We currently have the knowledge and experience to prevent much of human papillomavirus (HPV)-related disease burden globally. In many countries where prophylactic HPV vaccination programs have been adopted as highly effective public health programs with good vaccine coverage, we are already seeing, in real-world settings, reduction of vaccine-related HPV-type infections, genital warts and cervical pre-cancers with potential reductions in vulvar, vaginal and anal pre-cancers. Moreover, we are seeing a change in cervical screening paradigms, as HPV-based screening programs now have strong evidence to support their use as more sensitive ways to detect underlying cervical abnormalities, as compared with conventional cervical cytology. This article describes the impact of prophylactic vaccination on these outcomes and in settings where these vaccines have been implemented in national immunisation programs. Given the successes seen to date and the availability of essential tools, there has been a global push to ensure that every woman has access to effective cervical screening and every girl has the opportunity for primary prevention through vaccination. A gender-neutral approach by offering vaccination to young boys has also been adopted by some countries and is worthy of consideration given that HPV-related cancers also affect males. Furthermore, vaccination of young boys has the advantage of reducing the risk of HPV transmission to sexual partners, lowering the infectious pool of HPV in the general population and ultimately HPV-related diseases for both genders. Therefore, it is appropriate that all countries consider and promote national guidelines and programs to prevent HPV-related diseases.

Aim To describe the epidemiology of respiratory viruses in children before and during the 2020 SARS‐CoV‐2 pandemic and the relationship to public health measures instituted by the Victorian government. Methods Retrospective audit of respiratory viruses at a tertiary paediatric hospital in Melbourne from January 2015 up to week 47, 2020 in children under 18 years of age. The proportion of positive cases in weeks 1–47 in 2015–2019 (period 1) were compared to weeks 1–47, 2020 (period 2), and reviewed in the context of public health restrictions in Victoria. Results An annual average of 4636 tests were performed in period 1 compared to 3659 tests in period 2. Proportions of positive influenza A virus, influenza B virus, respiratory syncytial virus (RSV) and human parainfluenza virus were significantly reduced in period 2 compared to period 1: 77.3, 89.4, 68.6 and 66.9% reductions, respectively (all P < 0.001). From week 12–47, 2020, 28 893 SARS‐CoV‐2 tests were performed with a 0.64% positivity rate. Influenza viruses were not detected after week 17, RSV was not detected after week 35. Conclusions Strict public health measures and border closures were successful in eliminating community transmission of SARS‐CoV‐2 in Melbourne. This was associated with a significant reduction in other respiratory virus infections in children. Identifying sustainable and effective ongoing public health interventions to reduce transmission of RSV and influenza could result in reduced morbidity and mortality in children and requires further research.

Background: Universal screening of pregnant women at 35-37 weeks gestation is recommended for detection of anogenital group B streptococcus carriage.Intrapartum chemoprophylaxis is prescribed to carriers to prevent transmission to babies, reducing early-onset neonatal group B streptococcal sepsis. Aims: To review compliance with, and the effects of education on group B streptococcus screening and intrapartum chemoprophylaxis practices at The Royal Women's Hospital, Melbourne, Australia. Materials and Methods: A retrospective audit of women delivering in February 2016 and February-March 2017 was conducted. In February 2017, updated earlyonset group B streptococcal disease prevention guidelines were released and promoted with targeted education of clinical staff. Compliance was considered appropriate if practices followed up-to-date local protocols.Results: Screening rate for group B streptococcus was 84.4% (599/710) and carriage rate 19.5% (109/558), while intrapartum antibiotic prophylaxis was optimal in 83% of those labouring greater than four hours (39/47). There was no significant difference in compliance between 2016 and 2017. Of 113 women with unknown group B streptococcal status at delivery, only five of 33 (15%) with clinical risk factors for early-onset neonatal disease received intrapartum prophylaxis. Conclusions:Compliance remained stable, with no change during or after implementation of new protocols. Compliance with protocols was low for cases with unknown group B streptococcal status at delivery but with the presence of one or more clinical risk factors for early-onset group B streptococcal sepsis. K E Y W O R D Scompliance, group B streptococcus, pregnancy, prophylaxis, screening

