RESUMEN
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.
Asunto(s)
Infecciones por Pseudomonas , Humanos , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/etiología , Cuidados Posteriores , Australia/epidemiología , Nueva Gales del Sur/epidemiología , Brotes de Enfermedades , Pseudomonas aeruginosaRESUMEN
ISSUE ADDRESSED: The COVID-19 pandemic has highlighted organised cruise holidays as perfect incubators for microbiological infections due to the constant socialising within closed spaces. Little is known about people's health behaviours and perceptions during cruise holidays. METHODS: Narrative group interviews and respondent photo diary exercises were conducted with families (n = 25) residing in different areas across metropolitan NSW, Australia. Guided by a social practice theoretical approach we undertook a thematic analysis that identifies reasons for choosing a cruise, health considerations and behaviours in relation to cruise travel and awareness of official cruise health information. RESULTS: Cruise travel included a licence to abandon cautious behaviours, reinforced by confidence in the cruise organiser's risk management ability. Health concerns were not a high priority for participants and were mainly understood in terms of eating healthy, modest exercise, managing seasickness and having adequate supplies of medications. Awareness of official cruise health and risk information was largely non-existent. CONCLUSION: Understanding how travel health practices emerge and are likely to be modifiable produces health-promoting awareness and intervention efforts that recognise and link with people's ideas about cruise holidays as times of fun, leisure, relaxation, without interfering with or imposing on them. SO WHAT?: This study highlights the importance of developing health communication and promotion strategies that are responsive to the interconnected meanings, competencies and materials that have a bearing on how cruise travellers understand and enact health-related behaviours in preparation for and during a cruise holiday.
Asunto(s)
COVID-19 , Pandemias , Humanos , Viaje , Vacaciones y Feriados , Conductas Relacionadas con la SaludRESUMEN
OBJECTIVE: To determine the source and extent of a locally acquired hepatitis E virus (HEV) infection outbreak. DESIGN, SETTING AND PARTICIPANTS: A cluster of notified cases of HEV infection linked to a single restaurant (X) was identified in May 2014. People with laboratory-confirmed HEV infection in New South Wales between January 2013 and December 2014 were interviewed about potential risk factors for HEV infection. Co-diners at restaurant X and patients with suspected but unexplained viral hepatitis were retrospectively tested. Foods eaten by the infected persons were compared with those of seronegative co-diners. HEV RNA detected in sera from infected persons was sequenced and genotyped. Implicated foods were traced back to their sources. MAIN OUTCOME MEASURES: Potential sources of infection, including overseas travel and foods eaten, and origin of implicated food products. RESULTS: In 55 serologically confirmed cases of HEV infection, 24 people had not travelled overseas during their incubation periods. Of the 24, 17 reported having eaten at restaurant X, 15 of whom could be interviewed. All reported consuming pork liver pâté, compared with only four of seven uninfected co-diners (P < 0.05). The other seven people with locally acquired infections each reported consuming a pork product during their incubation periods. HEV RNA was detected in 16 of the 24 cases; all were of genotype 3. Sequencing indicated greater than 99% homology among restaurant X isolates. HEV RNA was isolated from pork sausages from a batch implicated in one of the locally acquired infections not linked with restaurant X. The pork livers used for pâté preparation by restaurant X were traced to a single Australian farm. CONCLUSIONS: This is the first reported HEV outbreak in Australia. HEV should be considered in patients presenting with a compatible illness, even without a history of overseas travel. Pork products should be thoroughly cooked before consumption.
Asunto(s)
Hepatitis E/epidemiología , Adolescente , Adulto , Anciano , Australia/epidemiología , Niño , Preescolar , Análisis por Conglomerados , Brotes de Enfermedades , Femenino , Virus de la Hepatitis E/genética , Humanos , Masculino , Productos de la Carne , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , ARN Viral/análisis , Carne Roja , Restaurantes , Estudios Retrospectivos , Serotipificación , Adulto JovenRESUMEN
From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.
