Publications by authors named "Adriana Parrella"

11 Publications

  • Page 1 of 1

School-based HPV vaccination positively impacts parents' attitudes toward adolescent vaccination.

Vaccine 2021 Jul 12;39(30):4190-4198. Epub 2021 Jun 12.

Speciality of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.

Introduction: This qualitative study aimed to explore parental attitudes, knowledge and decision-making about HPV vaccination for adolescents in the context of a gender-neutral school-based Australian National Immunisation Program (NIP).

Methods: Semi-structured interviews with parents of adolescents eligible for HPV vaccination were undertaken as part of an evaluation of a cluster-randomised controlled trial of a complex intervention in 40 schools (2013-2015). In this qualitative study, we purposively recruited a nested sample of parents from 11 schools across two Australian jurisdictions. Interviews explored parent knowledge and understanding of the HPV vaccine program; HPV vaccination decision-making; their adolescent's knowledge about HPV vaccination; and their adolescent's understanding about HPV vaccination, sexual awareness and behaviour. Transcripts were analysed using inductive and deductive thematic analysis.

Results: Parents' of 22 adolescents had positive attitudes towards the program; the school-based delivery platform was the key driver shaping acceptance of and decision-making about HPV vaccination. They had difficulty recalling, or did not read, HPV vaccination information sent home. Some adolescents were involved in discussions about vaccination, with parents' responsible for ultimate vaccine decision-making. All parents supported in-school education for adolescents about HPV and HPV vaccination. Parents' knowledge about HPV vaccination was limited to cervical cancer and was largely absent regarding vaccination in males.

Conclusions: Parents' positive attitudes towards the NIP and inclusion of the HPV vaccine is central to their vaccine decision-making and acceptance. More intensive communication strategies including school education opportunities are required to improve parents' knowledge of HPV-related disease and to promote vaccine decision-making with adolescents.
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July 2021

Safety of Tetanus, Diphtheria, and Pertussis Vaccination During Pregnancy: A Systematic Review.

Obstet Gynecol 2017 03;129(3):560-573

Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, School of Medicine and Robinson Research Institute, the University of Adelaide, North Adelaide, Australia; Children's Hospital of Eastern Ontario Research Institute and University of Ottawa, Ottawa, Ontario, Canada; and the Immunisation, Hepatitis, and Blood Safety Department, Public Health England, London, United Kingdom.

Objective: To assess antenatal, birth, and infant outcomes for pregnant women, fetuses, and infants after antenatal vaccination with any antigen present in combination pertussis vaccines.

Data Sources: PubMed, EMBASE, Literature in the Health Sciences in Latin America and the Caribbean,, Cochrane Library, and World Health Organization (inception to May 5, 2016).

Methods Of Study Selection: Studies reporting outcomes for pregnant women, their fetus, or infant after antenatal exposure to either monovalent or combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) or inactivated polio vaccines were considered for inclusion.

Results: A total of 21 studies were included in this review. Point estimates ranged from 0.47 to 1.50 for preterm birth (less than 37 weeks of gestation), 0.65-1.00 for small for gestational age (birth weight less than the 10th percentile), 0.36-0.85 for stillbirth, 0.16-1.00 for neonatal death, 0.76-1.20 for low birth weight (less than 2,500 g), and 0.20-0.91 for congenital anomalies. All lower 95% confidence intervals (CIs) were less than 1.0. Of three retrospective studies assessing chorioamnionitis after vaccination, one showed a small but statistically significant increase. Point estimates for all anomalies after antenatal tetanus toxoid vaccination ranged from 1.20 to 1.60 and had 95% CIs that crossed 1.0. There was substantial clinical and methodologic heterogeneity from mainly retrospective observational studies with an overall high risk of bias. Objective rates of fever were low, 3% or below, and more common systemic events observed included headache, malaise, and myalgia.

Conclusion: Evidence suggests that antenatal combined Tdap administered during the second or third trimester of pregnancy is not associated with clinically significant harms for the fetus or neonate. Medically attended events in pregnant women are similar between vaccinated and unvaccinated groups.
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March 2017

Prioritizing government funding of adolescent vaccinations: recommendations from young people on a citizens' jury.

