Professor Tom Snelling

A single blinded, phase IV, adaptive randomised control trial to evaluate the safety of coadministration of seasonal influenza and COVID-19 vaccines (The FluVID study)

We evaluated the frequency of moderate and severe adverse events following coadministration of seasonal influenza vaccine (SIV) versus placebo with COVID-19 vaccines among adults to support practice guidelines. 

FeBRILe3: Safety Evaluation of Febrile Infant Guidelines Through Prospective Bayesian Monitoring

Despite evidence supporting earlier discharge of well-appearing febrile infants at low risk of serious bacterial infection (SBI), admissions for ≥48 hours remain common. Prospective safety monitoring may support broader guideline implementation.

Association between pertussis vaccination in infancy and childhood asthma: A population-based record linkage cohort study

Asthma is among the commonest noncommunicable diseases of childhood and often occurs with other atopic comorbidities. A previous case-control study found evidence that compared to children who received acellular pertussis (aP) vaccines in early infancy, children who received one or more doses of whole-cell pertussis (wP) vaccine had lower risk of developing IgE-mediated food allergy. We hypothesized that wP vaccination in early infancy might protect against atopic asthma in childhood. 

Using causal directed acyclic graphs (DAGs) to select patient-important outcomes in transplantation trials—interventions to treat polyomavirus infection as an example

Randomised controlled trial of perinatal vitamin D supplementation to prevent early-onset acute respiratory infections among Australian First Nations children: the 'D-Kids' study protocol

Globally, acute respiratory infections (ARIs) are a leading cause of childhood morbidity and mortality. While ARI-related mortality is low in Australia, First Nations infants are hospitalised with ARIs up to nine times more often than their non-First Nations counterparts.

Modeling COVID-19 disease processes by remote elicitation of causal Bayesian networks from medical experts

COVID-19 is a new multi-organ disease causing considerable worldwide morbidity and mortality. While many recognized pathophysiological mechanisms are involved, their exact causal relationships remain opaque. Better understanding is needed for predicting their progression, targeting therapeutic approaches, and improving patient outcomes. While many mathematical causal models describe COVID-19 epidemiology, none have described its pathophysiology.

among children with pneumonia using a causal Bayesian network

Pneumonia remains a leading cause of hospitalization and death among young children worldwide, and the diagnostic challenge of differentiating bacterial from non-bacterial pneumonia is the main driver of antibiotic use for treating pneumonia in children. Causal Bayesian networks (BNs) serve as powerful tools for this problem as they provide clear maps of probabilistic relationships between variables and produce results in an explainable way by incorporating both domain expert knowledge and numerical data.

The AuTOMATIC trial: a study protocol for a multi-arm Bayesian adaptive randomised controlled trial of text messaging to improve childhood immunisation coverage

While most Australian children are vaccinated, delays in vaccination can put them at risk from preventable infections. Widespread mobile phone ownership in Australia could allow automated short message service (SMS) reminders to be used as a low-cost strategy to effectively 'nudge' parents towards vaccinating their children on time.

The Impact of a Multifaceted Tertiary Pediatric Hospital's Antimicrobial Stewardship Service

Antimicrobials are the most commonly prescribed drug class in children. Overuse through inappropriate prescribing is a key driver of antimicrobial resistance and is recognized as one of the top 10 threats to global health by the World Health Organization.

Urinary tract infections in children: building a causal model-based decision support tool for diagnosis with domain knowledge and prospective data

Diagnosing urinary tract infections (UTIs) in children in the emergency department (ED) is challenging due to the variable clinical presentations and difficulties in obtaining a urine sample free from contamination.

Prevalence of respiratory viruses in community-acquired pneumonia in children: a systematic review and meta-analysis

Respiratory viruses are increasingly detected in children with community-acquired pneumonia but prevalence estimates vary substantially. We aimed to systematically review and pool estimates for 22 viruses commonly associated with community-acquired pneumonia.

Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children

Population-level studies of severe pertussis extending beyond infancy are sparse, and none in the context of antenatal vaccination. We compared hospitalized pertussis cases from birth to 15 years of age before and after introduction of antenatal immunization.

