Sydney Children’s Hospitals Network

Respiratory Syncytial Virus (RSV) vaccination was first approved by the Therapeutic Goods Administration of Australia for older adults in January 2024. We aimed to evaluate uptake among people aged ≥75years across different socioeconomic thresholds. Male and female FluTracking participants were included in this cross-sectional study if they had an Australian residential postcode documented, returned at least one weekly survey between 30 March 2025 and 2 December 2025 while aged ≥75years, and had a recently documented RSV, influenza, and COVID-19 vaccination status. Socioeconomic status (SES) was allocated by matching participant residential postcode to the Index of Relative Socio-economic Disadvantage for that postcode. Relative difference in vaccine uptake across SES categories was evaluated using logistic regression. A total of 10,376 participants were included (61.4% aged 75-79years, 54.2% female). High, medium, and low SES categories were represented by 5347 (51.5%), 3658 (35.3%), and 1371 (13.2%) participants, respectively. Recent RSV vaccination was reported by 19.6% of participants, recent influenza vaccination by 92.5%, and recent COVID-19 vaccination by 67.1%. In age, sex, and state/territory adjusted analyses, the odds of vaccination in the medium compared with the high SES group for RSV, influenza, and COVID-19 were 42.3%, 19.8%, and 24.0% lower, respectively. The adjusted odds of vaccination in the low SES group compared with the high SES group for RSV, influenza, and COVID-19 were 47.1%, 35.1%, and 30.2% lower, respectively. We found lower uptake of RSV vaccination among adults aged ≥75years compared with recent vaccination for influenza and COVID-19. Lower SES groups had lower uptake of all three vaccines compared with the high SES group and the relative difference in uptake across socioeconomic levels were more pronounced for RSV vaccination. Broad public funding for RSV vaccination among older adults in Australia could help to reduce inequity in uptake.

Niemann-Pick disease type C (NP-C) is the fifth most prevalent lysosomal disorder in Australia. Diagnostic delay is common, impacted by disease heterogeneity, limited awareness within clinical gateway services and exclusion from state-based newborn screening programmes. A formal diagnosis, once established, places a substantial burden on the whole family, the negative impact of which is far-reaching. A clear understanding of diagnostic pathways and management objectives in NP-C is critical for optimal care. To develop an Australian standard of care for individuals diagnosed with NP-C and their families, reflecting international best practice and tailored to the Australian healthcare system. The Australian NPC Disease Foundation Inc. convened a national, multidisciplinary collaboration including NP-C treating clinicians, allied health professionals and a community advisory group. Using an iterative consensus approach, published international guidance statements were reviewed, ratified, excluded or modified to align with the Australian context. Consensus outputs included a diagnostic algorithm, a multidisciplinary care framework and management-centred management statements. The collaborative process resulted in a unified Australian standard of care for NP-C. This framework incorporates the carer perspective, emphasises shared decision-making and situates NP-C within the broader context of 'childhood dementias.' Consensus statements provide practical, evidence-aligned guidance on early recognition, diagnostic referral pathways and multidisciplinary management throughout disease progression. This initiative represents the first Australia-specific standard of care for NP-C. It is hoped that adoption of the framework will lead to improved experiences for Australians living with NP-C and their carers as they navigate the healthcare setting.

Risk prediction models for community-acquired pneumonia (CAP) in hospitalised children are limited, especially in upper-middle-income countries. We developed a PaEdiatric Pneumonia Severity (PEPS) score to aid early risk stratification and examined its discriminatory ability. Prospective cohort study. Between April 2022 and April 2023, children aged 1 month to <12 years hospitalised with radiographic-confirmed CAP were enrolled in Sabah, Malaysia. Key clinical factors were collected to develop risk profiles for mild, moderate, and severe CAP. The PEPS score was derived from the final multivariable model and its ability to discriminate CAP severity assessed. Among 868 children, 639 (73.6%) had mild, 83 (9.6%) moderate, and 146 (16.8%) severe CAP. Independent factors associated with moderate/severe CAP were age <6 months (adjusted OR (ORadj)=6.81, 95% CI 4.65 to 9.98), partial/unvaccinated status (ORadj=2.66, 95% CI 1.47 to 4.81), vomiting/refusal of feeds (ORadj=1.77, 95% CI 1.19 to 2.61), hypoxaemia (oxygen saturation 90-93% (ORadj=2.38, 95% CI 1.22 to 4.64); <90% (ORadj=28.88, 95% CI 13.37 to 62.35)) and anaemia (ORadj=1.76, 95% CI 1.17 to 2.67). The model demonstrated excellent discrimination in identifying risk of children having moderate/severe CAP (c-statistic=0.81, 95% CI 0.78 to 0.84). The developed PEPS score (0-13) stratified children into low-risk (score 0-1), moderate-risk (score 2-4) and high-risk (score ≥5) groups with observed rates of moderate/severe CAP 10.9%, 29.1%, and 76.9%, respectively, and demonstrated strong predictive performance for moderate/severe CAP (c-statistic=0.81, 95% CI 0.77 to 0.84). The PEPS score, the first developed in an upper-middle-income country using radiographic-confirmed CAP, accurately discriminates mild from moderate/severe hospitalised CAP. It may support case management in similar settings, but requires external validation before broader implementation.