Vaccine 2016 06 16;34(31):3592-7. Epub 2016 May 16.

Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia.

Objective: Adolescents' views, and preferences are often over-looked when public health policies that affect them are designed and implemented. The purpose of this study was to describe young people's views and preferences for determining government funding priorities for adolescent immunization programs.

Methods: In 2015 we conducted a youth jury in metropolitan Adelaide, South Australia to deliberate on the question "What criteria should we use to decide which vaccines for young people in Australia should receive public funding?" Fifteen youth aged 15-19 years participated in the jury. Jury members were recruited from the general community through a market research company using a stratified sampling technique.

Results: The jury's key priorities for determining publically funded vaccines were: Disease severity - whether the vaccine preventable disease (VPD) was life threatening and impacted on quality of life. Transmissibility - VPDs with high/fast transmission and high prevalence. Demonstration of cost-effectiveness, taking into account purchase price, program administration, economic and societal gain. The jury's recommendations for vaccine funding policy were strongly underpinned by the belief that it was critical to ensure that funding was targeted to not only population groups who would be medically at risk from vaccine preventable diseases, but also to socially and economically disadvantaged population groups. A novel recommendation proposed by the jury was that there should be a process for establishing criteria to remove vaccines from publically funded programs as a complement to the process for adding new vaccines.

Conclusions: Young people have valuable contributions to make in priority setting for health programs and their views should be incorporated into the framing of health policies that directly affect them.
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June 2016 study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents.

BMC Public Health 2015 Sep 15;15:896. Epub 2015 Sep 15.

School of Public Health, University of Sydney, Sydney, NSW, Australia.

Background: The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake.

Methods/design: is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.

Discussion: This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased.

Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628 , 14.04.2014.
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September 2015

Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA.

BMJ Open 2014 Aug 8;4(8):e005611. Epub 2014 Aug 8.

Department of Family Medicine, University of Washington, Seattle, Washington, USA.

Objective: Despite the growing number of point-of-care (POC) tests available, little research has assessed primary care clinician need for such tests. We therefore aimed to determine which POC tests they actually use or would like to use (if not currently available in their practice).

Design: Cross-sectional survey.

Setting: Primary care in Australia, Belgium (Flanders region only), the Netherlands, the UK and the USA.

Participants: Primary care doctors (general practitioners, family physicians).

Main Measures: We asked respondents to (1) identify conditions for which a POC test could help inform diagnosis, (2) from a list of tests provided: evaluate which POC tests they currently use (and how frequently) and (3) determine which tests (from that same list) they would like to use in the future (and how frequently).

Results: 2770 primary care clinicians across five countries responded. Respondents in all countries wanted POC tests to help them diagnose acute conditions (infections, acute cardiac disease, pulmonary embolism/deep vein thrombosis), and some chronic conditions (diabetes, anaemia). Based on the list of POC tests provided, the most common tests currently used were: urine pregnancy, urine leucocytes or nitrite and blood glucose. The most commonly reported tests respondents expressed a wish to use in the future were: D-dimer, troponin and chlamydia. The UK and the USA reported a higher actual and desired use for POC tests than Australia, Belgium and the Netherlands. Our limited data suggest (but do not confirm) representativeness.

Conclusions: Primary care clinicians in all five countries expressed a desire for POC tests to help them diagnose a range of acute and chronic conditions. Rates of current reported use and desired future use were generally high for a small selection of POC tests, but varied across countries. Future research is warranted to explore how specific POC tests might improve primary care.
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August 2014

Consumer reporting of adverse events following immunization (AEFI): identifying predictors of reporting an AEFI.

Hum Vaccin Immunother 2014 9;10(3):747-54. Epub 2014 Jan 9.

Discipline of Paediatrics; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide, Australia.

