The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study.

BACKGROUND: Legionnaires' disease is under-diagnosed because of inconsistent use of diagnostic tests and uncertainty about whom to test. We assessed the increase in case detection following large-scale introduction of routine PCR testing of respiratory specimens in New Zealand. METHODS: LegiNZ was a national surveillance study done over 1-year in which active case-finding was used to maximise the identification of cases of Legionnaires' disease in hospitals. Respiratory specimens from patients of any age with pneumonia, who could provide an eligible lower respiratory specimen, admitted to one of 20 participating hospitals, covering a catchment area of 96% of New Zealand's population, were routinely tested for legionella by PCR. Additional cases of Legionnaires' disease in hospital were identified through mandatory notification. FINDINGS: Between May 21, 2015, and May 20, 2016, 5622 eligible specimens from 4862 patients were tested by PCR. From these, 197 cases of Legionnaires' disease were detected. An additional 41 cases were identified from notification data, giving 238 cases requiring hospitalisation. The overall incidence of Legionnaires' disease cases in hospital in the study area was 5·4 per 100 000 people per year, and Legionella longbeachae was the predominant cause, found in 150 (63%) of 238 cases. INTERPRETATION: The rate of notified disease during the study period was three-times the average over the preceding 3 years. Active case-finding through systematic PCR testing better clarified the regional epidemiology of Legionnaires' disease and uncovered an otherwise hidden burden of disease. These data inform local Legionnaires' disease testing strategies, allow targeted antibiotic therapy, and help identify outbreaks and effective prevention strategies. The same approach might have similar benefits if applied elsewhere in the world. FUNDING: Health Research Council of New Zealand.

Costs of investigating and managing non-residents with possible tuberculosis: New Zealand experience of an international problem.

BACKGROUND AND OBJECTIVE: This study's aims were to identify the diagnoses, the public hospital costs and payments for non-New Zealand (non-NZ) patients referred because of possible tuberculosis (TB). There have been no previous financial studies in this area. Funding arrangements for these patients were also reviewed. METHODS: A systematic, retrospective review was performed to identify the costs of investigating and managing non-NZ patients referred to the adult TB unit of a large, teaching hospital in Auckland, NZ. Patients were enrolled between 1 July 2002 and 30 June 2003. RESULTS: Forty-five non-NZ patients were studied. The mean age was 33.8 (+/-13.4) years. Thirty-four (75.5%) were managed under compulsion through Section 9 of the NZ TB Act. Thirty-two (71%) patients received TB treatment: 11 (24%) had infectious pulmonary TB and four had active extra-pulmonary TB. There were no multi-drug-resistant isolates. Three TB cases accounted for 250 (39%) inpatient days. One patient with rifampicin-resistant TB was responsible for 117 (29%) day-patient ward visits. Four (13%) infectious TB cases were managed as inpatients for more than 6 weeks. The total cost of services (US dollars) for the 45 patients was 350,236 dollars. The cost range was 544-43,513 dollars per patient. Four patients incurred costs over 25,000 dollars. CONCLUSIONS: TB in non-residents is a costly problem in NZ. Current policy applying to this area and the ability to determine its cost-effectiveness are in need of review.