A Novel Web-Based Application for Influenza and COVID-19 Outbreak Detection and Response in Residential Aged Care Facilities.

Unlabelled: The use of innovative digital health technologies in public health is expanding quickly, including the use of these tools in outbreak response. The translation of a digital health innovation into effective public health practice is a complex process requiring diverse enablers across the people, process, and technology domains. This paper describes a novel web-based application that was designed and implemented by a district-level public health authority to assist residential aged care facilities in influenza and COVID-19 outbreak detection and response. It discusses some of the challenges, enablers, and key lessons learned in designing and implementing such a novel application from the perspectives of the public health practitioners (the authors) that undertook this project.

Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study.

BACKGROUND: Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. OBJECTIVE: The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. METHODS: The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. RESULTS: Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. CONCLUSIONS: FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales.

A multiple site community outbreak of COVID-19 in Sydney, Australia.

OBJECTIVE: To investigate an outbreak of COVID-19 in Sydney, Australia. METHODS: Epidemiological linking and analysis of cases of COVID-19 across multiple outbreak sites. RESULTS: Fifteen cases of COVID-19 and 41 contacts were identified and linked in a cluster that included one workplace and five households. The mean incubation period in the cases ranged from 4.6 to 6.4 days, while the median incubation period was shorter, ranging from 3 to 5 days. The overall range of incubation periods was 2 to 12 days. Differential attack rates were found within households (86% adults vs. 9% children) and workplace (32%) settings. Conclusions and implications for public health: Our investigation links cases between multiple households and a workplace. When exploring these links using a rapid workplace assessment, real-time cluster data along with objective measurements of exposure, such as with the Australian Government COVIDSafe app, may have allowed these links to be identified more readily and potentially reduced further spread of COVID-19. We found age as a factor for infection, with children being less likely to both acquire SARS-CoV-2 infection and to develop symptoms. This finding aids in our understanding of how the virus affects children and cautiously supports face-to-face classroom teaching.

Pertussis Morbidity in Children 12-59 Months of Age: A NSW Public Health Network Study.

BACKGROUND: Pertussis continues to be a significant public health problem despite high levels of vaccination. Although hospitalizations and deaths among children greater than 12 months of age are much less frequent than among infants less than 6 months of age, only limited information is available for this age group on other measures of morbidity. METHODS: A cross-sectional study with a 6-week follow-up component was conducted in New South Wales, Australia in 2017 to measure morbidity among children 12-59 months of age notified to health authorities. Measures used included cough duration, cough severity, constitutional symptoms and impacts on the family. Associations between these outcomes and age group, vaccination status, asthma, treatment and family structure were explored. RESULTS: Three hundred and five of 472 (65%) notified cases were interviewed at baseline with approximately 20% having a severe cough with no trend in prevalence across age groups. Forty-eight percent of cases had experienced 3 or more constitutional symptoms with rates significantly higher among younger children. Children who had received an 18-month booster vaccination were significantly less likely to experience 3 or more constitutional symptoms (odds ratio: 0.46, 95% confidence interval: 0.22-0.97). Fifty-one percent of cases were still coughing at 6 weeks. One-third of carers initially reported having disrupted sleep 4 or more nights per week with substantial disruption to carers' sleep still recorded at 6 weeks. CONCLUSIONS: Substantial morbidity was observed in this age group with some evidence that the reintroduction of an 18-month acellular pertussis booster lessened disease severity.

Characteristics of gonorrhoea cases notified in inner and south-western Sydney, Australia: results of population-based enhanced surveillance.

Background: Gonorrhoea disproportionately affects young people and men who have sex with men (MSM). In Australia, the highest notification rates in urban areas occur in MSM, although characteristics of those infected are poorly described. Enhanced surveillance can provide population-based data to inform service delivery and health promotion activities. Methods: An enhanced surveillance and data collection form was sent to the ordering doctor for residents of Sydney and South Western Sydney Local Health Districts with positive gonorrhoea results notified between 1 August 2013 and 28 February 2014. Results: Questionnaires were sent for 777 notifications and 698 (89.8%) were returned. Eighty-five per cent (n = 594) were male. The majority (55.1%) resided in inner city Sydney. Of these, 91.9% were male, and 70.8% of these identified as MSM. Among females, regular partners were the most likely source of infection (44.1%), while MSM and heterosexual men identified casual partners as the likely source of infection (75.4% and 61.1% respectively). General practitioners diagnosed 60.5% of cases. MSM were more commonly diagnosed by sexual health clinics. Females were most commonly tested for contact tracing (35.6%), heterosexual males because of symptoms (86.3%), and MSM as part of sexually transmissible infection screening (40.6%). Conclusions: Our population-based analysis identified differing risk factors and testing characteristics between MSM, heterosexual males and females. Increasing rates of gonorrhoea and concerns over antibiotic resistance highlight the importance of obtaining accurate sexual histories to ensure appropriate testing. Intermittent enhanced surveillance can monitor trends in specific populations and help determine the impact of health promotion strategies.

Influenza outbreak preparedness: lessons from outbreaks in residential care facilities in 2014.

This report describes 6 influenza outbreaks in residential care facilities during the 2014 influenza season in the Sydney Local Health District. Vaccination rates were high among residents (95%) and low among staff (39%). The majority of residents with laboratory confirmed influenza (67%) did not meet the influenza-like illness case definition.Positive influenza specimens were subtyped as H3N2 (40%), H1N1 (5%) or not subtyped (55%). We illustrate the implications of low vaccine effectiveness and antigenic drift, and provide recommendations for the effective management of future influenza outbreaks.