Passive reporting of adverse events following immunization (AEFI) by consumers or healthcare professionals is the primary mechanism for post-marketing surveillance of vaccine safety. Although recent initiatives have promoted consumer reporting, there is a lack of research concerning consumer reporters. Computer assisted telephone interviews (CATI) were conducted in 2011 of a cross-sectional, random, general population sample of 191 South Australian parents who stated that their children had previously experienced an AEFI. We compared awareness of surveillance, vaccine safety opinions, and demographics of parents reporting an AEFI to either healthcare professionals or surveillance authorities with those who did not report their children's AEFI. Multivariate regression analyses measured: the association between reporting and safety views; and demographic predictors of reporting an AEFI. Reporting an AEFI to a healthcare professional or a surveillance authority was not significantly associated with awareness of a surveillance system. AEFI reporters, when compared with non-reporters, were more likely to be Australian-born (OR = 4.58, [1.64, 12.78], P = 0.004); were associated with the perception that a serious reaction was more likely to occur at their children's last immunization (OR = 2.54 [95%CI 1.22, 5.30], P = 0.013); and were less accepting of the risk of febrile convulsion, (OR = 3.59 [95%CI 1.50, 8.57], P = 0.004). Although reporting an AEFI was not associated with awareness of surveillance or most socio-demographics, the results suggest some difference in safety opinions. Further studies are required to ascertain if these differences pre-date the occurrence of an AEFI or are a consequence of the AEFI and how consumers can contribute further to vaccine safety surveillance.
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March 2015

Healthcare providers' knowledge, experience and challenges of reporting adverse events following immunisation: a qualitative study.

BMC Health Serv Res 2013 Aug 15;13:313. Epub 2013 Aug 15.

Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia.

Background: Healthcare provider spontaneous reporting of suspected adverse events following immunisation (AEFI) is central to monitoring post-licensure vaccine safety, but little is known about how healthcare professionals recognise and report to surveillance systems. The aim of this study was explore the knowledge, experience and attitudes of medical and nursing professionals towards detecting and reporting AEFI.

Methods: We conducted a qualitative study, using semi-structured, face to face interviews with 13 Paediatric Emergency Department consultants from a tertiary paediatric hospital, 10 General Practitioners, 2 local council immunisation and 4 General Practice nurses, recruited using purposive sampling in Adelaide, South Australia, between December 2010 and September 2011. We identified emergent themes related to previous experience of an AEFI in practice, awareness and experience of AEFI reporting, factors that would facilitate or impede reporting and previous training in vaccine safety. Thematic analysis was used to analyse the data.

Results: AEFI reporting was infrequent across all groups, despite most participants having reviewed an AEFI. We found confusion about how to report an AEFI and variability, according to the provider group, as to the type of events that would constitute a reportable AEFI. Participants' interpretation of a "serious" or "unexpected" AEFI varied across the three groups. Common barriers to reporting included time constraints and unsatisfactory reporting processes. Nurses were more likely to have received formal training in vaccine safety and reporting than medical practitioners.

Conclusions: This study provides an overview of experience and beliefs of three healthcare professional groups in relation to identifying and reporting AEFI. The qualitative assessment reveals differences in experience and awareness of AEFI reporting across the three professional groups. Most participants appreciated the importance of their role in AEFI surveillance and monitoring the ongoing safety of vaccines. Future initiatives to improve education, such as increased training to health care providers, particularly, medical professionals, are required and should be included in both undergraduate curricula and ongoing, professional development.
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August 2013

Parental perspectives of vaccine safety and experience of adverse events following immunisation.

Vaccine 2013 Apr 17;31(16):2067-74. Epub 2013 Feb 17.

Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Australia.

Introduction: We aimed to determine demographic predictors of parental vaccine safety and risk perceptions, and assess the relationship between the occurrence of children's perceived adverse events following immunisation (AEFI) on parents' opinions.

Methods: Computer-assisted telephone interviews (CATI) were conducted in 2011 with a cross-sectional, random general population sample of rural and metropolitan residents in South Australia. Multivariate ordinal logistic regression analyses examined associations between parental vaccine safety attitudes and socio-demographic factors, adjusting for whether children had ever experienced a previous suspected AEFI.