Pertussis burden and acellular pertussis vaccine effectiveness in high risk children

Pertussis hospitalisation is more common among infants born prematurely, who have significant comorbidities, or are Indigenous, but acellular pertussis (aP) vaccine effectiveness (VE) estimates in these sub-groups are lacking. We measured aP VE by Indigenous status, and policy-relevant categories of prematurity and comorbidity, in a population-based Australian cohort.

Pertussis immunisation in infancy and atopic outcomes: A protocol for a population-based cohort study using linked administrative data

The burden of IgE-mediated food allergy in Australian born children is reported to be among the highest globally. This illness shares risk factors and frequently coexists with asthma, one of the most common noncommunicable diseases of childhood.

Whole-cell pertussis vaccine in early infancy for the prevention of allergy in children

Atopic diseases are the most common chronic conditions of childhood. The apparent rise in food anaphylaxis in young children over the past three decades is of particular concern, owing to the lack of proven prevention strategies other than the timely introduction of peanut and egg.

Whole‐cell pertussis vaccine in early infancy for the prevention of allergy in children

Atopic diseases are the most common chronic conditions of childhood. The apparent rise in food anaphylaxis in young children over the past three decades is of particular concern, owing to the lack of proven prevention strategies other than the timely introduction of peanut and egg.

Bridging the gaps in test interpretation of SARS-CoV-2 through Bayesian network modelling

In the absence of an established gold standard, an understanding of the testing cycle from individual exposure to test outcome report is required to guide the correct interpretation of SARS-CoV-2 reverse transcriptase real-time polymerase chain reaction (RT-PCR) results and optimise the testing processes.

Nasopharyngeal density of respiratory viruses in childhood pneumonia in a highly vaccinated setting: findings from a case-control study

Detection of pneumonia-causing respiratory viruses in the nasopharynx of asymptomatic children has made their actual contribution to pneumonia unclear. We compared nasopharyngeal viral density between children with and without pneumonia to understand if viral density could be used to diagnose pneumonia.

Infant, maternal and demographic predictors of delayed vaccination: A population-based cohort study

Receiving vaccines at or close to their due date (vaccination timeliness) is a now key measure of program performance. However, studies comprehensively examining predictors of delayed infant vaccination are lacking. We aimed to identify predictors of short and longer-term delays in diphtheria-tetanus-pertussis (DTP) vaccination by dose number and ethnicity.

Core Outcome Measures for Trials in People With Coronavirus Disease 2019: Respiratory Failure, Multiorgan Failure, Shortness of Breath, and Recovery

Respiratory failure, multiple organ failure, shortness of breath, recovery, and mortality have been identified as critically important core outcomes by more than 9300 patients, health professionals, and the public from 111 countries in the global coronavirus disease 2019 core outcome set initiative. The aim of this project was to establish the core outcome measures for these domains for trials in coronavirus disease 2019. Three online consensus workshops were convened to establish outcome measures for the four core domains of respiratory failure, multiple organ failure, shortness of breath, and recovery.

Topical versus systemic antibiotics for chronic suppurative otitis media

Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), is a chronic inflammation and often polymicrobial infection (involving more than one micro-organism) of the middle ear and mastoid cavity, characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Antibiotics are the most common treatment for CSOM, which act to kill or inhibit the growth of micro-organisms that may be responsible for the infection.

OPTIMUM study protocol: an adaptive randomised controlled trial of a mixed whole-cell/acellular pertussis vaccine schedule

Combination vaccines containing whole-cell pertussis antigens were phased out from the Australian national immunisation programme between 1997 and 1999 and replaced by the less reactogenic acellular pertussis (aP) antigens. In a large case-control study of Australian children born during the transition period, those with allergist diagnosed IgE-mediated food allergy were less likely to have received whole-cell vaccine in early infancy than matched population controls (OR: 0.77 (95% CI, 0.62 to 0.95)). We hypothesise that a single dose of whole-cell vaccine in early infancy is protective against IgE-mediated food allergy.

