Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives.

In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country via application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.

Tuberculosis patients' knowledge and beliefs about tuberculosis: a mixed methods study from the Pacific Island nation of Vanuatu.

BACKGROUND: The setting for this study was the Pacific island nation of Vanuatu, an archipelago of 82 islands, located in the South Pacific Ocean. Our objective was to assess the knowledge, attitudes and practices of tuberculosis (TB) patients towards TB. METHODS: This was a descriptive study using qualitative and quantitative methods. Quantitative analysis was based on the responses provided to closed questions, and we present frequencies to describe the TB patients' knowledge, attitudes and practice relating to TB. Qualitative analysis was based on open questions permitting fuller explanations. We used thematic analysis and developed a posteriori inductive categories to draw conclusions. RESULTS: Thirty five TB patients were interviewed; 22 (63%) were male. They attributed TB to cigarettes, kava, alcohol, contaminated food, sharing eating utensils and "kastom" (the local term for the traditional way of life, but also for sorcery). Most (94%) did not attribute TB to a bacterial cause. However, almost all TB patients (89%) thought that TB was best treated at a hospital with antibiotics. Three quarters (74%) experienced stigma after their TB diagnosis. Seeking health care from a traditional healer was common; 54% of TB patients stated that they would first consult a traditional healer for any illness. When seeking a diagnosis for signs and symptoms of TB, 34% first consulted a traditional healer. Patients cited cost, distance and beliefs about TB causation as reasons for first consulting a traditional healer or going to the hospital. Of the TB patients who consulted a traditional healer first, there was an average of two weeks delay before they consulted the health service. In some cases, however, the delay was up to six years. CONCLUSION: The majority of the TB patients interviewed did not attribute TB to a bacterial cause. Consulting a traditional healer for health care, including while seeking a diagnosis for TB symptoms, was common and may have delayed diagnosis. People require better information about TB to correct commonly held misperceptions about the disease. Traditional healers could also be engaged with the national TB programme, in order to refer people with signs and symptoms of TB to the nearest health service.

Evaluation of three population health capacity building projects delivered by videoconferencing in NSW.

UNLABELLED: Three population health projects in falls prevention, smoking cessation and refugee health secured funding through the NSW Telehealth Initiative. All were capacity building projects delivered through live videoconferencing sessions between April and August 2007. Videoconferencing as a mode of delivery was evaluated from the perspective of those who delivered the projects. METHOD: Qualitative semi-structured interviews with 12 key informants explored for each project: the organisation and delivery of the education sessions; the utility of videoconferencing for delivering training programs; and the perceived potential to apply videoconferencing to other functions. RESULTS: The projects were all delivered successfully through live videoconferencing. The main benefits observed were: the ability to deliver training to large numbers of people across multiple locations within a relatively short time and for reasonable costs; and the ability to improve access to high quality professional development for rural and remote workers. Technical difficulties were minor. The support required for these kinds of e-learning projects to succeed were identified. CONCLUSION: The evaluation confirmed the value of videoconferencing as a vehicle through which equity of access to learning opportunities for population health workers across NSW can be achieved.

The evaluation of web-based data collection for enhanced surveillance of cryptosporidiosis.

Following an increase in the number of people diagnosed with cryptosporidiosis in November 2005, the Communicable Diseases Branch initiated enhanced surveillance using a developmental version of NetEpi Collection, an open-source, web-based data collection tool. We evaluated the usefulness of NetEpi Collection for enhanced surveillance, using the Centers for Disease Control and Prevention's Updated Guidelines for Evaluating Public Health Surveillance Systems as a guide. Most staff (73 per cent) who used NetEpi Collection found it easy to use. Although ongoing support was thought to be adequate by 82 per cent of respondents who used NetEpi Collection, 36 per cent reported that training was limited and 27 per cent reported technical problems such as internet, server and password problems. In order to improve its usefulness in enhanced surveillance, training in NetEpi Collection should be enhanced and the stability of the system improved.

EPIREVIEW. Pertussis in New South Wales, 1993-2005: the impact of vaccination policy on pertussis epidemiology.

OBJECTIVE: To assess whether changes in vaccination policy have affected the epidemiology of pertussis in NSW between 1993 and 2005. METHODS: Surveillance data from the NSW Notifiable Diseases Database was reviewed for the period. RESULTS: 35,695 cases of pertussis were notified; annual incidence rates varied from 18.4 to 84.2 per 100,000 people. The highest rates of pertussis were consistently found in infants aged 0-6 months. Rates of disease in other age groups changed markedly over the study period, with high rates currently observed in adult age groups. CONCLUSIONS: New strategies may be needed to control pertussis in infants and in adults who now comprise the largest proportion of cases.

Birth outcomes for Australian mother-infant pairs who received an influenza vaccine during pregnancy, 2012-2014: The FluMum study.

INTRODUCTION: In Australia, influenza vaccination is recommended for all women who will be pregnant during the influenza season. Vaccine safety and effectiveness are key concerns and influencers of uptake for both vaccine providers and families. We assessed the safety of receiving an influenza vaccination during any trimester of pregnancy with respect to preterm births and infant birthweight. METHODS: We conducted a nested retrospective cohort study of 'FluMum' participants (2012-2014). Our primary exposure of interest was influenza vaccination during pregnancy. The primary outcomes of interest were infant birthweight and weeks' gestation at birth for live singleton infants. Analyses included comparisons of these birth outcomes by vaccination status and trimester of pregnancy an influenza vaccine was given. We calculated means, proportions, and relative risks and performed multivariable logistic regression for potential confounding factors. RESULTS: In the 7126 mother-infant pairs enrolled in this study, mean maternal age at infant birth was 31.7years. Influenza vaccine uptake in pregnancy was 34%. Most mothers with a known date of vaccination received a vaccine in the second trimester (51%). Those mothers with a co-morbidity or risk factor were 13% more likely to have influenza vaccine during pregnancy compared to other mothers (RR 1.13, 95% CI 1.04-1.24, p=0.007). Mean weeks' gestation at birth was 38.7 for the vaccinated and 38.8 for the unvaccinated group (p=0.051). Infants in the vaccinated group weighed 15g less in birthweight compared to the unvaccinated infants (95% CI -12.8 to 42.2, p=0.29). CONCLUSION: Results arising from this large Australian cohort study are reassuring with respect to two critical safety outcomes; preterm births and low infant birthweights. Studies examining a broader range of birth outcomes following influenza vaccination during pregnancy are required, particularly now that maternal vaccination in pregnancy has expanded to include pertussis as well as influenza.