Asunto(s)
Brotes de Enfermedades , Parechovirus/genética , Infecciones por Picornaviridae/epidemiología , Monitoreo Epidemiológico , Femenino , Genes Virales , Genotipo , Humanos , Lactante , Recién Nacido , Masculino , Técnicas de Diagnóstico Molecular , Nueva Gales del Sur/epidemiología , Infecciones por Picornaviridae/diagnóstico , Infecciones por Picornaviridae/virologíaAsunto(s)
Brotes de Enfermedades , Fútbol Americano , Paperas/epidemiología , Fútbol Americano/fisiología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Paperas/diagnóstico , Paperas/inmunología , Paperas/prevención & control , Vacuna contra la Parotiditis , Nueva Gales del Sur/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the rate of HIV and tuberculosis co-infection and changes in HIV testing practices for patients with tuberculosis managed in South Eastern Sydney Local Health District (SESLHD), New South Wales, Australia. DESIGN, PARTICIPANTS AND SETTING: A retrospective review of tuberculosis notification data from four public tuberculosis treatment clinics in SESLHD (population, >800,000), 2008-2013. Data were extracted from the NSW Notifiable Conditions Information Management System. INTERVENTION: Published evidence regarding clinical management of HIV and tuberculosis co-infection and feedback of HIV testing rates was provided to senior clinicians managing tuberculosis in SESLHD between 2008 and 2012. MAIN OUTCOME MEASURES: Proportion of patients with tuberculosis with HIV infection status ascertained and proportion with HIV co-infection. RESULTS: Of 506 people with notified tuberculosis treated in SESLHD during the study period, 369 had their HIV status ascertained (72.9%), of whom 20 were HIV co-infected (5.4%). Eleven of these cases were new HIV diagnoses. Seven people offered an HIV test declined the offer. The rates of HIV co-infection varied between clinics (1.5%-9.7%; P=0.02) as did the rate of HIV status ascertainment (61.5%-85.4%; P<0.001). The rate of HIV status ascertainment increased between 2008 and 2013 (52.9%-87.1%; P<0.001). CONCLUSIONS: The rate of HIV co-infection among people treated for tuberculosis in south-eastern Sydney is of clinical importance. Rates of HIV testing in this population have increased, but further gains are desirable. It is unclear if the intervention influenced the increase in HIV testing rates.
Asunto(s)
Coinfección/diagnóstico , Infecciones por VIH/diagnóstico , Tuberculosis/virología , Coinfección/epidemiología , Notificación de Enfermedades/estadística & datos numéricos , Infecciones por VIH/epidemiología , Humanos , Pruebas Inmunológicas/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Nueva Gales del Sur/epidemiología , Estudios Retrospectivos , Tuberculosis/epidemiología , Tuberculosis/terapiaRESUMEN
Abstract: The standard practice of blood borne virus (BBV) follow-up in New South Wales is a passive approach of general-practitioner-led testing. The value of this approach is unknown. We undertook an active contact tracing method with the aims of investigating a potential hepatitis B source, along with accurately measuring the participation rate, to consider the value of this and other follow-up methods for future BBV investigations. Investigation of a newly-acquired hepatitis B infection was undertaken at a dental practice identified as a possible exposure site. To screen for hepatitis B infection among potential source or co-exposed clients, we actively followed up with staff and clients of the practice to request they undertake hepatitis B serology. Eligible staff and clients received up to four phone calls and were provided with a pathology request form by the public health unit (PHU). Access to free serology was offered to people who did not have access to Medicare. Reminder calls were made if serology results were not received by the PHU. As the ordering doctor, the public health physician was responsible for providing results and referring for follow-up care. Of 160 clients, 63 (39%) undertook hepatitis B serology. Of these 63, none were found to have hepatitis B infection. It was estimated the active investigation involved an extra 430 hours of PHU staff time at a cost in Australian dollars of $30,000. Active follow-up allows an accurate participation rate to be documented. Despite intense active follow-up, only 39% of clients undertook testing, bringing into question the yield of the usual approach in which active follow-up of potential mass BBV exposures is not undertaken. While active follow-up is resource intensive, it should be considered where the risks and consequences from the BBV infection are high.
Asunto(s)
Infecciones por VIH , Hepatitis B , Anciano , Humanos , Estudios de Seguimiento , Australia/epidemiología , Programas Nacionales de Salud , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Hepatitis B/prevención & controlRESUMEN
Background: Legionnaires' disease is a notifiable condition in New South Wales (NSW), Australia; clinicians and laboratories are required to report the disease to NSW Health. We describe the investigation of a sporadic case associated with the use of a communal spa pool in the case's apartment building complex and the use of whole genome sequencing to examine relatedness between clinical and environmental Legionella pneumophila serogroup 1 (Lp1) strains. Methods: In February 2018, a confirmed case of Lp1 infection was notified in a man in his 60s hospitalised with pneumonia. We asked the clinical team to obtain sputum in the event we found a potential source. The case described the use of the communal spa pool in his apartment building on two occasions during the putative exposure period. Environmental Health Officers from the Public Health Unit inspected the spa pool and found that the free chlorine level was well below the recommended concentration; a water sample was submitted for microbial analysis. Results: Lp1 was grown from the case's sputum and microbial analysis of the spa water sample found Lp1 at a concentration of 20 CFU/mL. The human and environmental isolates were subjected to whole genome sequencing and found to be highly genomically related. There was no other plausible environmental source of legionella. Conclusions: Whole genome sequencing of the clinical and environmental Lp1 isolates implicated a contaminated spa pool as the source of the case's exposure. This strongly supports the application of whole genome sequencing to the investigation of single cases of legionellosis. Communal spa pools in apartment buildings are not regulated in most Australian jurisdictions but must be considered to pose a potential legionella risk if improperly maintained.
