Public health action following an outbreak of toxigenic cutaneous diphtheria in an Auckland refugee resettlement centre.

Global forced displacement has climbed to unprecedented levels due largely to regional conflict. Degraded public health services leave displaced people vulnerable to multiple environmental and infectious hazards including vaccine preventable disease. While diphtheria is rarely notified in New Zealand, a 2 person outbreak of cutaneous diphtheria occurred in refugees from Afghanistan in February 2015 at the refugee resettlement centre in Auckland. Both cases had uncertain immunisation status. The index case presented with a scalp lesion during routine health screen and toxigenic Corynebacterium diphtheriae was isolated. A secondary case of cutaneous diphtheria and an asymptomatic carrier were identified from skin and throat swabs. The 2 cases and 1 carrier were placed in consented restriction until antibiotic treatment and 2 clearance swabs were available. A total of 164 contacts were identified from within the same hostel accommodation as well as staff working in the refugee centre. All high risk contacts (n=101) were swabbed (throat, nasopharynx and open skin lesions) to assess C. diphtheriae carriage status. Chemoprophylaxis was administered (1 dose of intramuscular benzathine penicillin or 10 days of oral erythromycin) and diphtheria toxoid-containing vaccine offered regardless of immunisation status. Suspected cases were restricted on daily monitoring until swab clearance. A group of 49 low risk contacts were also offered vaccination. Results suggest a significant public health effort was required for a disease rarely seen in New Zealand. In light of increased worldwide forced displacement, similar outbreaks could occur and require a rigorous public health framework for management.

Impact of the COVID-19 related border restrictions on influenza and other common respiratory viral infections in New Zealand.

BACKGROUND: New Zealand's (NZ) complete absence of community transmission of influenza and respiratory syncytial virus (RSV) after May 2020, likely due to COVID-19 elimination measures, provided a rare opportunity to assess the impact of border restrictions on common respiratory viral infections over the ensuing 2 years. METHODS: We collected the data from multiple surveillance systems, including hospital-based severe acute respiratory infection surveillance, SHIVERS-II, -III and -IV community cohorts for acute respiratory infection (ARI) surveillance, HealthStat sentinel general practice (GP) based influenza-like illness surveillance and SHIVERS-V sentinel GP-based ARI surveillance, SHIVERS-V traveller ARI surveillance and laboratory-based surveillance. We described the data on influenza, RSV and other respiratory viral infections in NZ before, during and after various stages of the COVID related border restrictions. RESULTS: We observed that border closure to most people, and mandatory government-managed isolation and quarantine on arrival for those allowed to enter, appeared to be effective in keeping influenza and RSV infections out of the NZ community. Border restrictions did not affect community transmission of other respiratory viruses such as rhinovirus and parainfluenza virus type-1. Partial border relaxations through quarantine-free travel with Australia and other countries were quickly followed by importation of RSV in 2021 and influenza in 2022. CONCLUSION: Our findings inform future pandemic preparedness and strategies to model and manage the impact of influenza and other respiratory viral threats.

Reactive arthritis incidence in a community cohort following a large waterborne campylobacteriosis outbreak in Havelock North, New Zealand.

OBJECTIVES: In August 2016, Campylobacter spp contaminated an untreated reticulated water supply resulting in a large-scale gastroenteritis outbreak affecting an estimated 8320 people. We aimed to determine the incidence of probable reactive arthritis (ReA) cases in individuals with culture-confirmed campylobacteriosis (CC), self-reported probable campylobacteriosis (PC) and those reporting no diarrhoea (ND). DESIGN: We conducted a retrospective cohort study to identify incidence of probable ReA cases. We identified cases with new ReA symptoms using an adapted acute ReA (AReA) telephone questionnaire. Those reporting ≥1 symptom underwent a telephone interview with the study rheumatologist. Probable ReA was defined as spontaneous onset of pain suggestive of inflammatory arthritis in ≥1 previously asymptomatic joint for ≥3 days occurring ≤12 weeks after outbreak onset. SETTING: Population-based epidemiological study in Havelock North, New Zealand. PARTICIPANTS: We enrolled notified CC cases with gastroenteritis symptom onsets 5 August 2016-6 September 2016 and conducted a telephone survey of households supplied by the contaminated water source to enrol PC and ND cases. RESULTS: One hundred and six (47.3%) CC, 47 (32.6%) PC and 113 (34.3%) ND cases completed the AReA telephone questionnaire. Of those reporting ≥1 new ReA symptom, 45 (75.0%) CC, 13 (68.4%) PC and 14 (82.4%) ND cases completed the rheumatologist telephone interview. Nineteen CC, 4 PC and 2 ND cases developed probable ReA, resulting in minimum incidences of 8.5%, 2.8% and 0.6% and maximum incidences of 23.9%, 12.4% and 2.15%. DISCUSSION: We describe high probable ReA incidences among gastroenteritis case types during a very large Campylobacter gastroenteritis outbreak using a resource-efficient method that is feasible to employ in future outbreaks.

