EpiReview: tuberculosis in NSW, 2008.

AIM: To describe the epidemiology of tuberculosis cases notified in NSW in 2008. METHOD: Data on tuberculosis cases resident in NSW that were reported in 2008 were extracted from the Notifiable Diseases Database. Demographic, microbiological, clinical and other characteristics of cases were described. Incidence rates per 100 000 were calculated. RESULTS: In 2008, 498 tuberculosis cases were notified in NSW (7.1 cases per 100 000 population). Most cases were newly diagnosed (n = 479, 96%). The lung was the most common site of disease (n = 304, 61%). Eight of 269 tested cases (1.6%) had a HIV-tuberculosis co-infection. One case had multidrug-resistant tuberculosis. Most cases reported past residence (n = 429, 86%) or birth (n = 378, 76%) in a country with a high incidence of tuberculosis. CONCLUSION: The incidence of tuberculosis in NSW increased slightly in 2008. Most cases had links to countries with a high tuberculosis incidence.

Egg-associated Salmonella outbreak in an aged care facility, New South Wales, 2008.

Salmonellosis is a bacterial disease that causes acute gastroenteritis, with sudden onset of headache, abdominal pain, diarrhoea, nausea and sometimes vomiting. Infection is often associated with the consumption of foods prepared using raw eggs. During July to August 2008 an outbreak at an aged care facility (ACF) in New South Wales was confirmed as Salmonella Typhimurium phage type 44 (Stm 44) in eight of 45 residents. Two additional probable cases also occurred. Cases were located in each unit of the ACF and for 5 cases, onset of diarrhoea was between 45 to 64 hours (median of 46 hours) after consumption of a dessert containing raw eggs. Onset for 5 further cases occurred up to 9 days after this meal. Eggs were supplied to the ACF from a local farm. Stm 44 was detected on an egg in an unopened box at the ACF from this supplier. The raw-egg dessert was epidemiologically implicated as the likely source of the Salmonella and delayed onset cases may have resulted from ingestion of a smaller dose of Salmonella, or ongoing transmission through cross-contamination of kitchen machinery or surfaces. This outbreak demonstrates that inadequate cooking of eggs continues to pose a risk for Salmonella infection in settings with vulnerable populations. The findings of the investigation provide support for the importance of food safety regulations and demand further advocacy for measures to reduce the risks associated with the distribution, storage and preparation of shell eggs.

Estimate of the number of Campylobacter infections in the Hunter region, NSW, 2004-2007.

OBJECTIVES: Campylobacteriosis is not notifiable in NSW and the number of cases of Campylobacter disease is thus not well described. METHODS: De-identified campylobacteriosis records for 2004-2007 were requested from laboratories in the Hunter region of NSW. Based on notifying laboratory, a Salmonella notification weighting was applied to laboratory-confirmed campylobacteriosis cases to provide an overall estimate of Campylobacter disease in the area. RESULTS: The estimated median of the annual number of laboratory-confirmed campylobacteriosis cases was 788 (range 700-1022). The ratio of estimated Campylobacter cases to Salmonella notifications was 5.5 : 1. CONCLUSION: Campylobacter infection causes considerable disease in the Hunter, and likely in NSW. Regular review of Campylobacter laboratory results may be valuable.

An evaluation of the Australian Rotavirus Surveillance Program.

The Australian Rotavirus Serotyping Program (ARSP) serotypes rotavirus isolates obtained from stool samples sent from Australian laboratories. In collaboration with ARSP the Australian Government Department of Health and Ageing evaluated the program for its utility and capacity to monitor effectiveness of the rotavirus vaccines recently introduced into the Australian National Immunisation Program. The system was described using ARSP annual reports and staff interviews. The attributes of the system were assessed by adapting standard guidelines for evaluating a surveillance system. Email surveys or face to face interviews were conducted with staff of ARSP, participating laboratories, rotavirus vaccine manufacturing companies and representatives of the Communicable Diseases Network Australia. The ability of the ARSP to monitor changes in rotavirus serotype epidemiology was assessed. ARSP serotypes rotavirus isolates received from participating laboratories at least bi-annually, with results being reported at least as often. Serotype analyses have informed formulation of rotavirus vaccines and contributed to forecasting the extent of outbreaks caused by novel serotypes. The ARSP will be able to monitor changes in rotavirus serotype epidemiology and identify probable vaccination failures. Enhancement of the representativeness and sensitivity of the system are needed for the data to remain useful in the public health context. Methods for transferring data between the program and state and territory health departments need to be developed.