Prevalence of chronic disease risk factors in 35- to 44-year-old humanitarian arrivals to New South Wales (NSW), Australia.

The aim of this study is to compare the prevalence of chronic disease risk factors in humanitarian arrivals to Sydney, New South Wales (NSW) with the Australian Indigenous and non-Indigenous populations aged 35-44 years. Data on risk factors collected from 237 refugees presenting to the NSW Refugee Health Service (RHS) from January 2015 to August 2016 were retrospectively analysed and compared with data from the Australian Health Surveys, 2011-13 for the Indigenous and non-Indigenous Australian populations. This study found significantly higher levels of triglycerides (z=3; 95% CI, 0.16-0.26); hypertension (z=3.2; 95% CI, 0.17-0.29); and smoking (z=3.5; 95% CI, 0.27-0.33) in refugees compared with the general Australian population. The Indigenous population had significantly higher levels of triglycerides (z=4; 95% CI, 0.16-0.26); body mass indexes (BMIs) (z=3.3; 95% CI 0.58-0.72); and smoking (z=5.4; 95 CI 0.27-0.33) compared with refugees. Based on the study findings, screening for chronic disease risk factors from age 35 years may be warranted in all humanitarian arrivals to Australia, along with dietary and lifestyle advice.

Peeled off water chestnut in the knee.

Fibroma of tendon sheaths (FTS) is an uncommon soft tissue tumour which arises from the synovial sheath of tendons. We report a histologically proven case with intrarticular 'fibroma of tendon sheath' originating from the joint capsule of the knee, an even rarer entity, in a middle-aged female presenting with knee pain, swelling with limited range of motion. MRI and arthroscopy studies revealed an intra-articular mass originating from the synovial membrane with lobulated contours. Open excision was performed because of the large size of the mass, making it inaccessible arthroscopically. The patient is symptom free since the surgery done 15 months back.

Effectiveness of maternal pertussis vaccination in preventing infection and disease in infants: The NSW Public Health Network case-control study.

BACKGROUND: Infants are at the highest risk of severe complications - including death - as a result of pertussis infection. Controlling pertussis in this group has been challenging, particularly in those too young to be vaccinated. Following revised national recommendations in March 2015, the state of New South Wales, Australia, introduced a funded maternal vaccination campaign at 28 - 32 weeks of gestation using a 3-component tetanus-diphtheria-acellular pertussis vaccine (dTpa; Boostrix, GSK). This study aimed to assess the effectiveness of maternal vaccination and add to the growing body of evidence for this strategy. METHODS: A 1:1 matched case-control study was conducted between 16 August 2015 and 17 August 2016. Cases were laboratory or doctor notified, laboratory confirmed (nucleic acid testing or culture) and aged <6 months at onset. Each control infant was randomly selected from public hospital births in the same geographical area in the period up to 3 days before and after the case's birthdate. Odds ratios (OR) were calculated using conditional logistic regression. Vaccine effectiveness (VE) was calculated as 1 - OR. FINDINGS: In total, 117 cases and 117 controls were recruited. The overall VE estimate was non-significantly protective for infants <6 months old (VE 39%, 95% CI -12 to 66%). Higher VE was observed for infants <3 months old (VE 69%, 95% CI 13-89%) and against hospitalisation (VE 94%, 95% CI 59-99%). INTERPRETATION: Maternal pertussis vaccination with a 3-component acellular vaccine was found to be highly effective at preventing severe disease in infants, but was less effective at preventing disease which did not require hospitalisation. The overall VE reported in this study was lower than in prior studies and suggests that maternal vaccination, while an effective strategy at preventing severe pertussis, is less effective at protecting against infection or mild disease.

A Salmonella Typhimurium outbreak linked to Vietnamese bread rolls in South Western Sydney, Australia, 2015.

