A brief description of the epidemiology of dengue in Dili, Timor-Leste, 2018-2022.

Abstract: Dengue virus (DENV) infection causes 390 million infections per year and 40,000 deaths globally. It is endemic in many countries in Asia, Africa, the Americas, the Caribbean, and Oceania. Dengue is endemic in Timor-Leste year-round, but peak transmission occurs during the rainy season. We briefly describe the epidemiology of DENV in the Municipality of Dili between 2018 and 2022. There were 6,234 cases notified, with a mean annual incidence rate of 330 cases per 100,000 population. There were 55 deaths (case fatality rate 0.9%). The peak annual incidence (3,904 cases) occurred in 2022 after an outbreak was declared in January of that year; this outbreak included 760 cases of dengue haemorrhagic fever and 35 deaths. The number of outbreak cases requiring hospital treatment exceeded the usual capacity, but facilities established for coronavirus disease 2019 (COVID-19) isolation and treatment were repurposed to meet this demand. Existing strategies of vector control, minimising breeding sites and promoting early presentation for treatment should continue, as should the utilisation of surveillance systems and treatment facilities established during the COVID-19 pandemic. However, dengue incidence remains high, and other dengue control strategies-including the deployment of Wolbachia-infected mosquitoes-should be considered in Timor-Leste.

Monitoring the incidence and causes of disease potentially transmitted by food in Australia: Annual report of the OzFoodNet network, 2016.

ABSTRACT: In 2016, a total of 44,455 notifications of enteric diseases potentially related to food were received by state and territory health departments in Australia. Consistent with previous years, campylobacteriosis (n = 24,171) and salmonellosis (n = 18,060) were the most frequently-notified infections. Notable increases in incidence were observed for shiga toxin-producing Escherichia coli (n = 343; 166% increase), shigellosis (n = 1,408; 93% increase), campylobacteriosis (33% increase) and salmonellosis (30% increase) when compared with the historical five-year mean. The extent to which the introduction of culture-independent testing as a method of diagnosis has contributed to these increases remains unclear. In total, 188 gastrointestinal outbreaks, including 177 foodborne outbreaks, were reported in 2016. The 11 non-foodborne outbreaks were due to environmental or probable environmental transmission (nine outbreaks) and animal-to-person or probable animal-to-person transmission (two outbreaks). No outbreaks of waterborne or probable waterborne transmission were reported in 2016. Foodborne outbreaks affected 3,639 people, resulting in at least 348 hospital admissions and four deaths. Eggs continue to be a source of Salmonella Typhimurium infection across the country: 35 egg-related outbreaks, affecting approximately 510 people, were reported across six jurisdictions in 2016. Three large multi-jurisdictional Salmonella outbreaks associated with mung bean sprouts (n = 419 cases); bagged salad products (n = 311 cases); and rockmelons (n = 144 cases) were investigated in 2016. These outbreaks highlight the risks associated with fresh raw produce and the ongoing need for producers, retailers and consumers to implement strategies to reduce potential Salmonella contamination.

A protracted outbreak of Salmonella Hessarek infection associated with one brand of eggs­South Australia, March 2017 - July 2018

Salmonella Hessarek is an uncommon serotype in Australia. We report on the investigation of a protracted outbreak of 25 cases of S. Hessarek gastroenteritis in which cases were defined as any laboratory confirmed case of Salmonella Hessarek notified to the South Australian Communicable Disease Control Branch from 1st March 2017 to 3 July 2018. We conducted a descriptive case series investigation interviewing all cases and 17 (68%) reported consuming brand X free-range eggs. Four samples of one-dozen brand X eggs were cultured for the presence of Salmonella spp. One out of the four samples returned positive for S. Hessarek in the contents of the eggs; Salmonella was not present in any of the whole egg rinses of the four samples. The high proportion of cases reporting the consumption of brand X free-range eggs and the isolation of S. Hessarek from sampling four dozen brand X eggs is an unusually strong signal implicating brand X eggs as the source of this outbreak. From a public health perspective, it is important to understand the behaviour of S. Hessarek including its ability to be present in the content of eggs and further research is recommended. The findings in this investigation into a rare Salmonella serotype highlight the need for continuous monitoring of the epidemiology of Salmonella in Australia including the epidemiology of egg-associated Salmonella outbreaks of human disease.

