Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand.

A 3-month outbreak of invasive group A Streptococcus disease at an eldercare facility, in which 5 persons died, was biphasic. Although targeted chemoprophylaxis contained the initial outbreak, a second phase of the outbreak occurred after infection control processes ended. To retrospectively investigate the genomic epidemiology of the biphasic outbreak, we used whole-genome sequencing and multiple bioinformatics approaches. Analysis of isolates from the outbreak and isolates prospectively collected during the outbreak response indicated a single S. pyogenes emm81 clone among residents and staff members. Outbreak isolates differed from nonoutbreak emm81 isolates by harboring an integrative conjugative genomic element that contained the macrolide resistance determinant erm(TR). This study shows how retrospective high-resolution genomic investigations identified rapid spread of a closed-facilty clonal outbreak that was controlled, but not readily cleared, by infection control management procedures.

Lessons from a system-wide response to a measles outbreak, Canterbury, February-April 2019.

Despite New Zealand's "measles elimination" status, the risk of measles outbreaks persists, due to ongoing measles importation and sub-optimal vaccination coverage, including specific sub-populations with higher proportions of susceptible people. From February to April 2019, Canterbury experienced a measles outbreak with 38 local cases and an unidentified index case. The outbreak strain was linked to a large outbreak in the Philippines. The whole-of-health-system response included active case and contact follow-up by public health and hospital staff, and a prioritised vaccination campaign in primary care. Important features of a measles outbreak response in an "elimination" context include cross-system liaison, co-ordination of communications, careful prioritisation of use of available resources, and support for households affected by isolation and/or quarantine requests. Closer analysis of the effectiveness of outbreak control measures would help prioritise use of scarce public health and health care resources during outbreaks. Future measles outbreaks could be prevented by a systematic primary care-based MMR catch-up campaign.

Greater Christchurch Draft Urban Development Strategy 2005.

The first health impact assessment (HIA) performed on a high level local government policy in New Zealand was undertaken on the Greater Christchurch Urban Development Strategy in 2005. This report describes its development and implementation and the results from the process evaluation including some recommendations made in the assessment. We concluded that HIA is a useful tool for local government policy analysts and we recommend it.

Financing the Canterbury Health System post-disaster.

The Canterbury Health System has invested substantially in its transformation to a patient-centred, integrated system, enabling improved performance despite the significant and long-term impacts of the Christchurch earthquakes in 2010 and 2011. Questions have been raised about whether this transformation is sustainable and affordable. We argue that there is a need for a post-disaster health funding strategy that takes into account the challenge of following population movements after a large natural disaster, and higher costs resulting from the disruption and the effect on the population. Such a strategy should also provide stability in an unstable environment. However, funding for health in Canterbury has followed a 'business as usual' model using the population-based funding formula, which we view as problematic. Additionally, increases in funding using that formula have been below the national average, which we believe is perverse. Canterbury has received an additional $84 million government in deficit funding since 2010/11, and this has covered part of the extra cost attributable to the earthquake. However, without system-wide integration and innovation that was underway before, and that has continued since the earthquakes, it is likely the Canterbury Health System would not have been able to meet the health needs of its population. If health funding for Canterbury had continued to increase at the average rate applied across New Zealand over the past five years, deficit funding would not have been required.

A novel response to an outbreak of infectious syphilis in Christchurch, New Zealand.

During 2012, Christchurch experienced a dramatic increase in cases of infectious syphilis among men who have sex with men. This was accompanied by some novel trends; notably, the acquisition of infection in a younger age group, with local sexual contacts, commonly via the use of social media. This study is a report on an approach to case identification and public health communication as a component of a multifaceted outbreak response. Enhanced syphilis surveillance data on public health responses to outbreaks of sexually transmissible infections was collated and reviewed, alongside clinical records and literature. Reported outbreak response methods were adapted for the Christchurch cohort. A Facebook page was created to raise awareness of infectious syphilis, the importance of screening and where to get tested. Twenty-six males were diagnosed with infectious syphilis in 2012, an increase from previous years, of which 22 reported only male sexual contact. High use of social media used to find potential sexual contacts was reported. Enhanced syphilis surveillance characterised in detail an infectious syphilis outbreak in Christchurch. Index cases were identified, contact tracing mapping was used to identify transmission networks and social media was also used to educate the risk group. There was a decrease in infectious syphilis presentations, with no cases in the last 3 months of 2012.

Evaluation of the Canterbury under-18 seasonal influenza vaccination programme.

AIM: To evaluate the performance of the 2013 Canterbury under-18 seasonal influenza vaccination programme (Christchurch, New Zealand). METHODS: Routinely collected under 18 influenza vaccination uptake data were analysed to determine levels of vaccination uptake and equity of uptake across ethnic groups (NZ European, Maori and Pacific) and by level of deprivation. Qualitative data were collected to identify strategies that helped to achieve high uptake in primary care practices and schools. RESULTS: Overall uptake of influenza vaccination in 2013 was 32.9%, (compared to 18.5% in 2012), close to the target of 40%. Overall uptake in primary care was higher than in the school-based programme (29.2% versus 19.7%). Maori students had higher uptake than NZ European students in the school-based programme. In primary care, uptake for both Maori and Pacific children was lower than overall uptake and there was a marked gradient in uptake by socioeconomic quintile, with 30.2% uptake in the least deprived quintile compared to 21.9% uptake in the most deprived quintile. CONCLUSIONS: The cumulative effect of 3 years' consistency in offering the under-18 influenza vaccination in primary care practices, assisted by a timely media campaign and additional awareness generated by the school-based programme, has resulted in a marked increase in uptake of the vaccine in primary care in 2013. However, this was not equitably distributed. The school-based programme achieved better equity of uptake by deprivation and ethnicity. The challenge is to achieve both high and equitable uptake.