Asunto(s)
Legionella pneumophila , Enfermedad de los Legionarios , Humanos , Masculino , Australia/epidemiología , Brotes de Enfermedades , Legionella pneumophila/genética , Enfermedad de los Legionarios/diagnóstico , Enfermedad de los Legionarios/epidemiología , Serogrupo , Agua , Persona de Mediana EdadRESUMEN
The incidence of enterovirus D68 (EV-D68) in New South Wales, Australia, is unknown. As part of a state-wide surveillance program, enterovirus positive diagnostic specimens were assessed from patients presenting to hospitals with respiratory and meningitis syndromes from August 2018 to November 2019. Diagnostic enterovirus positive samples were collected from 339 patients and re-extracted followed by targeted PCR across the whole EV-D68 genome (7.4 kb). Obtained amplicons (n=208) were sequenced using Illumina sequencing technology and the phylogenetic relationships analysed relative to EV-D68 Fermon strain. We identified EV-D68 in 31 patients, both children (n=27) and adults (n=4). Phylogenetically, the majority (n=30) were from subclade B3, the same as that causing outbreaks of EV-D68 across the USA and Europe during 2018. These data strengthen the importance of having an active enterovirus surveillance network.
Asunto(s)
Enterovirus Humano D , Infecciones por Enterovirus , Infecciones del Sistema Respiratorio , Adulto , Niño , Brotes de Enfermedades , Enterovirus Humano D/genética , Infecciones por Enterovirus/diagnóstico , Infecciones por Enterovirus/epidemiología , Humanos , Lactante , Nueva Gales del Sur/epidemiología , Filogenia , Infecciones del Sistema Respiratorio/epidemiologíaRESUMEN
AIM: The aims of this study were to determine the level of knowledge among child-care centre directors regarding the National Health and Medical Research Council (NHMRC) recommendations for the immunisation of child-care workers, the extent to which this knowledge was translated into practice and any organisational barriers to the development and implementation of staff immunisation policy. METHODS: A cross-sectional survey, conducted in August 2006, in which a postal questionnaire was sent to a random sample of 784 NSW child-care centres. Centre directors were asked to complete the questionnaire on immunisation knowledge, policy and practice for the centre. A multivariate logistic-regression model was used to identify factors independently associated with centres with an immunisation policy for staff and centres that offered to pay all or part of the cost of vaccination of staff. RESULTS: Directors from 437 centres participated in the study for a response rate of 56%. Of these, 49% were aware of the NHMRC recommendations, and 57% had a staff immunisation policy in place. In the logistic regression model, centres with a written immunisation policy for staff were more likely to be aware of the NHMRC guidelines and offer long day care services. Centres that offered to pay all or part of the cost of immunisation for staff were more likely to be aware of the NHMRC guidelines, offer other child-care services and not operate for profit. Barriers to staff immunisation were related to the implementation of policy and included cost, time and access to information. CONCLUSIONS: The level of awareness of specific staff immunisation recommendations was relatively low. The transition of knowledge to policy was encouraging, although implementation of policies requires further commitment.
