Volume 207 Issue 9

Our plan is to provide long term, generational change that is evidence-based and able to make a real difference to people’s lives

The Hon Greg Hunt

There is an urgent need to translate high level commitments into concrete actions to protect future generations

Ruth Kelly · Sally C Davies

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

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 · Frank Oberklaid

A 15-year-old male presented with acute left forehead swelling and tenderness following a 1-month history of worsening headache secondary to extensive frontal sinusitis

Roza Nastovska · Lyn-Li Lim

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

Xavier Symons

Further success in controlling MRSA will require adapting our tactics to its shifting epidemiology

Alistair T Leanord · John Coia

The clinical, social and economic value of vaccination varies both with time and by population group

Andrew J Pollard · Hannah Christensen

Priorities include all children aged 2 months–5 years, Indigenous children under 10, and adolescents (15–19 years)

on behalf of the Australian Technical Advisory Group on Immunisation (ATAGI) Meningococcal Working Party

As the epidemiology of MRSA changes, so must strategies for containing it

Jason W Agostino · John K Ferguson · Keith Eastwood · Martyn D Kirk

Other factors, particularly rainfall patterns, play more significant roles

James D Stewart · Simon Smith · Josh Hanson

The burden of severe herpes zoster among Indigenous Australians in their 60s is higher than for non-Indigenous Australians

Meru Sheel · Frank H Beard · Aditi Dey · Kristine Macartney · Peter B McIntyre

Non-bacteraemic CAP constitutes the largest burden of pneumococcal disease in adults

J Kevin Yin · Sanjay H Jayasinghe · Patrick G Charles · Catherine King · Clayton K Chiu · Robert I Menzies · Peter B McIntyre

Reducing antibiotic use in Australian general practice will require a range of approaches

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

To the Editor:I read with interest the call by Menzies and colleagues1 for revitalised efforts to vaccinate a higher proportion of the adult Australian population against common infectious diseases. At present, the aim of the adult component of the National Immunisation Program is to protect against Streptococcus pneumoniae and the two viruses that cause influenza and herpes zoster — all prevalent pathogens in our environment. In addition to infections derived in Australia, adults are more likely than children to be the focus of imported cases of infection. Exposure of adults to, for instance, tropical infectious diseases, including those transmitted by biting insects (ie, dengue, yellow fever, chikungunya and Zika viruses, malaria, etc), will be far greater than that of juveniles. This is because adults have more reason to travel overseas and typically undertake more trips than children do.2 Vaccine uptake among travellers is mixed, and there are groups that are not sufficiently vaccinated, including people who travel overseas to visit friends and relatives (VFR). These so-called VFR travellers are more likely to consider themselves at low personal risk or threat when travelling to their country of origin, stemming from a sense of familiarity with the destination country and its infectious disease risks.3 Cultural beliefs and language barriers are also important factors associated with suboptimal uptake of pre-travel advice among VFR travellers. While infants accompany their parents for holidays and to visit family abroad, intercontinental travel for business and educational opportunities is largely restricted to adults.4 For typical short stay business trips, rather than for holidays lasting an extended period, it is tempting to neglect being up to date with vaccinations.2 In this instance, for the busy business flyer — often a last-minute traveller — the risk aversion to illness may be suppressed by avoidance of the perceived hassle of immunisation. Travel acts as a vector for spread of infection and many outbreaks are imported into Australia through overseas trips; nevertheless, travellers frequently neglect to seek pre-travel health advice.5 Improving rates of travel vaccination, especially in adults, is one area of focus that may help infectious disease control efforts nationally.

Andrew W Taylor-Robinson

In reply

Robert I Menzies · Jenny Royle · C Raina MacIntyre

To the Editor:While vaccine refusal is but one contributor among several to failures of vaccine-preventable disease control, as stated by Beard and colleagues,1 there are important ethical aspects of vaccine refusal. Intentionally opting out of vaccination imposes risks on others, and policies allowing some to opt out weigh their freedom to do so against the rights of others not to be harmed by vaccine-preventable diseases.2 In particular, people who cannot be safely vaccinated (eg, infants) or maintain immunity (eg, the immunosuppressed) are at increased risk of severe disease — including death — and depend on the immunity of others.2 It is true that herd immunity has no “magic threshold”:1 even with high population vaccination levels, severe harm may be caused when just one unvaccinated person has contact with an infectious person and then a vulnerable person. The death of an immunosuppressed woman from measles pneumonitis in the state of Washington, United States, in 2015 is a case in point.3 Tighter legislation on universal vaccination does not unfairly target vaccine refusal. Indeed, Victorian No Jab, No Play legislation has a general objective: “to increase immunisation rates for young children,”4 which applies equally to people who have unintentionally failed to vaccinate and those who intentionally opt out due to hesitancy or refusal. Policy should make vaccination the norm and aim for the highest possible coverage. Moreover, while we should revise financial penalties if they unfairly burden poor families (while the wealthy may pay to opt out), policy should, in some way, recognise that conscientious objection to vaccination has consequences for others.5 Measles outbreaks are correlated with vaccine refusal6 and lead to significant social costs, which Australia may avoid if high levels of vaccination are maintained. Though the true epidemiology is certainly more complex, if measles vaccination leads to immunity in 99% of vaccine recipients, and 95% of people are vaccinated,1 the population level of immunity would be 94.05%. Threshold concepts have limitations, but whether this is “comfortably exceeding” 94%,1 or perilously close to recurrent measles outbreaks — which impose avoidable risks of harm on others — is a matter for debate.

