Respiratory pandemics, urban planning and design: A multidisciplinary rapid review of the literature.

COVID-19 is the most recent respiratory pandemic to necessitate better knowledge about city planning and design. The complex connections between cities and pandemics, however challenge traditional approaches to reviewing literature. In this article we adopted a rapid review methodology. We review the historical literature on respiratory pandemics and their documented connections to urban planning and design (both broadly defined as being concerned with cities as complex systems). Our systematic search across multidisciplinary databases returned a total of 1323 sources, with 92 articles included in the final review. Findings showed that the literature represents the multi-scalar nature of cities and pandemics - pandemics are global phenomena spread through an interconnected world, but require regional, city, local and individual responses. We characterise the literature under ten themes: scale (global to local); built environment; governance; modelling; non-pharmaceutical interventions; socioeconomic factors; system preparedness; system responses; underserved and vulnerable populations; and future-proofing urban planning and design. We conclude that the historical literature captures how city planning and design intersects with a public health response to respiratory pandemics. Our thematic framework provides parameters for future research and policy responses to the varied connections between cities and respiratory pandemics.

Field effectiveness of hepatitis A vaccine and uptake of post exposure prophylaxis following a change to the Australian guidelines.

BACKGROUND: In 2009, national guidelines for hepatitis A control in Australia changed to recommend hepatitis A vaccine (HAV), instead of normal human immune globulin (NHIG), for post-exposure prophylaxis (PEP). AIMS: (1) Determine whether the uptake of PEP among contacts of hepatitis A cases changed after the introduction of the new guidelines, and (2) assess the field effectiveness of the HAV used as PEP in preventing infection among contacts of hepatitis A cases. METHODS: A retrospective cohort of contacts from hepatitis A cases reported to metropolitan Public Health Units in Sydney, Australia, between October 2008 and June 2010, was identified. Contacts were analysed by time period, age, PEP type, and susceptibility to hepatitis A. The relative risk (RR) of hepatitis A infection among susceptible contacts who received HAV, compared with susceptible contacts who had not received HAV, was calculated to estimate the effectiveness of the HAV when used as PEP. RESULTS: The uptake of PEP by susceptible contacts increased from 76% (n=133) to 89% (n=127) after the introduction of the new guidelines. Before the change in guidelines, no one who received PEP was later reported with hepatitis A. After the change in guidelines, one of the 123 contacts who received HAV as PEP was subsequently reported with hepatitis A. However, this case was likely to have been co-exposed with a primary case. Conservatively, assuming this was a secondary case, the vaccine effectiveness of HAV was 95.6% (66.1%-99.4%). Nine of 10 incident cases of hepatitis A were contacts who did not receive any PEP. CONCLUSION: The improved uptake of PEP and the high estimate of the effectiveness of HAV provides support for using HAV for PEP. The very high occurrence of hepatitis A among contacts who did not receive any PEP further highlights the importance of PEP in preventing hepatitis A infection.

Trends in notifiable blood lead levels in NSW, 1998-2008.

AIM: In the absence of published statewide notification data, the aim of this study was to analyse trends in notifiable blood lead levels (hereafter referred to as lead poisoning) in NSW from 1998 to 2008, to help inform lead poisoning notification policy. METHODS: NSW blood lead poisoning notification data for 1998-2008 were extracted from the Notifiable Diseases Database and analysed by age, gender and Area Health Service of residence. RESULTS: There were 6000 lead poisoning notifications from 1998 to 2008, with an average annual notification rate of 11.8 per 100 000 population for 1998-2003. This rate declined to an average of 4.0 per 100 000 population in the period 2004-2008. Males accounted for 92% of notifications, and males aged 20-59 years had average notification rates between 20 and 27 per 100 000 population. Children aged 0-4 years had notification rates of 9.3 per 100 000 population in girls and 13.6 per 100 000 population in boys. CONCLUSION: Notification rates have fallen dramatically, however children aged 0-4 years and men are disproportionately represented in lead poisoning notifications.

Trends and risk factors for hepatitis A in NSW, 2000-2009: the trouble with travel.

AIM: To analyse trends in hepatitis A notifications and information on exposure to risk factors, in particular international travel, collected through routine surveillance in NSW. METHODS: Hepatitis A notification data for the period 2000-2009 were extracted from the Notifiable Diseases Database and analysed by age group, gender, area of residence and exposure risk factors, including travel, food eaten and contact with other possible infectious cases. RESULTS: The notification rate for hepatitis A in NSW fell from 3.0 cases per 100000 population in 2000 to 1.4 cases per 100000 population in 2009. Notification rates were highest among people aged 20-24 years and residents of metropolitan Sydney. Travel to a country where hepatitis A is endemic was a risk exposure identified in 43% of cases. CONCLUSION: International travel to highly endemic countries continues to be the most common risk factor for hepatitis A infection notified in NSW despite recommendations that travellers be vaccinated prior to travel to these areas.