Publications by authors named "Bette Liu"

Issue Addressed: Adolescent e-cigarette use is increasing and is associated with subsequent smoking. This study examines potential protective factors associated with not vaping among First Nations adolescents in Australia to inform community programs.

Methods: The 'Next Generation: Youth Wellbeing Study' is a cohort study of First Nations adolescents aged 10-24 years from urban, rural and remote communities in Central Australia, Western Australia and New South Wales.

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Objective: Adverse birth outcomes and the maternal severity of influenza in pregnancy are well documented but information on pertussis is limited.

Design: Population-based linkage data were collected during 2001-2016.

Setting: New South Wales, Australia.

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Article Synopsis
  • The study looks at how risky behaviors in teenagers can affect their education later in life.
  • Researchers analyzed data from a group of young people and their parents over many years to see how things like smoking, drinking, and sex at a young age relate to finishing school.
  • Results showed that teens who waited longer to start smoking, drinking, or having sex tended to do better in school by the time they were 22.
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Background: Vaccine-preventable respiratory infections impact on healthcare systems globally. Despite availability of vaccines, fluctuations in vaccination rates, pathogen virulence and community transmission dynamics mean that these respiratory infections continue to pose substantial public health risks. To understand trends in vaccine-preventable respiratory infections, we analysed linked data from emergency department (ED), hospitalisations and deaths in New South Wales, Australia, from 2012 to 2022.

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Background: The Medicines Intelligence (MedIntel) Data Platform is an anonymised linked data resource designed to generate real-world evidence on prescribed medicine use, effectiveness, safety, costs and cost-effectiveness in Australia.

Results: The platform comprises Medicare-eligible people who are ≥18 years and residing in New South Wales (NSW), Australia, any time during 2005-2020, with linked administrative data on dispensed prescription medicines (Pharmaceutical Benefits Scheme), health service use (Medicare Benefits Schedule), emergency department visits (NSW Emergency Department Data Collection), hospitalisations (NSW Admitted Patient Data Collection) plus death (National Death Index) and cancer registrations (NSW Cancer Registry). Data are currently available to 2022, with approval to update the cohort and data collections annually.

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Disease surveillance data was critical in supporting public health decisions throughout the coronavirus disease 2019 (COVID-19) pandemic. At the same time, the unprecedented circumstances of the pandemic revealed many shortcomings of surveillance systems for viral respiratory pathogens. Strengthening of surveillance systems was identified as a priority for the recently established Australian Centre for Disease Control, which represents a critical opportunity to review pre-pandemic and pandemic surveillance practices, and to decide on future priorities, during both pandemic and inter-pandemic periods.

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Article Synopsis
  • Annual influenza epidemics significantly impact global health and economy, but their activity dropped during the COVID-19 pandemic, only to resurge in Australia in early 2022, coinciding with the Omicron variant wave.
  • * The current influenza vaccination program in Australia recommends yearly vaccinations for all individuals aged 6 months and older, with free vaccines provided for at-risk groups, but overall coverage, particularly among younger populations, remains low.
  • * To improve vaccination rates, strategies such as better monitoring, culturally appropriate resources, and addressing specific population needs are essential for enhancing the overall effectiveness of the immunization program.
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Background: While the 23-valent pneumococcal polysaccharide vaccine (PPV23) has demonstrated its role in preventing severe pneumococcal disease, its impact on more non-specific conditions like acute respiratory tract infection (ARI) and lower respiratory tract infections (LRTI) remains unclear. We aimed to investigate the role of PPV23 in prevention of presentations for ARI and LRTI and related antibiotic prescriptions among older adults in primary care.

Methods: Using a nationwide general practice dataset, we followed a cohort of regularly attending patients aged ≥65 years from 1 January 2014 until 31 December 2018 for presentations for ARI, LRTI, and related antibiotic prescriptions.

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Background: In 2020 Australia changed the funded universal older adult pneumococcal vaccination program from use of the 23-valent pneumococcal polysaccharide vaccine (PPV23) at age 65 to the 13-valent pneumococcal conjugate vaccine (PCV13) at age 70 years. We investigated uptake of both PCV13 and PPV23 in older adults before and after the program change.

Methods: We analysed a national dataset of records of patients attending general practices (GPs).

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Background: Data on SARS-CoV-2 vaccine effectiveness to reduce transmission of infection in household settings are limited. We examined the effects of SARS-CoV-2 vaccines on Delta variant transmission within households in an infection-naïve population.

Methods: This was a population-based data linkage cohort study in the Greater Sydney Metropolitan Area, New South Wales, Australia based on cases observed in June-November 2021.

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Background: The effects of seasonal influenza vaccination on cardiovascular disease (CVD) outcomes, including among individuals with established CVD, are uncertain.

Methods: To evaluate the efficacy and safety of influenza vaccines compared to no vaccines or placebo for preventing all-cause/CVD mortality or all-cause/CVD hospitalization in the general population and in populations with pre-existing CVD, we conducted a living systematic review (LSR) and prospective meta-analysis (PMA). Published randomized controlled trials (RCT) and observational studies between 1994 and 2023 were searched.

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To estimate the incidence and outcomes of sepsis hospitalisations in Aboriginal and Torres Strait Islander and non-Indigenous residents of New South Wales. Prospective cohort study of residents aged 45 years and older, recruited between 2006 and 2009, and followed for hospitalisation for sepsis. Incidence and hazard ratio (HR) of sepsis hospitalisation and intensive care unit (ICU) admission identified using International Classification of Diseases (10th revision) coding on discharge data.