Asunto(s)
Guarderías Infantiles/organización & administración , Control de Enfermedades Transmisibles/métodos , Conocimientos, Actitudes y Práctica en Salud , Enfermedades Profesionales/prevención & control , Vacunación/psicología , Vacunación/estadística & datos numéricos , Niño , Cuidado del Niño , Guarderías Infantiles/estadística & datos numéricos , Preescolar , Control de Enfermedades Transmisibles/estadística & datos numéricos , Estudios Transversales , Adhesión a Directriz , Política de Salud , Humanos , Inmunización/psicología , Inmunización/estadística & datos numéricos , Modelos Logísticos , Nueva Gales del Sur , Guías de Práctica Clínica como Asunto , Encuestas y CuestionariosRESUMEN
An outbreak of gastrointestinal illness was identified among attendees at a large community barbeque at a Sydney sports club on 30 January 2009. A retrospective cohort study was initiated, and attendees were identified through hospital emergency department gastroenteritis presentations, snowball recruitment through known cases, responders to linguistically specific press, and those returning to the venue the next week. A symptom and food history was collected from attendees, and stool samples were provided for microbiological investigation. An environmental investigation and trace back of implicated foods was also undertaken. Attendance estimates at the barbeque ranged from 100 to 180, and the food was prepared by a family that was not registered as a food business. Seventy one of the 87 attendees identified met the case definition. Thirty attendees (42%) had laboratory confirmed Salmonella Typhimurium phage-type 108/170, all with the same multilocus variable number of tandem repeat analysis typing. Burden of illness was high with 76% of cases seeking medical attention and 18% admitted to hospital. Microbiological evidence confirmed that a number of food items were contaminated with Salmonella Typhimurium 108/170, with the raw egg mayonnaise used in a Russian salad being the most likely primary food vehicle (adjusted odds ratio=10.3 [95% confidence interval 1.79-59.5]). Further, having Russian salad on the plate even if it was not consumed increased the relative risk of illness, thus suggesting that other food items may have been contaminated when they came into contact with it on the plate. This Salmonella outbreak highlighted the risks associated with the improper handling of food in private residences, which are then sold at a large public event.
Asunto(s)
Brotes de Enfermedades , Microbiología de Alimentos , Gastroenteritis/epidemiología , Intoxicación Alimentaria por Salmonella/epidemiología , Salmonella typhimurium/aislamiento & purificación , Adolescente , Adulto , Anciano de 80 o más Años , Tipificación de Bacteriófagos , Niño , Preescolar , Estudios de Cohortes , Intervalos de Confianza , Huevos/microbiología , Heces/microbiología , Femenino , Contaminación de Alimentos , Gastroenteritis/microbiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Oportunidad Relativa , Estudios Retrospectivos , Intoxicación Alimentaria por Salmonella/microbiología , Adulto JovenRESUMEN
INTRODUCTION: A record number of influenza outbreaks in aged care facilities (ACFs) in New South Wales (NSW) during 2017 provided an opportunity to measure the health impact of those outbreaks and assess the quality of routinely available surveillance data. METHODS: Data for all ACF influenza outbreaks in NSW in 2017 were extracted from the Notifiable Conditions Information Management System. The numbers of outbreaks, residents with influenza-like illness (ILI), hospital admissions and deaths were assessed. For each outbreak the attack rate; duration; timeliness of notification; resident and staff influenza vaccination coverage; and antiviral use for treatment or prophylaxis were analysed. Data were considered for NSW in total and separately for seven of the state's local health districts. Data completeness was assessed for all available variables. RESULTS: A total of 538 ACF outbreaks resulted in 7,613 residents with ILI, 793 hospitalisations and 338 deaths. NSW outbreaks had a median attack rate of 17% and median duration of eight days. Data completeness, which varied considerably between districts, limited the capacity to accurately consider some important epidemiological and policy issues. DISCUSSION: Influenza outbreaks impose a major burden on the residents and staff of ACFs. Accurate assessment of the year-to-year incidence and severity of influenza outbreaks in these facilities is important for monitoring the effectiveness of outbreak prevention and management strategies. Some key data were incomplete and strategies to improve the quality of these data are needed, particularly for: the number of influenza-related deaths among residents; resident and staff vaccination coverage prior to outbreaks; and recorded use of antiviral prophylaxis.
Asunto(s)
Gripe Humana , Anciano , Antivirales , Australia/epidemiología , Brotes de Enfermedades , Humanos , Gripe Humana/tratamiento farmacológico , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Nueva Gales del Sur/epidemiologíaRESUMEN
OBJECTIVES: To describe local operational aspects of the coronavirus disease 2019 (COVID-19) response during the first three waves of outbreaks in New South Wales (NSW), Australia, which began in January, July and December 2020. Type of program or service: Public health outbreak response. METHODS: Narrative with epidemiological linking and genomic testing. RESULTS: Epidemiological linking and genomic testing found that during the first wave of COVID-19 in NSW, a large number of community transmissions went undetected because of limited testing for the virus and limited contact tracing of cases. The second wave of COVID-19 in NSW emerged following reintroduction from the second wave in Victoria, Australia in July 2020, and the third wave followed undetected introduction from overseas. By the second and third waves, cases could be more effectively detected and isolated through an increased ability to test and contact trace, and to rapidly genomic sequence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolates, allowing most cases to be identified and epidemiologically linked. This greater certainty in understanding chains of transmission resulted in control of the outbreaks despite less stringent restrictions on the community, by using a refined strategy of targeted shutdown, restrictions on cases, their close contacts, identified hotspots and venues of concern rather than a whole of community lockdown. Risk assessments of potential transmission sites were constantly updated through our evolving experience with transmission events. However, this refined strategy did leave the potential for large point source outbreaks should any cases go undetected. [Addendum] A fourth wave that began in Sydney in June 2021 challenged this strategy due to the more transmissible nature of the Delta variant of SARS-CoV-2. LESSONS LEARNT: A wave of COVID-19 infections can develop quickly from one infected person. The community needs to remain vigilant, adhering to physical distancing measures, signing in to venues they visit, and getting tested if they have any symptoms. Signing out of venues on exit allows public health resources to be used more efficiently to respond to outbreaks.