Predictors of hospital readmission in infants less than 3 months old

To examine rates and predictors of 7-day readmission in infants hospitalised before 3 months of age with infectious and non-infectious conditions. A retrospective population-based data-linkage study of 121 854 infants from a 5-year metropolitan birth cohort (2008-2012). Cox proportional hazard models were used to examine associations between infant and maternal factors with 7-day readmission.

Retrospective Case-Control Study of 2017 G2P[4] Rotavirus Epidemic in Rural and Remote Australia

A widespread G2P[4] rotavirus epidemic in rural and remote Australia provided an opportunity to evaluate the performance of Rotarix and RotaTeq rotavirus vaccines, ten years after their incorporation into Australia's National Immunisation Program.

A platform in the use of medicines to treat chronic hepatitis C (PLATINUM C): protocol for a prospective treatment registry of real-world outcomes for hepatitis C

Safe, highly curative, short course, direct acting antiviral (DAA) therapies are now available to treat chronic hepatitis C. DAA therapy is freely available to all adults chronically infected with the hepatitis C virus (HCV) in Australia. If left untreated, hepatitis C may lead to progressive hepatic fibrosis, cirrhosis and hepatocellular carcinoma.

RSV prophylaxis use in high-risk infants in Western Australia, 2002-2013: a record linkage cohort study

The monoclonal antibody, palivizumab is licensed for use in high-risk infants to prevent severe illness caused by respiratory syncytial virus (RSV). The level of its use and compliance with current jurisdictional guidelines which were amended in 2010, is unknown.

Whole-cell pertussis vaccine in early infancy for the prevention of allergy

This is a protocol for a Cochrane Review (intervention). The objectives were to assess the efficacy and safety of whole‐cell pertussis (wP) vaccinations in comparison to acellular pertussis (aP) vaccinations in early infancy for the prevention of atopic diseases in children.

Predicting the causative pathogen among children with osteomyelitis using Bayesian networks – improving antibiotic selection in clinical practice

We have demonstrated the potential use of Bayesian Networks in improving antibiotic selection for children with osteomyelitis

Whole-Cell Pertussis Vaccination and Decreased Risk of IgE-Mediated Food Allergy: A Nested Case-Control Study

Australian infants who received whole-cell pertussis vaccines were less likely to be diagnosed with food allergy in childhood

10-Valent pneumococcal non-typeable H. influenzae protein D conjugate vaccine versus 13-valent pneumococcal conjugate vaccine (PCV13) as a booster dose

18 months of age infants receiving 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine will have higher antibody levels

Feasibility and acceptability of the multi-component P3-MumBubVax antenatal intervention to promote maternal and childhood vaccination: A pilot study

The P3-MumBubVax intervention is feasible and acceptable in the Australian public antenatal setting

Safety of live attenuated herpes zoster vaccine in adults 70–79 years: A self-controlled case series analysis using primary care data

No new safety concerns were identified for live attenuated herpes zoster vaccine in this study based on a novel, Australian primary care data source

FeBRILe3 Project: protocol for a prospective study and safety evaluation assessing Fever, Blood cultures and Readiness for discharge in Infants Less than 3 months old

Assess the safety and impact of the introduction of a guideline recommending early discharge of infants with fever without source at low risk of serious bacterial infection

Timeliness of signal detection for adverse events following influenza vaccination in young children: a simulation case study

Active vaccine safety surveillance leading to rapid detection of a safety signal would likely have resulted in earlier suspension of Fluvax from the vaccination programme

Birth outcomes in Aboriginal mother–infant pairs from the Northern Territory, Australia, who received 23-valent polysaccharide pneumococcal vaccination during pregnancy

We found a numerically higher rate of preterm births among women who received 23vPPV in pregnancy compared to unvaccinated pregnant women

Choosing primary endpoints for clinical trials of health care interventions

This narrative review describes the evolution, range and relative strengths and weaknesses of endpoints used in late phase trials

Effectiveness of Palivizumab against Respiratory Syncytial Virus: Cohort and Case Series Analysis

Palivizumab appeared effective for reducing virologically confirmed respiratory syncytial virus in this high-risk cohort

An introduction to clinical trial design

This manuscript will give a brief overview of clinical trial design including the strengths and limitations of various approaches

