiotics are mostly prescribed for acute respiratory infections, for which they provide only minor benefits.
Current surveillance is inadequate for monitoring community antibiotic resistance rates, prescribing rates by indication, and serious complications of acute respiratory infections (which antibiotic use earlier in the infection may have averted), making target setting difficult.
Categories of interventions that may support general practitioners to reduce prescribing antibiotics are: regulatory (eg, changing the default to “no repeats” in electronic prescribing, changing the packaging of antibiotics to facilitate tailored amounts of antibiotics for the right indication and restricting access to prescribing selected antibiotics to conserve them), externally administered (eg, academic detailing and audit and feedback on total antibiotic use for individual GPs), interventions that GPs can individually implement (eg, delayed prescribing, shared decision making, public declarations in the practice about conserving antibiotics, and self-administered audit), supporting GPs’ access to near-patient diagnostic testing, and public awareness campaigns.
Many unanswered clinical research questions remain, including research into optimal implementation methods.
Reducing antibiotic use in Australian general practice will require a range of approaches (with various intervention categories), a sustained effort over many years and a commitment of appropriate resources and support.

1 Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD
2 University of Queensland, Brisbane, QLD
3 Therapeutic Guidelines, Melbourne, VIC
4 NPS MedicineWise, Sydney, NSW

Correspondence: CDelMar@bond.edu.au

Acknowledgements:

We received funds from the National Health and Medical Research Council for the Centre for Research Excellence in Minimising Antibiotics in Acute Respiratory Infections in Primary Care.

Competing interests:

We have been commissioned by the Australian Commission for Safety and Quality and Health Care and Bupa to provide expertise and to design patient decision aids.

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Position statement summary

Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring

Christian R Hamilton-Craig, Clara K Chow, John F Younger, V M Jelinek, Jonathan Chan and Gary YH Liew

Med J Aust 2017; 207 (8): . || doi: 10.5694/mja16.01134
Published online: 16 October 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Diagnostic techniques and procedures

Summary

Introduction

This article summarises the Cardiac Society of Australia and New Zealand position statement on coronary artery calcium (CAC) scoring. CAC scoring is a non-invasive method for quantifying coronary artery calcification using computed tomography. It is a marker of atherosclerotic plaque burden and the strongest independent predictor of future myocardial infarction and mortality. CAC scoring provides incremental risk information beyond traditional risk calculators such as the Framingham Risk Score. Its use for risk stratification is confined to primary prevention of cardiovascular events, and can be considered as individualised coronary risk scoring for intermediate risk patients, allowing reclassification to low or high risk based on the score. Medical practitioners should carefully counsel patients before CAC testing, which should only be undertaken if an alteration in therapy, including embarking on pharmacotherapy, is being considered based on the test result.

Main recommendations

CAC scoring should primarily be performed on individuals without coronary disease aged 45–75 years (absolute 5-year cardiovascular risk of 10–15%) who are asymptomatic.
CAC scoring is also reasonable in lower risk groups (absolute 5-year cardiovascular risk, < 10%) where risk scores traditionally underestimate risk (eg, family history of premature CVD) and in patients with diabetes aged 40–60 years.
We recommend aspirin and a high efficacy statin in high risk patients, defined as those with a CAC score ≥ 400, or a CAC score of 100–399 and above the 75th percentile for age and sex.
It is reasonable to treat patients with CAC scores ≥ 100 with aspirin and a statin.
It is reasonable not to treat asymptomatic patients with a CAC score of zero.

Changes in management as a result of this statement

Cardiovascular risk is reclassified according to CAC score.
High risk patients are treated with a high efficacy statin and aspirin.
Very low risk patients (ie, CAC score of zero) do not benefit from treatment.

1 Heart and Lung Institute, The Prince Charles Hospital, Brisbane, QLD
2 Centre for Advanced Imaging, University of Queensland, Brisbane, QLD
3 The George Institute for Global Health, Sydney, NSW
4 Westmead Hospital, Sydney, NSW
5 Royal Brisbane and Women's Hospital, Brisbane, QLD
6 St Vincent's Hospital, Melbourne, VIC
7 Cardiovascular Research Centre, Australian Catholic University, Melbourne, VIC
8 Griffith University, Gold Coast, QLD
9 Gold Coast Heart Centre, Gold Coast, QLD
10 University of Adelaide, Adelaide, SA
11 Epworth HealthCare, Melbourne, VIC

Correspondence: c.hamiltoncraig@uq.edu.au

Competing interests:

No relevant disclosures.

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24. Budoff MJ, Hokanson JE, Nasir K, et al. Progression of coronary artery calcium predicts all-cause mortality. JACC Cardiovasc Imaging 2010; 3: 1229-1236.

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Rates of hospitalisation for herpes zoster may warrant vaccinating Indigenous Australians under 70

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Epidemiology of invasive meningococcal B disease in Australia, 1999–2015: priority populations for vaccination

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The right to know versus the right to privacy: donor anonymity and the Assisted Reproductive Treatment Amendment Act 2016 (Vic)

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Sinusitis complicated by frontal bone osteomyelitis in a young patient

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The increasing importance of community-acquired methicillin-resistant Staphylococcus aureus infections

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The kids are OK: it is discrimination not same-sex parents that harms children

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Reducing antibiotic prescribing in Australian general practice: time for a national strategy

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Summary

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Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring

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Atopic dermatitis: the new frontier

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The prevalence of monogenic diabetes in Australia: the Fremantle Diabetes Study Phase II

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Rates of hospitalisation for herpes zoster may warrant vaccinating Indigenous Australians under 70

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Epidemiology of invasive meningococcal B disease in Australia, 1999–2015: priority populations for vaccination

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The right to know versus the right to privacy: donor anonymity and the Assisted Reproductive Treatment Amendment Act 2016 (Vic)

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Sinusitis complicated by frontal bone osteomyelitis in a young patient

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The increasing importance of community-acquired methicillin-resistant Staphylococcus aureus infections

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Abstract

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Comment

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The kids are OK: it is discrimination not same-sex parents that harms children

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Comment

Do you have any competing interests to declare? *

Reducing antibiotic prescribing in Australian general practice: time for a national strategy

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Summary

Author

Comment

Do you have any competing interests to declare? *

Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring

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Summary

Author

Comment

Do you have any competing interests to declare? *

Atopic dermatitis: the new frontier

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Comment

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The prevalence of monogenic diabetes in Australia: the Fremantle Diabetes Study Phase II

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Pagination