Enteric fever in the Pacific: a regional retrospective study from Auckland, New Zealand.

BACKGROUND: There are limited clinical data on enteric fever in the Pacific and New Zealand (NZ) compared with the Indian subcontinent (ISC) and South-East Asia (SEA). Our objective was to describe enteric fever in Auckland - a large Pacific city, focusing on disease acquired in these regions. METHODS: We reviewed enteric fever cases hospitalised in Auckland from January 2005 to December 2010. RESULTS: Microbiologically confirmed EF was identified in 162 patients. Travel regions: Pacific, 40 cases (25%) (Samoa, 38; Fiji, two), ISC, 72 (44%), SEA, seven (4%), other, three (2%), no travel, 40 (25%). Enteric fever rates for Auckland resident travellers were: India 50.3/100 000; Samoa 19.7/100 000.All Pacific cases were Salmonella Typhi. Of local isolates (without travel history), 38 were S. Typhi (36 fully susceptible, one multi-drug resistant (MDR) + nalidixic acid resistant (NAR), one unknown) and two S. Paratyphi (both NAR). Of non-Pacific travel, 56/82 (69%) isolates were S. Typhi, the remainder S. Paratyphi (15 isolates were fully susceptible, only 1% were MDR). Significant associations of serotype and antibiotic resistance with different travel regions and similarity of phage types (local and Pacific) were observed. Headache, vomiting and acute kidney injuries were more frequent with Pacific travel, while abdominal distension and cholecystitis with local disease. Shorter duration of treatment in the Pacific group was seen despite length of stay in hospital not being reduced. Local cases were associated with longer hospital admissions. CONCLUSIONS: One half of cases in Auckland are acquired either from Pacific or locally. Similarities mean that disease acquired locally is likely of Pacific origin.

Residential mobility in childhood and health outcomes: a systematic review.

OBJECTIVE: To assess evidence for residential mobility in childhood having an adverse association with health outcomes through the life course. METHODS: A systematic search of medical and social sciences literature was undertaken to identify research defining residential mobility as an independent variable and in which health outcomes were described and objectively measured. Studies were excluded that investigated international migration for asylum or were limited to educational outcomes. Two reviewers assessed each study using quality criteria with particular attention to the consideration of confounders and potential for bias. Data were extracted for analysis using a structured form. RESULTS: Twenty-two studies were included for this review. Outcomes identified in association with residential mobility included: higher levels of behavioural and emotional problems; increased teenage pregnancy rates; accelerated initiation of illicit drug use; adolescent depression; reduced continuity of healthcare. Studies assessed as having lower quality were less likely to demonstrate statistically significant effects. Heterogeneity precluded meta-analysis. CONCLUSIONS: Residential mobility interacts at neighbourhood, family and individual levels in cumulative and compounding ways with significance for the wellbeing of children. High frequency residential change is potentially a useful marker for the clinical risk of behavioural and emotional problems. The evidence supports the reorientation of health services effectively to engage these residentially mobile children for whom health and psychological needs may be identified. The impact of housing and economic policies on childhood residential mobility should be evaluated considering this evidence.