Effectiveness of pneumococcal conjugate vaccine against hospital admissions for pneumonia in Australian children

Reductions in pneumonia-coded hospital admissions in unvaccinated children predominated in non-Aboriginal children with low incidence of pneumonia

Effectiveness of rotavirus vaccines in an Australian population: A case-control study

RV1 and RV5 were both effective in preventing laboratory confirmed and notified rotavirus infections among children aged <5 years

Timeliness and factors associated with rotavirus vaccine uptake among Australian Aboriginal and non-Aboriginal children: A record linkage cohort study

Aboriginal children are at greater risk of rotavirus disease than non-Aboriginal children and delayed vaccine receipt is substantially higher

Discrete choice experiment to evaluate preferences of patients with cystic fibrosis among alternative treatment-related health outcomes: A protocol

The aim of this study is to identify and quantify the preferences of patients with cystic fibrosis regarding treatment outcomes

Influenza vaccination in pregnancy among a group of remote dwelling Aboriginal and Torres Strait Islander mothers in the Northern Territory

We examined uptake of inactivated influenza vaccination in pregnancy and report adverse birth outcomes amongst a predominantly unvaccinated group

RD-RAP: Beyond rare disease patient registries, devising a comprehensive data and analytic framework

We introduce and describe the concept of a Rare Disease Registry and Analytics Platform

Agreement between units of measure for paediatric antibiotic utilisation surveillance using hospital pharmacy supply data

Agreement between the DDD and vial-based measures of use supports the use of DDD for select antibiotics that may be targeted by antimicrobial stewardship programs

Links2HealthierBubs' cohort study: Protocol for a study on the safety, uptake and effectiveness of influenza and pertussis vaccines among pregnant Australian women

Multi-jurisdictional cohort of mother-infant pairs to measure the uptake, safety and effectiveness of antenatal IIV and dTpa vaccines in three Australian jurisdictions

Impact of influenza on hospitalization rates in children with a range of chronic lung diseases

This large population-based study suggests a significant healthcare burden associated with influenza in children with a range of chronic lung diseases

Identification of the determinants of incomplete vaccination in Australian children

Most parents are supportive of vaccination. Sociodemographic factors may contribute more to the risk of incomplete vaccination than attitudes or beliefs.

Combination of clinical symptoms and blood biomarkers can improve discrimination between bacterial or viral community-acquired pneumonia in children

Combining elevated CRP with the presence or absence of clinical signs/ symptoms differentiates definite bacterial from presumed viral pneumonia better than CRP alone

Research Note: Adaptive trials

This Research Note has explored the strengths, risks and potential complexity of adaptive trials

Factors associated with adherence to antimicrobial stewardship after-hours

Restricted antimicrobials acquired after-hours are not routinely antimicrobial stewardship adherent at the time of acquisition or the next standard working day

Trial refresh: A case for an adaptive platform trial for pulmonary exacerbations of cystic fibrosis

This review will discuss the necessary steps required for a Bayesian adaptive platform trial to optimize treatment of pulmonary exacerbations of cystic fibrosis

The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: A case - Control study

Respiratory viruses, particularly respiratory syncytial virus and human metapneumovirus, are major contributors to pneumonia in Australian children

Perinatal Risk Factors Associated With Gastroenteritis Hospitalizations in Aboriginal and Non-Aboriginal Children in Western Australia (2000-2012)

Given the beneficial effect of infant rotavirus vaccination efforts should be taken to optimize rotavirus vaccine coverage in those at highest risk

Baseline incidence of adverse birth outcomes and infant influenza and pertussis hospitalisations prior to the introduction of influenza and pertussis vaccination

These baseline data are essential to assess the safety and effectiveness of influenza and pertussis vaccinations in pregnant women from the NT

Midwives’ attitudes, beliefs and concerns about childhood vaccination: A review of the global literature

The majority of midwives supported vaccination, although a spectrum of beliefs and concerns emerged

Sharing knowledge about immunisation (SKAI): An exploration of parents' communication needs to inform development of a clinical communication support intervention

The Sharing Knowledge About Immunisation project aims to develop effective communication tools to support primary health care providers' consultations with parents