Salmonella Typhimurium and Outbreaks of Egg-Associated Disease in Australia, 2001 to 2011.

INTRODUCTION: Salmonellosis is a significant public health problem, with eggs frequently identified as a food vehicle during outbreak investigations. Salmonella enterica serovar Typhimurium and Salmonella enterica serovar Enteritidis are the two most frequently identified causes of egg-associated disease in industrialized countries. In Australia, a comprehensive review of egg-associated outbreaks has not been previously undertaken. METHODS: Using a national register of foodborne outbreaks, we undertook a descriptive review of egg-associated outbreaks between 2001 and 2011. Included in our review was additional detail from the findings of trace back investigations conducted to the farm level. Evidence classifications were developed and applied to each outbreak based on descriptive and analytical epidemiology, food safety investigations, and microbiological testing of clinical, food, and trace back-derived samples. RESULTS: Over the study period, the proportion of foodborne Salmonella outbreaks linked to eggs increased significantly (p < 0.001). In total, 166 outbreaks were identified, with 90% caused by Salmonella Typhimurium. The majority of outbreaks were linked to commercial food providers, with raw egg use the major contributing factor. These events resulted in more than 3200 cases, more than 650 hospitalizations, and at least 4 deaths. Fifty-four percent of investigations used analytical epidemiology, food microbiology, and trace back microbiology to demonstrate links between human illness and eggs. Trace back investigations identified S. enterica indistinguishable from outbreak-associated clinical or food samples on 50% of sampled egg farms. CONCLUSION: Effective control of egg-associated salmonellosis remains a challenge in Australia, with Salmonella Typhimurium dominating as the causative serotype in outbreak events. Although outbreaks predominantly occur in the settings of restaurants, the high recovery rate of indistinguishable Salmonella on epidemiologically implicated egg farms suggests that further efforts to minimize infection pressure at the primary production level are needed in Australia.

Approaches to the Surveillance of Foodborne Disease: A Review of the Evidence.

Foodborne disease surveillance aims to reduce the burden of illness due to contaminated food. There are several different types of surveillance systems, including event-based surveillance, indicator-based surveillance, and integrated food chain surveillance. These approaches are not mutually exclusive, have overlapping data sources, require distinct capacities and resources, and can be considered a hierarchy, with each level being more complex and resulting in a greater ability to detect and control foodborne disease. Event-based surveillance is generally the least resource-intensive system and makes use of informal data sources. Indicator-based surveillance is seen as traditional notifiable disease surveillance and consists of routinely collected data. Integrated food chain surveillance is viewed as the optimal practice for conducting continuous risk analysis for foodborne diseases, but also requires significant ongoing resources and greater multisectoral collaboration compared to the other systems. Each country must determine the most appropriate structure for their surveillance system for foodborne diseases based on their available resources. This review explores the evidence on the principles, minimum capabilities, and minimum requirements of each type of surveillance and discusses examples from a range of countries. This review forms the evidence base for the Strengthening the Surveillance and Response for Foodborne Diseases: A Practical Manual.

Esophageal cancer in Indigenous Australians in Far North Queensland.

BACKGROUND AND AIMS: There is very little information known about esophageal cancer in Indigenous persons. In this retrospective study, we investigated the epidemiological and clinical features of Indigenous Australians with esophageal cancer. METHODS: A retrospective study was carried out on Indigenous and non-Indigenous Australians diagnosed with esophageal cancer at Cairns Base Hospital during the period 1 January 2001 to 31 December 2006. Information was obtained from hospital medical records, Queensland Cancer Registry survival data and Queensland Health Pathology Services laboratory results. RESULTS: Thirteen Indigenous and 53 non-Indigenous patients were diagnosed with esophageal cancer. Squamous cell carcinoma accounted for a significantly higher proportion of esophageal cancers among Indigenous (11/13) than non-Indigenous patients (24/53) (P = 0.0135). Among patients with esophageal squamous cell cancer, Indigenous patients were more likely than non-Indigenous patients to present with metastatic disease (P = 0.0271) at a younger mean age (50.7 years vs 67.2 years; P = 0.0002). There was no significant difference between Indigenous and non-Indigenous patients concerning their mean survival time from date of biopsy (P = 0.7834) and whether patients had ever smoked (P = 0.0721) or consumed alcohol (P = 0.2849). CONCLUSION: There is a high incidence of squamous esophageal cancer in the Indigenous population in Far North Queensland. Indigenous persons tend to present at a younger age and with metastatic disease.