Asunto(s)
COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , Prueba de COVID-19/métodos , Niño , Preescolar , Control de Enfermedades Transmisibles/organización & administración , Trazado de Contacto/métodos , Brotes de Enfermedades/prevención & control , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Distanciamiento Físico , Salud Pública , Cuarentena/métodos , SARS-CoV-2/aislamiento & purificación , Victoria/epidemiología , Adulto JovenRESUMEN
Objective New South Wales (NSW) experienced a severe influenza season in 2017. In 2018, NSW Health implemented a campaign to improve healthcare worker (HCW) influenza vaccination coverage. The South Eastern Sydney Local Health District (LHD) trialled a centralised online database to monitor HCW uptake of the vaccination. This paper outlines how the monitoring system was chosen and developed, the process of implementation and the effectiveness of the system in this setting. Methods A literature review was conducted to identify an appropriate database. Stakeholder working groups took place across the LHD regarding implementation. An online vaccination consent form was developed and installed on the LHD network within 2 weeks. Administrative staff ensured timely entry of HCW data and vaccination status and analysis of uptake using Microsoft Excel. Results REDCap (Vanderbilt University, Nashville, TN, USA) was identified as the most appropriate web-based platform based on the ease of developing a secure and inexpensive data collection tool in a short time period. In all, 10064 employees were recorded in REDCap as having received the influenza vaccine. Customised REDCap reports allowed managers to follow up staff yet to receive their vaccination, which resulted in further vaccinations. Conclusions REDCap was successfully used as a data collection tool to track the influenza vaccination rates of staff. The data assisted the District Workforce Services in ensuring that facilities complied with NSW Health policy. This study highlights how REDCap may be used by similar organisations to monitor influenza vaccination of HCWs. What is known about the topic? There is increasing recognition of the need to ensure high-quality monitoring of HCW influenza vaccination rates, yet coverage is often difficult to measure accurately due to a lack of centralised reporting and monitoring systems. What does this paper add? This paper outlines how a computerised database (REDCap) was used by a NSW Health jurisdiction to monitor a vaccination program. REDCap is an inexpensive and easy to use system that allowed public health authorities rapid analysis of HCW vaccination coverage rates. What are the implications for practitioners? The findings add to the growing body of evidence demonstrating the utility of online systems for monitoring HCW influenza vaccinations. These results will be relevant to healthcare organisations and public health practitioners seeking quick and feasible research and data collection platforms.
Asunto(s)
Vacunas contra la Influenza , Gripe Humana , Personal de Salud , Humanos , Gripe Humana/prevención & control , Nueva Gales del Sur , Vacunación , Cobertura de VacunaciónRESUMEN
BACKGROUND: Syndromic surveillance is increasingly being evaluated for its potential for early warning of increased disease activity in the population. However, interpretation is hampered by the difficulty of attributing a causative pathogen. We described the temporal relationship between laboratory counts of influenza and respiratory syncytial virus (RSV) detection and alternative groupings of Emergency Department (ED) respiratory diagnoses. METHODS: ED and laboratory data were obtained for the south-eastern area of Sydney, NSW for the period 1 June 2001 - 1 December 2006. Counts of ED visits and laboratory confirmed positive RSV and influenza cases were aggregated by week. Semi-parametric generalized additive models (GAM) were used to determine the association between the incidence of RSV and influenza and the incidence of respiratory syndrome ED presentations while controlling for temporal confounders. RESULTS: For every additional RSV laboratory count, ED diagnoses of bronchiolitis increased by 3.1% (95%CI: 2.7%-3.5%) in the same week. For every additional influenza laboratory count, ED diagnoses of influenza-like illness increased by 4.7% (95%CI: 4.2%-5.2%) one week earlier. CONCLUSION: In this study, large increases in ED diagnoses of bronchiolitis and influenza-like illness were independent and proxy indicators for RSV and influenza activity, respectively.