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We followed 4,081,257 Australian adults aged ≥ 65 years between November 2022 and May 2023 for COVID-19-specific mortality, when recombinant SARS-CoV-2 Omicron lineages (predominantly XB and XBB) as well as BA.2.75 were circulating.

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Article Synopsis
  • The study analyzed the effectiveness of COVID-19 vaccines against mortality in older adults using extensive population data from Australia, specifically focusing on two key periods in 2022 amidst the Omicron variant waves.
  • Results showed that the effectiveness of booster doses significantly decreased over time, with a 3rd dose having a 93% effectiveness within 3 months, while a 2nd dose given over 6 months prior had only a 34% effectiveness during the first period.
  • The findings highlight the critical need for ongoing booster vaccinations to protect vulnerable populations, as the vaccines remain highly effective against COVID-19 mortality, but their effectiveness declines with time since the last vaccine dose.
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Objectives: Compare two approaches to analyzing time series data-interrupted time series with segmented regression (ITS-SR) and Bayesian structural time series using the CausalImpact R package (BSTS-CI)-highlighting advantages, disadvantages, and implementation considerations.

Study Design And Setting: We analyzed electronic health records using each approach to estimate the antibiotic prescribing reduction associated with an educational program delivered to Australian primary care physicians between 2012 and 2017. Two outcomes were considered: antibiotics for upper respiratory tract infections (URTIs) and antibiotics of specified formulations.

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Background: Respiratory infections including influenza and pertussis are associated with significant morbidity and mortality in mothers and newborns. Vaccination during pregnancy against influenza and pertussis is recommended for all women but data on uptake in Australia is limited.

Methods: We conducted a retrospective population-based cohort study in Australia's largest state, New South Wales (NSW), using a Perinatal Data Collection (PDC).

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Background: There is limited data directly comparing the effectiveness of different COVID-19 vaccines.

Methods: We compared rates of SARS-CoV-2 Omicron BA.1/2 infection during March to May 2022 in Australian adults who had received one of four COVID-19 vaccines in the last 14-63 days as either a primary course or a booster dose using Cox proportional hazards models adjusting for age and other characteristics.

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Background: The impact of pneumococcal conjugate vaccines (PCVs) on pneumonia in children is well-documented but data on 23-valent pneumococcal polysaccharide vaccine (PPV23) are lacking. Between 2001 and 2011, Indigenous children in Western Australia (WA) were recommended to receive PPV23 at 18-24 months of age following 3 doses of 7-valent PCV. We evaluated the incremental effectiveness of PPV23 against pneumonia hospitalisation.

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Article Synopsis
  • In November 2016, Australia introduced the live-attenuated zoster vaccine (Zostavax) for older adults as part of their National Immunisation Program to reduce cases of herpes zoster (HZ), especially among those at higher risk like the elderly and immunocompromised individuals.
  • While there have been modest reductions in HZ incidence and complications, challenges persist, such as inadequate vaccine coverage and safety issues when the vaccine is mistakenly given to immunocompromised patients.
  • The introduction of a new recombinant subunit zoster vaccine (Shingrix) in 2021, which is more effective and safer for immunocompromised individuals, offers potential solutions, but it has not yet proven
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Background: Previous mixed findings on the associations between whole blood (WB) donation and risk of cardiovascular diseases (CVD) may in part reflect inadequate adjustment for the "healthy donor effect" (HDE).

Methods: We used the Sax Institute's 45 and Up Study linked with blood donation history and other health-related databases to examine the association between regular, high-frequency WB donation and the risk of CVD. To mitigate the impact of HDE, we used a "5-years qualification period," in which donors must donate at least 1 WB donation in the 1st and 5th year of "qualification period.

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Using linked public health data from Australia to measure uptake of COVID-19 vaccination by infection status, we found coverage considerably lower among infected than uninfected persons for all ages. Increasing uptake of scheduled doses, including among previously infected persons after the recommended postinfection delay, is needed to reduce COVID-19 illness rates.

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Article Synopsis
  • A study in Malawi found that after a round of mass drug administration for trachoma, the overall prevalence was below 5%, but some children still had the disease.
  • The analysis of 16,142 children revealed that having a handwashing facility and living farther away from water sources were linked to lower cases of trachoma.
  • The findings suggest that enhancing water, sanitation, and hygiene (WASH) factors can help further reduce trachoma rates, but more detailed data collection is needed to fully understand these relationships.
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Background: Evidence regarding the association between acute respiratory infections during pregnancy and congenital anomalies in babies, is limited and conflicting. The aim of this study was to examine the association between acute respiratory infections during the first trimester of pregnancy and congenital anomalies in babies using record linkage.

Methods: We linked a perinatal register to hospitalisation and disease notifications in the Australian state of New South Wales (NSW) between 2001 to 2016.

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We critically appraised the literature regarding in-flight transmission of a range of respiratory infections to provide an evidence base for public health policies for contact tracing passengers, given the limited pathogen-specific data for SARS-CoV-2 currently available. Using PubMed, Web of Science, and other databases including preprints, we systematically reviewed evidence of in-flight transmission of infectious respiratory illnesses. A meta-analysis was conducted where total numbers of persons on board a specific flight was known, to calculate a pooled Attack Rate (AR) for a range of pathogens.

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