Hesitant compliers': Qualitative analysis of concerned fully-vaccinating parents

Parents interpreted pivotal vaccine-related events in the community as requiring them to take personal responsibility for vaccine decisions

Active surveillance of 2017 seasonal influenza vaccine safety: An observational cohort study of individuals aged 6 months and older in Australia

AusVaxSafety surveillance demonstrated comparable and expected safety outcomes for the 2017 quadrivalent inactivated influenza vaccine brands used in Australia

Assessment of on-time vaccination coverage in population subgroups: A record linkage cohort study

On-time coverage of the 2-4-6 month schedule is only 50-60% across specific population subgroups representing a significant avoidable public health risk

Topical versus systemic antibiotics for chronic suppurative otitis media

To assess the relative effectiveness of topical versus systemic antibiotics for people with chronic suppurative otitis media

The influence of incomplete case ascertainment on measures of vaccine efficacy

A biologically active vaccine may produce a low measured vaccine efficacy under a range of epidemiological, vaccine-related and logistical conditions

Effectiveness of a 3 + 0 pneumococcal conjugate vaccine schedule against invasive pneumococcal disease among a birth cohort of 1.4 million children in Australia

Our population-based cohort study demonstrates that >90% coverage in the first year of a universal 3 + 0 PCV program provided high population-level protection

Paediatric antimicrobial stewardship and safe prescribing: An assessment of medical staff knowledge and behaviour

Participants demonstrated a good understanding of safe prescribing and antimicrobial stewardship

Association between respiratory syncytial viral disease and the subsequent risk of the first episode of severe asthma in different subgroups of high-risk Australian children: a whole-of-population-based cohort study

To determine the contribution of RSV to the subsequent development of severe asthma in different subgroups of children at risk of severe RSV disease.

Role of viral and bacterial pathogens in causing pneumonia among Western Australian children: A case-control study protocol

We aim to determine the contribute of bacteria and virus to childhood CAP to inform further development of effective strategies.

The NICE-GUT trial protocol: A randomised, placebo controlled trial of oral nitazoxanide for the empiric treatment of acute gastroenteritis among Australian Aboriginal children

Diarrhoeal disease is the second leading cause of death in children under 5 years globally, killing 525 000 annually. Australian Aboriginal and Torres Strait Islander (hereafter Aboriginal) children suffer a high burden of disease.

Protocol for Pertussis Immunisation and Food Allergy (PIFA): a case-control study of the association between pertussis vaccination in infancy

We therefore speculate that removal of wP from the vaccine schedule contributed to the observed rise in IgE-mediated food allergy among Australian infants

Advances in Vaccines to Prevent Viral Respiratory Illnesses in Children

Childhood vaccination has played a critical role in the reduction of morbidity and mortality from communicable diseases, including specific respiratory pathogens

Paediatrician beliefs and practices around influenza vaccination

We aimed to determine Australian paediatricians' beliefs and practices around the influenza vaccination of children.

A 15-Year Old Burmese Girl With Hemoptysis: A Case Report

A 15 year old girl, born in Hakha, Myanmar, presented with 2 months of intermittent hemoptysis 3 years after immigrating to Australia, via Malaysia.

Comprehending the Health Informatics Spectrum: Grappling with System Entropy and Advancing Quality Clinical Research

We outline three scenarios from across the health spectrum where issues with health informatics are exemplified.

Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination the Western Australian Aboriginal population

The PCV7 was introduced to prevent IPD in WA Aboriginal people in 2001 to a lesser extent in older people.

Probabilistic linkage of national immunisation and state-based health records for a cohort of 1.9 million births to evaluate Australia’s childhood immunisation program

To describe the process for assembling a linked study that will enable the conduct of population-based studies related to immunisation and immunisation policy.

Dose-Banding of Intravenous Piperacillin-Tazobactam in Pediatric Surgical Inpatients

Dosing errors are the most commonly reported medication error in children. Dosing is often prescribed per weight or based on body area.

