The Australian and New Zealand governments have allocated significant funding to advance efforts towards a group A Streptococcus (Strep A) vaccine. The argument for Strep A vaccine development has to date focussed on prevention of non‐invasive disease (e.g. pharyngitis) and immune‐mediated complications (especially rheumatic heart disease). Because of the poorer prognosis and theoretically more precisely known burden of invasive, compared to non‐invasive disease, exploration of the burden of invasive Strep A disease could lend further support to the vaccine business case. This narrative review critically assesses the Australian incidence of invasive Strep A disease. Case notification data were first assessed through government sources, expressing annual incidence as cases per 100 000 population. Published literature accessed through PubMed and MEDLINE was assessed to March 2020. Where estimates could be updated by replicating reported methods with publicly available data, this was performed. Invasive Strep A disease is currently notifiable in Queensland and the Northern Territory only. The magnitude, degree of certainty and recency of estimates vary by state/territory and between sub‐populations, including higher incidence among Indigenous Australians compared to non‐Indigenous Australians. According to inpatient records from 2017 to 2018, the Australian incidence of invasive Strep A disease was 8.3 per 100 000. However, this is likely to be an underestimate. Preventing invasive Strep A disease is an important use for a Strep A vaccine. This narrative review highlights deficiencies in our current understanding of the Australian disease burden. These difficulties would be overcome by nationally consistent mandatory case reporting.
To our knowledge this report contains the most complete list of active national and large regional cardiac arrest registries. Register data support current guidelines on effective resuscitation however, even the largest registries include relatively small numbers, particularly of paediatric events. A less fragmented approach has the potential to improve the utility of registration data for the benefit of patients.
BackgroundCardiac arrests are associated with poor outcomes. The International Liaison Committee on Resuscitation (ILCOR) evaluates resuscitation science and produced, until 2015, five-yearly consensus statements on treatment recommendations (CoSTRs), informing global resuscitation guidelines (RGs).We aimed to identify similarities/differences in RGs from ILCOR members, noting concurrence over time, and CoSTRs influence on these guidelines.
MethodsWe considered the component elements of paediatric and adult, basic and advanced RGs, published in 2010 and 2015, along with matching ILCOR CoSTRs to examine their influence. We contacted the responsible councils when guidelines were unavailable online.
ResultsComplete RGs were found for six of the seven ILCOR council members. The Resuscitation Council of Asia only had adult basic life support (BLS) guidelines in English. Three members used the AHA guidelines. Therefore, five rather than seven sets of RGs were compared to the CoSTRs.
Concurrence between CoSTRs recommendations and ILCOR council member'sRGs has improved over time. Minor variations were identified in both basic and advanced life support, with most variance in paediatric guidelines, but these narrowed over time.
ConclusionThe improved concurrence across the RGs with the CoSTRs suggests that ILCOR members accept and hence incorporate CoSTRs recommendations to inform their own RGs. This is one step towards the development of international universal guidelines for adult and paediatric resuscitation.
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