Euzebiusz Jamrozik

In reply

Frank H Beard · Julie Leask · Peter B McIntyre

Dr Jim Stewart has stayed the course over almost two decades to get where he, his partner, and 4-week-old son, want to be

Cate Swannell

The recipients of Citations for Outstanding Contributions to Student Learning, through the Australian Awards for University Teaching have been announced and health and medical educators have featured heavily. From the Australian National University, Professor Emily Banks was cited for outstanding leadership within epidemiology and public health and for the development of an innovative team and systems-based approach to student supervision. From Charles Sturt University, Dr Louise Pemberton was cited for facilitating success in biomedical science through the Science Learner Engagement with Great Outcomes creative learning activities. From the University of NSW, Dr Louisa Smith was cited for the design, development and implementation of research-led accessible and innovative teaching and learning resources in the field of disability studies. From the University of Sydney, the Health Collaboration Challenge Team was cited for innovation in interprofessional learning for health students using videography and peer assessment. From Flinders University, Flinders NT was cited for facilitating quality workplace-based supervision practice for health professionals in remote locations through development and provision of context-responsive inter-professional training and peer review resources. From the University of WA, Associate Professor Denese Playford was cited for developing and leading innovative medical education programs using transformative learning experiences to inspire and prepare students to serve rural and disadvantaged people. From Curtin University, Associate Professor Janet Beilby was cited for the creation of internationally recognised, innovative, work-integrated learning resources to ensure industry-ready health science graduates, capable of delivering world-class client care. From Bond University, Assistant Professor Christian Moro was cited for developing innovative technology-enhanced curriculum, experiential visualisation tools and resources that positively impact medical and biomedical students’ learning and application of physiology and anatomy. From the Queensland University of Technology, Professor Fiona Naumann was cited for sustained leadership in transitioning Exercise Physiology towards competency-based education through curriculum innovation, scholarly inquiry and strategic collaborations with the profession and universities. From the University of Queensland, Dr Lisa Fitzgerald was cited for challenging and supporting public health students through a learning journey to gain a deeper understanding of the social determinants of health. From Monash University, Dr Julia Choate was cited for developing, implementing and evaluating student-centred active learning strategies that engage biomedical, medical, nutrition and science undergraduates and enhance their learning of physiology. From the University of Melbourne, Dr Jason Ivanusic was cited for leadership in anatomy teaching that provides innovative, engaging and internationalised learning experiences for students of biomedical sciences. Also from the University of Melbourne, Ms Shawana Andrews was cited demonstrating sustained excellence in developing an Indigenised curriculum as a lecturer in Indigenous health within the health sciences. https://docs.education.gov.au/system/files/doc/other/ed17-0285_aaut_booklet_internals_04.pdf Professor Jennifer Martin, director of Griffith University’s Institute for Drug Discovery has been awarded Bragg Membership of the Royal Institution of Australia at a ceremony attended by Prince Andrew, the Duke of York. Professor Martin’s research focuses on protein structure and function in health and disease and the application of structure-based approaches to the design and development of new drugs. Professor Martin has previously been awarded the inaugural ARC Australian Laureate Fellowship, the ASBMB Roche Medal, the Queensland Smart Women Smart State Research Scientist Award, and the Women in Biotech Outstanding Achievement Award. She is the President of the Asian Crystallography Association, a former President of the Society of Crystallographers in Australia and New Zealand, and a former chair of the National Committee for Crystallography of the Australian Academy of Science. Professor Martin was a Foundation Member of the Australian Academy of Science’s Science in Australia Gender Equity committee, charged with addressing gender equity in STEMM. https://riaus.org.au/wp-content/uploads/2017/09/170920-Media-Release-New-Inductees-of-Prestigious-Bragg-Membership-website.pdf