Community Outbreak of Pseudomonas aeruginosa Infections Associated with Contaminated Piercing Aftercare Solution, Australia, 2021.

In April 2021, the South Eastern Sydney Local Health District Public Health Unit (Sydney, New South Wales, Australia) was notified of 3 patients with Pseudomonas aeruginosa infections secondary to skin piercings performed at the same salon. Active case finding through laboratories, clinician alerts, and monitoring hospital visits for piercing-related infections identified additional cases across New South Wales, and consumers were alerted. We identified 13 confirmed and 40 probable case-patients and linked clinical isolates by genomic sequencing. Ten confirmed case-patients had used the same brand and batch of aftercare solution. We isolated P. aeruginosa from opened and unopened bottles of this solution batch that matched the outbreak strain identified by genomic sequencing. Piercing-related infections returned to baseline levels after this solution batch was recalled. Early outbreak detection and source attribution via genomic sequencing are crucial for controlling outbreaks linked to contaminated products. Manufacturing standards for nonsterile cosmetic products and guidance for piercing aftercare warrant review.

Weather extremes associated with increased Ross River virus and Barmah Forest virus notifications in NSW: learnings for public health response.

OBJECTIVE: To examine the sequence of environmental and entomological events prior to a substantial increase in Ross River virus (RRV) and Barmah Forest virus (BFV) notifications with a view to informing future public health response. METHODS: Rainfall, tidal, mosquito and human arboviral notification data were analysed to determine the temporality of events. RESULTS: Following two extremely dry years, there was a substantial increase in the abundance of mosquitoes along coastal New South Wales (NSW) two weeks after a significant rainfall event and high tides in February 2020. Subsequently, RRV and BFV notifications in north east NSW began to increase eight and nine weeks respectively after the high rainfall, with RRV notifications peaking 12 weeks after the high rainfall. CONCLUSIONS: Mosquito bite avoidance messaging should be instigated within two weeks of high summer rainfall, especially after an extended dry period. IMPLICATIONS FOR PUBLIC HEALTH: Intense summertime rain events, which are expected to increase in frequency in south-east Australia with climate change, can lead to significant increases in arboviral disease. These events need to be recognised by public health practitioners to facilitate timely public health response. This has taken on added importance since the emergence of Japanese encephalitis virus in southeastern Australia in 2022.

Button battery exposures in Australian children: a prospective observational study highlighting the role of poisons information centres.

CONTEXT: Button battery ingestion is a worldwide problem, with evidence of increasing harms and deaths in recent decades. Australian Poisons Information Centre (PIC) experience includes cases of treatment delay due to lack of healthcare professional recognition of risks, and/or lack of local resources. This study aims to characterise Australian button battery exposures, focusing on exposure circumstances, and preventable health system shortcomings. METHODS: A prospective observational study of button battery exposure calls to New South Wales PIC, November 2015-May 2017, using a follow-up survey to obtain outcome data and additional details. Survey data was combined with nationwide PIC data over the same period. RESULTS: Australian PICs were consulted on 578 exposures over the 19-month study period, including 506 paediatric cases. The median (IQR) age for the paediatric cases was 23 months (14-36 months). Where the source was identified, batteries came from toys in 26% of cases, with hearing aids, watches, and remote controls being other common sources. Children in outer regional, remote and very remote areas were overrepresented, and 15 cases were referred to a different hospital due to X-ray facilities being unavailable at their nearest hospital. We identified inconsistent triage from a range of first responders, and knowledge gaps regarding button battery dangers amongst some healthcare professionals. DISCUSSION: Button battery exposures are a common call to Australian PICs. This study highlights a potential role of education campaigns, professional guidelines, and child-resistant battery compartments in toys and household devices. PICs calling ahead to ensure X-ray availability/diversion to a different hospital likely reduced delays for this time-critical exposure. CONCLUSIONS: Button battery exposures continue to be a problem in Australia. Data collected by PICs can provide useful information for public health and product safety initiatives. A PIC-led protocol to direct initial medical management of button battery exposures could reduce delays and improve outcomes.

Climate change, health and wellbeing: challenges and opportunities in NSW, Australia.

The NSW (New South Wales) Climate Change Policy Framework, launched by the NSW Government in 2016, recognises that climate change presents risks to health and wellbeing. Risks to health and wellbeing come from direct impacts of extreme weather events, and from indirect impacts through effects on air, water, food and ecosystems. Responding to these challenges offers an opportunity to protect and promote health by enhancing environmental amenities, and building adaptive capacity and resilience in populations and systems. To develop policy that effectively protects and promotes health in the face of climate change in NSW it is necessary to define the expected impacts of climate change on health and wellbeing in NSW.

A systematic review of the health risks from passive exposure to electronic cigarette vapour.