Impact of the COVID-19 nonpharmaceutical interventions on influenza and other respiratory viral infections in New Zealand.

Stringent nonpharmaceutical interventions (NPIs) such as lockdowns and border closures are not currently recommended for pandemic influenza control. New Zealand used these NPIs to eliminate coronavirus disease 2019 during its first wave. Using multiple surveillance systems, we observed a parallel and unprecedented reduction of influenza and other respiratory viral infections in 2020. This finding supports the use of these NPIs for controlling pandemic influenza and other severe respiratory viral threats.

Impact of the COVID-19 nonpharmaceutical interventions on influenza and other respiratory viral infections in New Zealand.

Stringent nonpharmaceutical interventions (NPIs) such as lockdowns and border closures are not currently recommended for pandemic influenza control. New Zealand used these NPIs to eliminate coronavirus disease 2019 during its first wave. Using multiple surveillance systems, we observed a parallel and unprecedented reduction of influenza and other respiratory viral infections in 2020. This finding supports the use of these NPIs for controlling pandemic influenza and other severe respiratory viral threats.

Pertussis control strategies: A consistent approach for New Zealand. Synopsis of Ministry of Health Workshop, April 2015.

In the past decade, pertussis has made a global resurgence, driving reconsideration of national immunisation schedules and vaccine usage. A workshop held by the Ministry of Health in 2015 discussed New Zealand's pertussis disease control strategies. Data were presented from current research into vaccine safety during pregnancy and the effectiveness of the immunisation schedule in preventing pertussis throughout childhood. The greatest burden of disease and mortality remains in infants under 1 year of age, especially infants too young to be immunised, those of Maori and Pacific ethnicity, and those living in deprivation. The workshop considered strategies including the timing of the scheduled vaccines, maternal immunisation, improving immunisation coverage, vaccination timeliness and service delivery to reduce inequalities and overall disease burden. It concluded that the current infant schedule appears to be working well to protect older infants from severe pertussis. Significant gains for reducing severe disease in vulnerable young infants could be made with improvements in maternal vaccine uptake. Other strategic directions include attention to schedule adherence and timeliness of vaccine delivery, and more effective communication approaches for healthcare professionals and the public.

Whooping cough­where are we now? A review.

AIMS: This paper describes the recent trends of pertussis and vaccine uptake in New Zealand based on notifications and immunisation registration information since 2011. It highlights the current risk for the infant in the first months after birth and the crucial role a pertussis booster in pregnancy could play. It also aims to show that protection of infants by the acellular pertussis vaccine can be improved by timely immunisation even in a situation of improving overall uptake rates that are nearing the national target of 95%. METHODS: We analysed New Zealand notification data for pertussis, extracted from EpiSurv between August 2011 and December 2013, which included the period of the last epidemic. Pertussis immunisation coverage data were extracted from the National Immunisation Register (NIR). Population estimates were based on 2006 census data. Deprivation was analysed using the New Zealand Deprivation Index 2006. RESULTS: Despite immunisation coverage at 12 months having exceeded 90% New Zealand experienced a large epidemic from 2011 to 2014, with several hundred infant hospitalisations and three deaths. Notification data indicated an average annual rate of pertussis in the New Zealand population of 102 per 100,000 with the highest rates in the youngest age groups. While an overall increase in immunisation coverage in New Zealand was evident and the timeliness showed improvement across ethnic groups and deprivation deciles, there was a marked geographical variation within DHBs and between ethnic groups. CONCLUSIONS: Given the recent published evidence, pertussis vaccination should be offered to all mothers between weeks 28 and 38 of pregnancy. Further improvements are still possible in coverage at 6 months, particularly in Maori and but also in Pacific populations, as well as in more deprived populations. DHBs work towards achieving the 95% target can contribute to the improvement in the timeliness of immunisation.

Synopsis of New Zealand's inaugural Influenza Symposium - influenza is a severe vaccine- preventable disease.

Influenza is a vaccine-preventable disease that can lead to serious acute respiratory illnesses and other complications. Influenza viruses are widespread in wild avian species and infect several animal species in addition to humans. Constant evolutionary changes to the influenza virus make the disease challenging to control. In November 2014, the Immunisation Advisory Centre held New Zealand's inaugural Influenza Symposium (NZiS) to focus upon influenza and vaccine strategies in New Zealand. International and local experts discussed advances in vaccine effectiveness, safety and disease prevalence and impact. Disease surveillance and vaccine effectiveness studies are identifying those at greatest risk from influenza to target vaccination campaigns. Influenza vaccine safety is closely monitored in order to improve public confidence. In New Zealand, around 27% of the total population are vaccinated against influenza annually, with 67% coverage for those aged 65 years and over who are eligible to funded vaccine. Seasonal influenza vaccination is vigorously promoted each year to help to improve vaccine uptake. However, there are inequalities in disease impact, with the elderly and very young, socioeconomically deprived and those with Maori and Pacific Island ethnicity remaining at-risk of serious disease and hospitalisation, which may be addressed by further improving access to influenza vaccine.