Results: Of 469 parents interviewed, 95% were confident in vaccine safety in general, but almost half expressed concern for pre-licensure testing of vaccines. Of all parents, 41% responded that at least one of their children had experienced an AEFI. Almost one third of the AEFI parent group indicated they reported their children's symptoms to either a healthcare professional or the Department of Health. Parental acceptability of the risks of febrile convulsion and anaphylaxis were 73% and 76% respectively. Ordinal logistic regression analyses showed parents of children who had experienced a suspected AEFI were associated with greater concern for vaccine safety (OR:0.53, p≤0.01) and more were likely to expect either a mild or a serious AEFI. After adjusting for demographics, parental confidence in vaccine safety was significantly associated with higher levels of education (OR:2.58, p=0.01) and being born in Australia OR:2.30, p=0.004. Mothers, when compared with fathers, were less accepting of the two vaccine risks presented: febrile convulsion (OR:0.57, p=0.04) and anaphylaxis, (OR:0.55, p=0.04).

Conclusions: Parents commonly perceive and report that their child has experienced an AEFI. In this group of parents the subsequent expectation of an AEFI and vaccine safety concerns may be heightened. Further research should investigate parental understandings of differentiating an expected event from an adverse event as this could inform immunization risk communication and consumer AEFI reporting strategies.
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April 2013

Parental views on vaccine safety and future vaccinations of children who experienced an adverse event following routine or seasonal influenza vaccination in 2010.

Hum Vaccin Immunother 2012 May 1;8(5):662-7. Epub 2012 May 1.

Disciplines of Paediatrics and Public Health, School of Paediatrics and Reproductive Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, SA, Australia.

To assess parental vaccine safety views and future vaccination decisions after an adverse event following immunization (AEFI) experienced by their child. A cross-sectional telephone survey was conducted of parents of children aged 0-7 y, identified in AEFI reports submitted to the South Australian Immunization Section, Department Health. The reports included childhood National Immunization Program (NIP), seasonal or pandemic influenza vaccines. Interviews were conducted following a national suspension of the 2010 seasonal trivalent influenza (STIV) vaccine. Parental attitudes toward vaccine safety, reasons for reporting the AEFI and impact on future vaccination intent were assessed. Of 179 parents interviewed, 88% were confident in the safety of vaccines in general. Parents reporting an AEFI to the STIV were more likely to state the event had influenced future vaccination decisions than the NIP vaccine reporters (65% vs 14%, p < 0.001), with 63% stating refusal or hesitance to re-vaccinate their children against influenza. Media reports of the 2010 STIV program suspension was the most common reason for reporting an AEFI for parents of children who received an influenza vaccination. The AEFI experience did not impact on parental decision to continue with routine childhood NIP schedules, regardless of whether children received influenza or NIP vaccines. In contrast, most parents whose child experienced an AEFI to the 2010 STIV stated decreased confidence in the safety of influenza vaccines, which is likely to have impacted on the uptake of seasonal influenza vaccination in 2011. Addressing influenza vaccine safety concerns to promote influenza vaccination in the community is required.
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May 2012

ASPREN surveillance system for influenza-like illness - A comparison with FluTracking and the National Notifiable Diseases Surveillance System.

Aust Fam Physician 2009 Nov;38(11):932-6


Background: General practitioners play an important role in the detection and clinical management of influenza. The Australian Sentinel Practice Research Network (ASPREN) has been collecting data from sentinel GPs on selected conditions, including influenza-like illness (ILI), since 1991 to inform public health authorities of communicable disease activity in the community.

Methods: Weekly incidence of ILI data reported by ASPREN GPs in 2007-2008 was compared with data from two separate surveillance systems: New South Wales data from FluTracking, an online self reporting ILI surveillance system; and national laboratory notifications of influenza reported to the National Notifiable Diseases Surveillance System between 2003 and 2008.

Results: ASPREN recorded peak ILI rates of 47 per 1000 consultations in week 30 (ending 29 July) 2007 and 34 per 1000 consultations in week 36 (ending 7 September) 2008. Similar trends in incidence were seen in FluTracking cough and fever rates, ASPREN data in New South Wales and National Notifiable Diseases Surveillance System laboratory notifications.

Discussion: Data captured by the three separate surveillance systems provide complementary information regarding influenza in the Australian population.
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November 2009

The Australia and New Zealand horizon scanning network.

Aust Health Rev 2005 Nov;29(4):395-7

Public Health, University of Adelaide, Adelaide, SA, Australia.

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November 2005