OBJECTIVES: Electronic cigarettes (ECs) have recently become popular around the world, and their safety is being widely discussed in the scientific literature. Previous studies have examined the chemicals in e-liquids and vapour, and demonstrated that the aerosol from ECs can contain toxic chemicals that are harmful to health. However, little is known about the potential adverse health effects of passive exposure to EC vapour. The aim of this paper is to summarise and review all studies that have examined potential adverse health effects of passive exposure from inhaling EC vapour. Specifically, our research objectives were to describe 1) the absolute impact of passive exposure from inhaling vapour when compared with background, and 2) the relative impact of passive exposure from inhaling vapour when compared with passive exposure from inhaling conventional cigarette smoke. METHODS: A systematic review was conducted to identify articles published from 1996 to 10 September 2015 from Embase, Ovid MEDLINE and PreMEDLINE. Papers eligible for inclusion had to be written in English, study health effects from passive exposure to EC vapour in animals or humans, test or analyse the EC vapour directly or in the ambient air (with an inference made about passive or second-hand vapour exposure). The review was conducted using the PRISMA guidelines for reporting on systematic reviews. We identified 312 studies, and 16 were relevant for inclusion in our review. RESULTS: A variety of study designs were used to investigate potential health risks from passive exposure to EC vapour. These included direct exposure studies involving humans and animals, and indirect exposure studies using volunteer EC users or smoking machines. The majority of studies determined that passive exposure to EC vapour may pose a health risk to bystanders. All papers encountered a number of limitations. CONCLUSION: Our review found that the absolute impact from passive exposure to EC vapour has the potential to lead to adverse health effects. The risk from being passively exposed to EC vapour is likely to be less than the risk from passive exposure to conventional cigarette smoke.

Evidence for predominance of CCR5-using HIV-1 strains during highly active antiretroviral therapy.

BACKGROUND: Very little is known about the influence of Highly Active Antiretroviral Therapy (HAART) on the surface expression of CCR5 and CXCR4 with respect to receptor tropism and replication kinetics of autologous HIV strains, during continuous therapy and structured treatment interruption (STI) regimens. OBJECTIVES: The main objectives of this study were to assess whether continuous therapy and STI regimens had any modulatory effects on expression of CCR5 and CXCR4 on T lymphocytes. STUDY DESIGN: We studied 6 patients on continuous HAART, 4 patients on STI and 1 treatment-naïve patient. Sequential peripheral blood mononuclear cells (PBMC) samples were analyzed to determine viral replication kinetics, the genotype influencing tropism of the autologous strain, in vitro co-receptor usage patterns in relation to the surface expression of each co-receptor. RESULTS: Our data suggest that predominant CCR5 expression and tropism, during therapy, but significant down-modulation of CXCR4 expression. During the off-therapy phases of STI, CXCR4 expression increased, which correlated with increased CXCR4 tropism of isolates from these time points. In-vitro tropism during therapy was consistent with the HIV-1 V3 genotype, which was characteristic of CCR5 using strains. CONCLUSIONS: These results suggest that certain HAART regimens influence the surface expression of CXCR4, which may have profound implications for antiretroviral treatment.

Drug resistance and viral evolution in plasma and peripheral blood cells during structured treatment interruption (STI) and non-interrupted HAART.

BACKGROUND: Highly active antiretroviral therapy (HAART) can successfully reduce plasma and tissue levels of HIV-1 RNA and results in reductions in HIV-related morbidity and mortality, but the slow viral evolution during therapy in cellular reservoirs is a continuing problem. In addition, little remains known how viral evolutionary process may differ between cell-free and cell-associated compartments, over time, in vivo in patients receiving HAART or STI. OBJECTIVES: The main objectives of this study were to assess viral replication kinetics, drug resistance and viral evolution during HAART and STI. STUDY DESIGN: We have conducted a longitudinal study of virus culture kinetics in vitro, molecular analysis of uncultured HIV-1 variants from plasma and PBMC of 6 patients on HAART, 4 patients on STI, and 6 from treatment-naïve patients. RESULTS: Our data suggest that drug resistance mutations remained compartmentalized between plasma and PBMC. The divergent distribution of resistance mutations between plasma and PBMC coincided with divergent env gene evolution in these compartments. In contrast, the HIV strains from therapy-naive patients showed tight genetic and phylogenetic concordance between plasma and PBMC. Both STI and non-STI groups showed the presence of resistance mutations to both RT and protease inhibitors, which correlated with inadequate suppression of viremia and partially with the virus culture isolation in vitro. CONCLUSIONS: Overall, STI for HIV patients has no added advantage over regular HAART at the virologic level and in the diminution of resistance mutations that result in therapy failure. Under both forms of anti-retroviral therapies, virus could be isolated in vitro from the PBMC showing continuing low-level viral replication under suppressive therapy. Overall, these data may be useful in predicting the late emergence of drug resistance mutations via the latent integrated provirus.