INTRODUCTION: In September 2015, the South Western Sydney (SWS) Public Health Unit was notified of a cluster of Salmonella Typhimurium (STm) cases with a common multiple-locus variable-number tandem repeats analysis (MLVA) pattern. An investigation was conducted to identify a source and contain the outbreak. METHODS: The cluster was initially identified through routine geographic information system cluster scanning applied to the New South Wales Notifiable Conditions Management System. Additional cases were identified through a complaint to local council about a bakery. The bakery was inspected and 48 environmental and food swabs were collected for analysis. RESULTS: A total of 26 suspected cases were identified, of which 14 were interviewed. STm MLVA type 3-16-9-11-523 was identified in 19 of 26 case stool specimens. Most cases (12/14) consumed bread rolls containing pork or chicken with chicken liver pâté and raw egg mayonnaise filling. Five cases identified a common bakery exposure. Environmental and food samples from the bakery isolated STm with an identical MLVA pattern. DISCUSSION: An STm cluster in SWS was investigated and found to be linked to Vietnamese bread rolls containing pork or chicken with chicken liver pâté and raw egg mayonnaise filling. Confirmation of a distinct MLVA pattern among STm isolates from clinical, food and environmental samples provided evidence to establish an epidemiological link between the cases and the implicated premises and informed public health action to contain the outbreak.

A Q fever cluster among workers at an abattoir in south-western Sydney, Australia, 2015.

BACKGROUND: In September 2015, the Public Health Unit of the South Western Sydney Local Health District was notified of two possible Q fever cases. Case investigation identified that both cases were employed at an abattoir, and both cases advised that co-workers had experienced similar symptoms. Public Health Unit staff also recalled interviewing in late 2014 at least one other Q fever case who worked at the same abattoir. This prompted an outbreak investigation. METHODS: The investigation incorporated active case finding, microbiological analysis, field investigation and a risk factor survey. Included cases were laboratory definitive or suspected cases occurring from October 2014 to October 2015, residing or working in south-western Sydney. A suspected case had clinically compatible illness, high-risk exposure and was epidemiologically linked to another confirmed case. A confirmed case included laboratory detection of C. burnetti. RESULTS: Eight cases met the case definition with seven confirmed (including a deceased case) and one suspected. The eight cases were all males who had been employed at an abattoir in south-western Sydney during their incubation period; symptom onset dates ranged from November 2014 to September 2015. Field investigation identified multiple potential risk factors at the abattoir, and the majority (75%) of employees were not vaccinated against Q fever despite this high-risk setting. CONCLUSION: This cluster of Q fever in a single abattoir confirms the significance of this zoonotic disease as an occupational hazard among persons working in high-risk environments. Implementation of Q fever vaccination programmes should eliminate Q fever in high-risk occupational settings.

Screen time of infants in Sydney, Australia: a birth cohort study.

OBJECTIVES: To determine the amount of daily screen time in children 18 months of age and ascertain correlations that may be contributing to excessive screen use. DESIGN: A birth cohort was followed with telephone interviews at 6, 12 and 18 months of age. Information about screen time was collected at 18 months. SETTING: Parents were recruited from postnatal wards of 2 major public hospitals and at home visits conducted for new mothers within 4 weeks of birth in South Western Sydney (SWS). PARTICIPANTS: Parents of 500 children with infants 18 months of age residing in SWS. PRIMARY AND SECONDARY OUTCOMES: Screen time in infants 18 months of age and associated correlations. RESULTS: A large percentage of children 18 months of age (40%) had screen times >2 hours daily. There were significant associations between more than 2 hours of screen time daily and mothers without a partner (OR 4.32 (95% CI 1.67 to 11.15)); having <3 siblings (no siblings: OR 2.44 (95% CI 1.20 to 4.94); 1-2 siblings: OR 2.08 (95% CI 1.06 to 4.08)); an employed father (OR 1.96 (95% CI 1.09 to 3.52)); no outdoor equipment at home (OR 1.89 (95% CI 1.08 to 3.34)) and fewer than 5 outings per week (OR 2.08 (95% CI 1.37 to 3.17)). CONCLUSIONS: There is emerging evidence that excess screen time in children causes adverse cognitive, developmental and health outcomes. This study has shown that a large proportion of very young children residing in SWS have screen exposures for >2 hours per day. Factors contributing to excess screen time have also been identified in this study; however, a greater understanding of risk factors needs to be ascertained in order to facilitate greater public health efforts to reduce screen exposure.