The re-emergence of influenza following the COVID-19 pandemic in Victoria, Australia, 2021 to 2022.

BackgroundCOVID-19 pandemic mitigation measures, including travel restrictions, limited global circulation of influenza viruses. In Australia, travel bans for non-residents and quarantine requirements for returned travellers were eased in November 2021, providing pathways for influenza viruses to be re-introduced.AimWe aimed to describe the epidemiological and virological characteristics of the re-emergence of influenza in Victoria, Australia to inform public health interventions.MethodsFrom 1 November 2021 to 30 April 2022, we conducted an epidemiological study analysing case notification data from the Victorian Department of Health to describe case demographics, interviewed the first 200 cases to establish probable routes of virus reintroduction and examined phylogenetic and antigenic data to understand virus diversity and susceptibility to current vaccines.ResultsOverall, 1,598 notifications and 1,064 positive specimens were analysed. The majority of cases (61.4%) occurred in the 15-34 years age group. Interviews revealed a higher incidence of international travel exposure during the first month of case detections, and high levels of transmission in university residential colleges were associated with return to campus. Influenza A(H3N2) was the predominant subtype, with a single lineage predominating despite multiple importations.ConclusionEnhanced testing for respiratory viruses during the COVID-19 pandemic provided a more complete picture of influenza virus transmission compared with previous seasons. Returned international travellers were important drivers of influenza reemergence, as were young adults, a group whose role has previously been under-recognised in the establishment of seasonal influenza epidemics. Targeting interventions, including vaccination, to these groups could reduce future influenza transmission.

Surveying the changing climate of Northern Territory medical workforce retention.

INTRODUCTION: Low retention is a significant contributor to medical workforce shortages in rural and remote regions of Australia, including in the Northern Territory (NT). Many of these areas are susceptible to climate change, which could exacerbate workforce retention problems. OBJECTIVE: To examine factors influencing medical workforce retention in the NT, including the potential impact of climate change. DESIGN: Cross sectional online survey of NT medical professionals, distributed via email through professional networks. Predominantly quantitative mixed methods (descriptive statistics, multivariate logistic regression, thematic analysis). Main 2 outcome measures reported were proportion of respondents intending to leave the NT, timeframe of intention to leave and motivating factors. FINDINGS: Of 1407 registered practising medical professionals in the NT, 362 responded who met inclusion criteria (26% estimated response rate) and 351 completed all questions. Of the latter, 143 (41%) intended to leave the NT, 102 (29%) were unsure, and 106 (30%) did not intend to leave. Among doctors in training (DITs) 67 (55%) intended to leave and 29 (24%) were unsure. The best multivariable predictive model included only practice type (with general practitioners/rural generalists and non-GP specialists significantly less likely to intend to leave compared to DITs), and location of primary medical degree (with non-NT training non-significantly associated with greater intention to leave). Of those intending to leave 94 (66%) reported planning to do so within two years. Training and career development opportunities, job dissatisfaction, moving to a preferred location and family-related factors were all important motivators. Of those considering leaving, 58 (24%) identified climate change as a motivating factor. CONCLUSION: Retention remains a key challenge in addressing rural workforce shortages. In addition to established factors, climate change is an important driver that has the potential to worsen workforce shortages in susceptible regions.

Impacts of extreme weather on the health and well-being of people who are homeless.

This letter responds to the article by Cusack et al., 'Extreme weather-related health needs of people who are homeless' (Australian Journal of Primary Health, 2013, 19(3), 250-255), which addressed the impacts of extreme weather on the health of the homeless population in inner city Adelaide. We compare the findings of Cusack et al. to our own original research, based on interviews with service providers to the homeless in urban and rural Victoria. We further place this issue in the broader context of climate change, which is crucial given the expected increase in extreme weather events and associated health impacts.

Estimates of Seasonal Influenza Burden That Could Be Averted by Improved Influenza Vaccines in the Australian Population Aged Under 65 Years, 2015-2019.

BACKGROUND: The interpretation of relative vaccine effectiveness (rVE) of improved influenza vaccines is complex. Estimation of burden averted is useful to contextualise their potential impact across different seasons. For the population aged under 65 years in Australia, this study estimated the additional morbidity and mortality that could be averted using improved influenza vaccines. METHODS: We used observed, season-specific (2015-2019) influenza notification and influenza-coded hospitalisation frequencies and published modelled estimates of influenza-associated hospitalisations and deaths that occurred under the prevailing influenza vaccination coverage scenario. After back-calculating to the estimated burden in the population without vaccination, we applied published standard influenza vaccine effectiveness and coverage estimates to calculate the burden potentially averted by standard and improved influenza vaccines. A plausible range of rVE values were used, assuming 50% coverage. RESULTS: The percentage point difference in absolute vaccine effectiveness (VE) of an improved vaccine compared to a standard vaccine is directly proportional to its rVE and inversely proportional to the effectiveness of the standard vaccine. The incremental burden averted by an improved vaccine is a function of both its difference in absolute VE and the severity of the influenza season. Assuming an rVE of 15% with 50% coverage, the improved vaccine was estimated to additionally avert 1517 to 12,641 influenza notifications, 287 to 1311 influenza-coded hospitalisations and 9 to 33 modelled all-cause influenza deaths per year compared to the standard vaccine. CONCLUSIONS: Improved vaccines can have substantial clinical and population impact, particularly when the effectiveness of standard vaccines is low, and burden is high.

Japanese encephalitis clinical update: Changing diseases under a changing climate.

BACKGROUND: Japanese encephalitis virus (JEV) is a mosquito-borne arbovirus endemic to the Asia-Pacific that causes high morbidity and mortality in those who develop symptomatic disease. Prior to 2021, only five locally acquired cases had been detected in Australia, all in northern Australia. Following a sentinel case in 2021, widespread dissemination of JEV was detected in northern and south-eastern Australia, accompanied by an increase in locally acquired cases, which have been detected as far south as Victoria. This expansion has occurred in the setting of warmer and wetter conditions under the influence of climate change. OBJECTIVE: To provide Australian general practitioners (GPs) an overview of JEV, given its recent expansion, and the potential for sustained endemicity. DISCUSSION: As the distribution of JEV expands under the influence of climate change, Australian GPs need to be familiar with this condition, especially those practicing in rural areas and where detections have occurred.

General practice in the era of planetary health: Responding to the climate health emergency.

BACKGROUND: It has been a decade since a landmark Lancet publication declared that 'climate change is the biggest global health threat of the 21st century'. Since then, Australia has experienced unprecedented warming related to climate change and an associated increase in the frequency and intensity of extreme weather events, including heatwaves, droughts, storms, bushfires and air pollution. These events have had major impacts on community physical and mental health. OBJECTIVE: The aim of this article is to describe the health impacts of climate change and the role of general practitioners (GPs) in responding to these impacts. DISCUSSION: While the clinical skills that underpin general practice have not changed, the environmental and planetary context has shifted. A 'planetary health' approach is required. Climate change should now be considered a health emergency. GPs have a critical role in mitigation and adaptation. Responding to climate change aligns with principles of preventive health and can produce 'co-benefits' for individual and population health.