EV71 infection is likely to continue to be a public health problem in Australia. Surveillance of routinely collected emergency department data can provide a useful indication of its activity in the community.

EV71 is in Australia and all clinicians seeing children in primary, secondary and tertiary care centres need to be aware of the disease, the subtle nature of initial symptoms and the potentially devastating consequences.

Palivizumab is often prescribed without meeting recognised best practice guidelines, and patients eligible are frequently not prescribed palivizumab. The streamlined IPU, implemented in hospital A, excluded patients who did not meet guidelines. The pro forma needs further refinement, and complementary strategies introduced to improve compliance.

Research Motivation: Gastroesophageal reflux disease (GERD) is a well-recognised cause of respiratory symptoms in children. Confirming a diagnosis of reflux aspiration remains difficult, due to limitations in currently available investigations. The presence of pepsin in respiratory secretions has been documented in literature as a marker of reflux aspiration; however the correlation of pepsin assay results with clinical outcomes has not previously been reported. Aim: This study investigates the way in which results of pepsin assays influence the management of children with suspected reflux aspiration, as well as clinician attitudes towards pepsin assay. Methodology: Retrospective chart review of 318 patient records from January 2005 -December 2009, at Sydney Children's Hospital. Pepsin assay results were compared with results from other standard investigations for GERD. Findings: Children with GERD and respiratory symptoms were 1.8 times as likely to be positive for pepsin compared to children without respiratory symptoms (OR 1.8, 95% C.I. = 1.09 -2.96). A significantly greater quantity of pepsin was detected in tracheal aspirates of children with GERD and respiratory symptoms compared to those without (median 43, 0-996FU, p=0.002). In children with GERD and respiratory symptoms, pepsin assay, unlike standard GERD investigations was the only tool found to have statistical significance as a marker of possible reflux aspiration. Clinicians found the pepsin assay to be useful in the management of children with suspected reflux aspiration. Implications: The findings of this study show that the pepsin assay helps in the assessment of children with GERD and respiratory symptoms in who reflux aspiration are suspected.