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bFor rapid results, we adapted the CarbaNP test by using 5-hour-old cultures; the sensitivity and specificity for detection of carbapenemase production were 100% for non-OXA-producing organisms. The sensitivity from early cultures was 94% for detection of carbapenemase production in Enterobacteriaceae strains. Utilizing younger cultures allows the test to be incorporated into a single day's workflow, facilitating timely patient care and antimicrobial stewardship. C arbapenemase-producing Enterobacteriaceae strains pose significant problems in clinical practice because of limited treatment options (1). Prompt detection of these organisms with current screening techniques, including the modified Hodge test (MHT), growth on selective media, and antimicrobial susceptibility testing, is difficult and time-consuming (2-5). Molecular methods are the gold standard for identification of carbapenemase genes (5, 6), but they are expensive, require technical experience, and are unable to detect novel genes (6). The CarbaNP test is inexpensive, rapid, and easy to perform and interpret; it utilizes imipenem hydrolysis, visualized by a color change, to identify carbapenemase production in Enterobacteriaceae and Pseudomonas species (7-10). In previous publications, isolates were taken from 1-day-old cultures (11) or the age of the culture was not mentioned (7-10). This study aims to determine whether the age of the isolates and the media used affect the ability of the CarbaNP test to detect carbapenemase production.A total of 157 isolates (Enterobacteriaceae, n ϭ 111; Pseudomonas spp., n ϭ 38; Acinetobacter spp., n ϭ 8) were suspected to harbor a carbapenemase because they had at least one of the following features: disc diffusion testing using CLSI guidelines (12) demonstrating decreased susceptibility to ertapenem with a zone diameter of Ͻ22 mm, meropenem MIC of Ն0.5 mg/liter determined by using a Vitek 2 system (bioMérieux Inc., Durham, NC), growth on ChromID Carba medium (bioMérieux, Inc., Durham, NC), or a positive MHT result. These isolates were recovered from clinical or environmental specimens at three tertiary hospital microbiology laboratories in Melbourne, Australia, between 2004 and 2014.All isolates underwent PCR testing using primers designed for the carbapenemase genes bla IMP , bla KPC , bla NDM , bla OXA-23-like , bla OXA-24/40-like ,bla ,bla OXA-51-like ,bla OXA-58-like ,bla OXA-48-like , and bla VIM (13-17). Fifty-eight isolates were confirmed to be carbapenemase producers by PCR, with typing as follows: IMP, n ϭ 34; NDM, n ϭ 6; KPC, n ϭ 3; VIM, n ϭ 2; OXA-23, n ϭ 6; OXA-23-like/OXA-51-like, n ϭ 1; OXA-24, n ϭ 1; OXA-181, n ϭ 2; OXA-24/40, n ϭ 1; OXA-48, n ϭ 1; OXA-51, n ϭ 1. IMP and NDM carbapenemases were subtyped by sequencing for selected isolates.The CarbaNP test was performed according to published methods (1,8,18), with modifications of culture age and inoculum. Solution A contained phenol red solution with ZnSO 4 , and solution B contained phenol red solution, ZnSO 4 and 6 mg/ml imipenem (7,8,18). Al...

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Objective To compare the concordance and acceptability of saliva testing with standard‐of‐care oropharyngeal and bilateral deep nasal swab testing for severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in children and in general practice. Design Prospective multicentre diagnostic validation study. Setting Royal Children’s Hospital, and two general practices (cohealth, West Melbourne; Cirqit Health, Altona North) in Melbourne, July–October 2020. Participants 1050 people who provided paired saliva and oropharyngeal‐nasal swabs for SARS‐CoV‐2 testing. Main outcome measures Numbers of cases in which SARS‐CoV‐2 was detected in either specimen type by real‐time polymerase chain reaction; concordance of results for paired specimens; positive percent agreement (PPA) for virus detection, by specimen type. Results SARS‐CoV‐2 was detected in 54 of 1050 people with assessable specimens (5%), including 19 cases (35%) in which both specimens were positive. The overall PPA was 72% (95% CI, 58–84%) for saliva and 63% (95% CI, 49–76%) for oropharyngeal‐nasal swabs. For the 35 positive specimens from people aged 10 years or more, PPA was 86% (95% CI, 70–95%) for saliva and 63% (95% CI, 45–79%) for oropharyngeal‐nasal swabs. Adding saliva testing to standard‐of‐care oropharyngeal‐nasal swab testing increased overall case detection by 59% (95% CI, 29–95%). Providing saliva was preferred to an oropharyngeal‐nasal swab by most participants (75%), including 141 of 153 children under 10 years of age (92%). Conclusion In children over 10 years of age and adults, saliva testing alone may be suitable for SARS‐CoV‐2 detection, while for children under 10, saliva testing may be suitable as an adjunct to oropharyngeal‐nasal swab testing for increasing case detection.

Background Household studies are crucial for understanding the transmission of SARS-CoV-2 infection, which may be underestimated from PCR testing of respiratory samples alone. We aim to combine assessment of household mitigation measures; nasopharyngeal, saliva and stool PCR testing; along with mucosal and systemic SARS-CoV-2 specific antibodies, to comprehensively characterise SARS-CoV-2 infection and transmission in households. Methods Between March and September 2020, we obtained samples from 92 participants in 26 households in Melbourne, Australia, in a 4-week period following onset of infection with ancestral SARS-CoV-2 variants. Results The secondary attack rate was 36% (24/66) when using nasopharyngeal swab (NPS) PCR positivity alone. However, when respiratory and non-respiratory samples were combined with antibody responses in blood and saliva, the secondary attack rate was 76% (50/66). SARS-CoV-2 viral load of the index case and household isolation measures were key factors that determine secondary transmission. In 27% (7/26) of households, all family members tested positive by NPS for SARS-CoV-2 and were characterised by lower respiratory Ct-values than low transmission families (Median 22.62 vs 32.91; IQR 17.06 to 28.67 vs 30.37 to 34.24). High transmission families were associated with enhanced plasma antibody responses to multiple SARS-CoV-2 antigens and the presence of neutralising antibodies. Three distinguishing saliva SARS-CoV-2 antibody features were identified according to age (IgA1 to Spike 1, IgA1 to nucleocapsid protein (NP), suggesting that adults and children generate distinct mucosal antibody responses during the acute phase of infection. Conclusion Utilising respiratory and non-respiratory PCR testing, along with measurement of SARS-CoV-2 specific local and systemic antibodies, provides a more accurate assessment of infection within households and highlights some of the immunological differences in response between children and adults.