Keeping up with COVID: identification of New Zealand's earliest known cluster of COVID-19 cases.

We report the earliest known cluster of SARS-CoV-2 infection so far reported, which occurred in New Zealand in late February 2020. The cluster includes one confirmed and five probable cases. The cluster was identified while investigating a weak positive nasopharyngeal swab (NPS) polymerase chain reaction (PCR) test that was returned by a male in his 60s in September 2020. The PCR result, combined with a clear clinical and epidemiological history of a COVID-19 like illness in late February 2020, prompted serological testing. SARS-CoV-2 IgG antibodies were detected and supported historical infection. Serology was also reactive for five close contacts who had also experienced a COVID-19 like illness in February 2020. Combined case histories and investigations suggest that this local cluster was import related, with the index case identified as a family member visiting from Italy in February. Case investigation also suggests this cluster was active in New Zealand prior to any previously documented local cases, indicating that SARS-CoV-2 was present and local transmission was occurring earlier than initially suspected. A weak positive PCR result, six months after acute infection, supports international evidence that SARS-CoV-2 genetic material can be detected for several months after initial COVID-19 infection, and that this is not necessarily indicative of infectivity.

Impact of the COVID-19 nonpharmaceutical interventions on influenza and other respiratory viral infections in New Zealand.

Stringent nonpharmaceutical interventions (NPIs) such as lockdowns and border closures are not currently recommended for pandemic influenza control. New Zealand used these NPIs to eliminate coronavirus disease 2019 during its first wave. Using multiple surveillance systems, we observed a parallel and unprecedented reduction of influenza and other respiratory viral infections in 2020. This finding supports the use of these NPIs for controlling pandemic influenza and other severe respiratory viral threats.

Impact of the COVID-19 nonpharmaceutical interventions on influenza and other respiratory viral infections in New Zealand.

Stringent nonpharmaceutical interventions (NPIs) such as lockdowns and border closures are not currently recommended for pandemic influenza control. New Zealand used these NPIs to eliminate coronavirus disease 2019 during its first wave. Using multiple surveillance systems, we observed a parallel and unprecedented reduction of influenza and other respiratory viral infections in 2020. This finding supports the use of these NPIs for controlling pandemic influenza and other severe respiratory viral threats.

Neonatal conjunctivitis in the New Zealand Midland region.

AIMS: To assess the incidence of chlamydial and gonorrhoeal neonatal conjunctivitis (CON and GON), across six district health boards in the greater Midland region of New Zealand. METHODS: All positive nucleic acid amplification test (NAAT) eye swabs for Chlamydia trachomatis and NAAT and bacterial eye swabs for Neisseria gonorrhoeae in infants under one year of age were retrieved from three laboratories from 2013-2016. Incidence density rates were calculated using births information from Statistics New Zealand. A subgroup analysis of Waikato and Tairawhiti cases were further analysed. RESULTS: Calculated rates for the Greater Midland region are CON, 145.9 per 100,000 births/year and GON, 3.79 per 100,000 births/year. For Tairawhiti and Waikato, the incidence of CON is 2.5 times greater in Maori than non-Maori (95% CI 1.3-5.1, P<0.01). There was no significant difference in mean NZDep13 for Maori vs non-Maori. Mean maternal age at birth was 20. CONCLUSIONS: Greater Midland region rates of CON and GON are higher compared to other international reported rates. For Tairawhiti and Waikato, rates of CON are significantly higher in Maori than non-Maori, although there is no difference in mean NZDep13 scores between Maori and non-Maori. CON appears to be a condition of babies of young mothers with higher deprivation.

First cases of KPC-type carbapenemase-producing bacteria in patients in New Zealand hospitals.

The emergence and global spread of Klebsiella pneumoniae carbapenemases (KPCs) is a significant public health problem. Between October 2010 and July 2013, KPC-producing K. pneumoniae were isolated from four patients in New Zealand hospitals. These cases are the first known isolations of KPC-producing organisms in New Zealand. All four patients were transferred from, or had recently been in, hospitals in countries where KPC-producing organisms are prevalent (China, India, Greece and Italy). The blaKPC-2 gene was identified in the isolates from three patients and blaKPC-3 was identified in the isolate from the remaining patient. The isolates belonged to different multilocus sequence type clonal complexes, usually those prevalent in the country in which the patient had been previously hospitalised. Currently in New Zealand, the common factor associated with having a KPC-producing organism is prior hospitalisation in another country where these organisms are prevalent.

Unusually virulent coagulase-negative Staphylococcus lugdunensis is frequently associated with infective endocarditis: a Waikato series of patients.

BACKGROUND: Staphylococcus lugdunensis, a species of coagulase-negative staphylococci is associated with a wide variety of infections ranging from mild skin and soft tissue infections to serious infections which include brain abscess, chronic osteomyelitis and infective endocarditis. The aim of this study was to review cases of S. lugdunensis bacteraemia isolated from a New Zealand tertiary institution and describe the clinical presentation, diagnosis and treatment of the patients. METHODS: All blood cultures reported positive for S. lugdunensis from the Microbiology Laboratory, Waikato Hospital, New Zealand between March 2006 to April 2011 were reviewed. RESULTS: A total of 11 cases of S. lugdunensis bacteraemia were identified during the 5-year period. Three (27%) cases were due to infective endocarditis with one delayed diagnosis due to the failure of recognize the coagulase-negative Staphylococcus. Transthoracic or transoesophageal echocardiography was performed in 6 (55%) of the patients. One patient with endocarditis required early surgery and the other two were managed successfully with intravenous antibiotics. There was no in hospital mortality in the patients with endocarditis. The remaining 8 cases included 1 (9%) necrotizing fasciitis, 1 (9%) immunocompromised nosocomial multiple organism sepsis, 1 (9%) deep tissue infection requiring 6 weeks of intravenous antibiotics, 2 (18.5%) superficial skin infection, 1 (9%) nosocomial post-pacemaker insertion infection and 2 (18.5%) had fever of unknown origin. All isolates were sensitive to Flucloxacillin and Vancomycin. Overall the survival rate of the acute presentation and treatment was 91% (10/11). CONCLUSION: Three of our 11 patients (27%) with S. lugdunensis bacteraemia were diagnosed with infective endocarditis. Evaluation for endocarditis is therefore advised in patients who have positive blood culture for this organism.

Rat-bite fever: a cautionary tale.

We present the first ever report of streptobacillary rat-bite fever in New Zealand. The patient was a young man who was admitted with systemic sepsis. He presented with a high fever, hypotension, and tender axillary lymphadenopathy. He had been bitten by a rat a week earlier. Blood cultures grew Streptobacillus moniliformis, thus confirming the diagnosis. The literature on rat-bite fever is also reviewed.