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Spirometry remains the cornerstone of respiratory function testing and is the key to diagnosing and monitoring the most common respiratory disorders. Spirometry measures how quickly the air can empty from the lungs (flow) and how much air can be moved during a maximal expiration (volume). It is a valuable clinical tool to detect diseases that impair respiratory function, help exclude respiratory disease as a cause of current symptoms, assess the severity of any impairment in function, and monitor the effects of any therapeutic intervention or of disease progression.
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Series editors
Balakrishnan (Kichu) Nair
Simon O’Connor
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It is time for legal action to recover health care costs from the tobacco industry
Australia’s 2011 precedent-setting plain packaging legislation1 reinforced the country’s reputation within the tobacco industry as “the darkest market in the world”.2 The country’s commitment to tobacco control, and a declining national smoking rate that is among the lowest in the world should not, however, mislead the public or policy makers into a mistaken belief that tobacco is done.
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Ross MacKenzie is supported by the National Cancer Institute, US National Institutes of Health, grant no. R01-CA091021.
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Despite being addictive and deadly, tobacco is widely accessible in all communities
Given that two-thirds of regular smokers in Australia will die from smoking-related causes,1 tobacco is remarkably available and easy to purchase. Tobacco is sold in every community, on every high street and in every retail precinct. Australian consumers can freely purchase cigarettes in the same places where they buy healthy household staples such as fruit and vegetables, milk and bread. With an estimated 40 000 outlets selling tobacco across Australia,2 it is one of the most widely accessible consumer goods on the market — yet the most dangerous when used as intended. While Australia has delivered crippling hits to the tobacco industry’s ability to promote its products, we have yet to land even a glancing blow to how and where it sells its products.
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On 31 May 2017, I attended the Tobacco Retail Summit hosted by the Cancer Council New South Wales. Australian and international speakers and participants discussed reforming the tobacco retail sector and I am indebted to their collective wisdom in helping inform this commentary.
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Objective: To evaluate trends in the proportion and severity of community-acquired pneumonia (CAP) attributable to Streptococcus pneumoniae (pneumococcus) in Australians aged 18 years and over.
Study design: Systematic review with unpublished data from the largest study.
Data sources: Multiple key bibliographic databases to June 2016.
Study selection: Australian studies on the aetiology of CAP in adults.
Data synthesis: In the 12 studies identified, pneumococcus was the most common cause of CAP. Four studies were assessed as being of good quality. Participants in two studies were predominantly non-Indigenous (n = 991); the proportion of pneumococcal CAP cases declined from 26.4% in 1987–88 to 13.9% in 2004–06, and the proportion with bacteraemia decreased from 7.8% to 3.8%. In two studies with predominantly Indigenous participants (n = 252), the proportion with pneumococcal bacteraemia declined from 6.8% in 1999–2000 to 4.2% in 2006–07. In the largest study (n = 885; 2004–06), 50.8% (60/118) of pneumococcal CAP occurred in people who were ≥ 65 years old. Among patients aged ≥ 65 years, intensive care unit admission and death were more common in patients who were ≥ 85 years old compared with younger patients (12.5% v 6.8%; 18.8% v 6.8% respectively), and also more common in the 19 patients with bacteraemia than in those without it (15.8% v 2.6%; 10.5% v 7.9% respectively). Of 17 cases of bacteraemia serotyped, 12 were due to 13-valent pneumococcal conjugate vaccine (13vPCV) serotypes and three to additional serotypes in 23-valent pneumococcal polysaccharide vaccine (23vPPV).
Conclusions: Available data suggest that the proportion of CAP attributable to pneumococcus (both bacteraemic and non-bacteraemic) has been declining in Australian adults. Should 13vPCV replace the 23vPPV currently funded by the National Immunisation Program for persons aged ≥ 65 years, surveillance to track non-bacteraemic pneumococcal CAP will be essential to evaluate the impact.
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The Australian Government Department of Health supported the National Centre for Immunisation Research and Surveillance (NCIRS) of vaccine preventable diseases in Australia. However, the views expressed are not necessarily those of the department. The study was undertaken as part of the regular policy deliberations of the Australian Technical Advisory Group on Immunisation. We thank the members of the Australian Community-acquired Pneumonia Study Collaboration.
Since the completion of this study and the submission of the manuscript for publication, J Kevin Yin left his employment at the NCIRS to work for Sanofi Pasteur Australia and New Zealand.
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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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.
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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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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.
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.
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.
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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.
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We thank Jillian Lau for her contribution to the clinical case, editing of early drafts and contribution of clinical photography.
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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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Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD-X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at http://copdx.org.au.
Main recommendations:
Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non-pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.