Nurses are underutilised in antimicrobial stewardship - Results of a multisite survey in paediatric and adult hospitals

Nurses consider antimicrobial stewardship activities within their roles, but are underutilised in antimicrobial stewardship programs

Population-based estimates of the effectiveness of pneumococcal vaccination in Australia

Australia’s Childhood Immunisation Register (ACIR) is one of only a handful of national immunisation registers world-wide.

Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling

A single dose of rubella vaccine will take longer to reduce the burden of rubella and will be less robust to lower vaccine coverage

Transiently increased IgE responses in infants and pre-schoolers receiving only (DTaP) vaccines compared to those initially receiving at least one dose of DTwP vaccine

Confirm the generalised IgE-trophic activity of the DTaP vaccine in pre-schoolers and demonstrate similar (albeit transient) effects in infants

Risk factors associated with RSV hospitalisation in the first 2 years of life, among different subgroups of children in NSW

Data on risk factors for respiratory syncytial virus (RSV)-associated hospitalisation in Australian children may be informative for preventive measures.

High burden of RSV hospitalization in very young children: a data linkage study

RSV was associated with substantial burden of childhood hospitalization specifically in children aged <3 months and in Indigenous children and pre-term children

Australian trachoma surveillance annual report, 2013

National Trachoma Surveillance and Reporting Unit to collate, analyse and report trachoma prevalence data and document trachoma control strategies in Australia

Respiratory syncytial virus is present in the neonatal intensive care unit

The results suggest that though the risk for RSV in the NICU remains low, personnel clothing are contaminated with RSV-RNA and may have a role in transmission

Whither pertussis?

This article discusses the rising prevalence of pertussis disease in countries which have switched to acellular vaccines.

Real-time safety surveillance of seasonal influenza vaccines in children, Australia, 2015

This paper reports the results from the safety surveillance of influenza vaccines in children in Australia, in 2015.

Impact of high coverage of monovalent human rotavirus vaccine on Emergency Department presentations for rotavirus gastroenteritis

The program was associated with a substantial decline in rotavirus attributable non-admitted AGE presentations to ED among children aged <5 years.

Characterization of G2P[4] rotavirus strains causing outbreaks of gastroenteritis in the Northern Territory, Australia, in 1999, 2004 and 2009

Outbreaks of rotavirus diarrhea cause a large disease burden in the Alice Springs region of the Northern Territory, Australia.

Prevalence and determinants of influenza vaccine coverage at tertiary pediatric hospitals

This study aimed to examine the uptake of influenza vaccination amongst a cohort of Australian children and factors associated with vaccine acceptance.

Management of invasive group A streptococcal infections

Invasive group A streptococcal disease in children includes deep soft tissue infection, bacteraemia, bacteraemic pneumonia, meningitis and osteomyelitis

Parental Tdap boosters and infant pertussis: a case-control study

Case households had fewer immunized mothers (22% vs 32%) or fathers (20% vs 31%) but were more likely to include additional and older children. After...

Waning vaccine immunity in teenagers primed with whole cell and acellular pertussis vaccine: Recent epidemiology

The recent epidemics of pertussis (whooping cough) in parts of the USA and Australia have led to the largest numbers of annual cases reported in over half a...

Assessing the effect of meningitis prevention and treatment.

In high-income countries serious bacterial infections such as meningitis are uncommon, but their severity has led to prompt adoption of vaccines for...

Nitazoxanide for the treatment of infectious diarrhoea in the Northern Territory, Australia 2007-2012

This paper examines the use of a new antibiotic to treat diarrhoea cause by Cryptosporidium infection in Australian Indigenous children.

Duration of protection after first dose of acellular pertussis vaccine in infants

Without a booster dose, the effectiveness of 3 doses waned more rapidly from 2 to 4 years of age than previously documented for children >6 years of age who...

Effectiveness of Palivizumab in Preventing RSV Hospitalization in High Risk Children: A Real-World Perspective

This review supports the recommended use of palivizumab for reducing RSV-associated hospitalisation rates in premature babies born at gestational age <33 weeks.

Characterization of a G1P[8] rotavirus causing an outbreak of gastroenteritis in the Northern Territory, Australia, in the vaccine era

In 2010, a large outbreak of rotavirus gastroenteritis occurred in the Alice Springs region of the Northern Territory, Australia.