Precision medicine tailors an individual's healthcare to their genetics, environment and behaviour. This has been driven by rapid advances in genomics, where an individual's entire genetic code can now be sequenced. General practitioners (GPs) are increasingly involved in genomics throughout the lifespan, including performing prenatal screening during pregnancy, requesting reproductive genetic carrier screening and arranging genetic referrals for cancer and other conditions. Patients are relying on their GPs to appropriately counsel, test, refer and manage genetic conditions, and provide genomic healthcare. This article provides an overview of the GP's expanding role in genomic medicine, some tools to assist GPs to navigate this landscape, and barriers to genomic uptake. GPs are integral to supporting patients and families in the genomics and precision medicine era. Resources specifically aimed at, and codesigned with, GPs are required to enable broader and equitable access for the benefit of all Australians.

Primary care (PC) represents a widely accessed health care service for youths and families in the United States. In recent years, there has been an increase in youth presenting to PC with suicidal thoughts and behaviors. This study aims to better understand current suicide prevention practices and provider perspectives regarding suicide prevention practices in PC with pediatric populations. Two studies (one using focus groups, the other using individual interviews) were conducted with 40 PC staff (including physicians and physician assistants, integrated behavioral health staff, nurses and nurse practitioners, and clinic leaders) from pediatric PC clinics in Washington State. Focus groups/interviews elicited feedback on current suicide care practices, staff and clinic needs, barriers, facilitators, and suggestions for improvement. Focus groups/interviews were recorded, transcribed, and analyzed using thematic analysis. Results were similar across clinics and highlight challenges and needs for pediatric PC including time limitations, lack of resources for parents, need for additional provider training in suicide prevention, need for team-based approaches, need for standardized and streamlined pathways for patients at different risk levels, and need for integrating screening and intervention components into existing workflows. Overall, results suggest that suicide care is difficult to implement within PC contexts. Understanding PC staff needs, barriers, and facilitators is imperative to adapt feasible suicide care pathways for PC. Results highlight important needs and key components for implementation strategies to target. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

ABSTRACTPyridox(am)ine 5′ Phosphate Oxidase deficiency (PNPO) presents with refractory epilepsy responsive to treatment with pyridoxal 5′ phosphate (PLP) or pyridoxine. A 15‐year‐old boy with PNPO deficiency and cirrhosis underwent orthotopic liver transplantation for hepatocellular carcinoma without extra‐hepatic disease. Pre‐transplant, the boy was cognitively normal with well controlled epilepsy on PLP 50 mg/kg/day. Continuous EEG monitoring was used pre‐operatively and post‐operatively to identify encephalopathy resulting from PLP deficiency. B6 vitamers (pyridoxine [PN], pyridoxamine [PM], pyridoxal [PL] and phosphorylated forms [PNP, PMP, PLP]) were assayed at times of encephalopathy (symptoms and/or EEG) and for pharmacokinetics. Doses of PLP were titrated to prevent encephalopathy and limit side effects. The intraoperative/immediate postoperative periods were managed with intravenous PLP at a dose which could be reduced to 7.8 mg/kg/day before encephalopathy recurred. Post‐transplant, transition to oral PLP (100 mg/kg/day) led to fulminant hepatic impairment, which improved when IV dosing resumed. Subsequent transition to full oral PLP dosing took 9 months with a final dose of 24 mg/kg/day oral PLP. PLP showed dose dependent hepatotoxicity with associated rises in alpha‐fetoprotein levels. Gradual PLP dose changes and frequent oral dosing minimised encephalopathy episodes and hepato‐toxicity. Six years post‐transplant, liver biopsy showed moderate portal fibrosis (Ishak fibrosis stage 2/6, LAFSc score 3/9). Encephalopathy/seizures were associated with lower plasma PL concentrations (40 times above physiological levels); but high plasma PLP concentrations did not prevent encephalopathy. Despite liver transplantation, requirements for supraphysiologic doses of PLP continued, suggesting impaired neuronal PLP salvage is the major factor determining PLP requirements in PNPO deficiency.