Influenza activity in Cambodia during 2006-2008.

BACKGROUND: There is little information about influenza disease among the Cambodian population. To better understand the dynamics of influenza in Cambodia, the Cambodian National Influenza Center (NIC) was established in August 2006. To continuously monitor influenza activity, a hospital based sentinel surveillance system for ILI (influenza like illness) with a weekly reporting and sampling scheme was established in five sites in 2006. In addition, hospital based surveillance of acute lower respiratory infection (ALRI) cases was established in 2 sites. METHODS: The sentinel sites collect weekly epidemiological data on ILI patients fulfilling the case definition, and take naso-pharyngeal specimens from a defined number of cases per week. The samples are tested in the Virology Unit at the Institut Pasteur in Phnom Penh. From each sample viral RNA was extracted and amplified by a multiplex RT-PCR detecting simultaneously influenza A and influenza B virus. Influenza A viruses were then subtyped and analyzed by hemagglutination inhibition assay. Samples collected by the ALRI system were tested with the same approach. RESULTS: From 2006 to 2008, influenza circulation was observed mainly from June to December, with a clear seasonal peak in October shown in the data from 2008. CONCLUSION: Influenza activity in Cambodia occurred during the rainy season, from June to December, and ended before the cool season (extending usually from December to February). Although Cambodia is a tropical country geographically located in the northern hemisphere, influenza activity has a southern hemisphere transmission pattern. Together with the antigenic analysis of the circulating strains, it is now possible to give better influenza vaccination recommendation for Cambodia.

Influenza A/H5N1 virus infection in humans in Cambodia.

BACKGROUND: Between January 2005 and April 2006, six patients of influenza A/H5N1 virus infection were reported in Cambodia, all with fatal outcome. OBJECTIVES: We describe the virological findings of these six H5N1 patients in association with clinical and epidemiologic findings. STUDY DESIGN: Broncho-alveolar lavage, nasopharyngeal, throat and rectal swabs and sera were cultured for virus isolation and viral load quantified in clinical specimens by real-time RT-PCR. We compared sequences obtained from different body sites within the same patient to detect viral quasi-species. RESULTS: H5N1 virus strains isolated in Cambodia belong to genotype Z, clade 1 viruses. H5N1 viruses were isolated from serum and rectal swab specimens in two patients. The haemagglutinin gene sequences of the virus in different body sites did not differ. Amino acid substitutions known to be associated with a change in virus binding were not observed. CONCLUSION: The high frequency of virus isolation from serum and faecal swabs highlights that H5N1 is likely to be a disseminated infection in humans and this has implications for antiviral treatment, biosafety in clinical laboratories and on risks for nosocomial and human-to-human transmission. There were no tissue-specific adaptive mutations in the HA gene from viruses isolated from different organs.

Low frequency of poultry-to-human H5NI virus transmission, southern Cambodia, 2005.

To understand transmission of avian influenza A (H5N1) virus, we conducted a retrospective survey of poultry deaths and a seroepidemiologic investigation in a Cambodian village where a 28-year-old man was infected with H5N1 virus in March 2005. Poultry surveys were conducted within a 1-km radius of the patient's household. Forty-two household flocks were considered likely to have been infected from January through March 2005 because >60% of the flock died, case-fatality ratio was 100%, and both young and mature birds died within 1 to 2 days. Two sick chickens from a property adjacent to the patient's house tested positive for H5N1 on reverse transcription-PCR. Villagers were asked about poultry exposures in the past year and tested for H5N1 antibodies. Despite frequent, direct contact with poultry suspected of having H5N1 virus infection, none of 351 participants from 93 households had neutralizing antibodies to H5N1. H5N1 virus transmission from poultry to humans remains low in this setting.

Australia's notifiable diseases status, 2003 annual report of the National Notifiable Diseases Surveillance System.

In 2003, 58 diseases and conditions were notifiable at a national level in Australia. States and territories reported a total of 104,956 cases to the National Notifiable Diseases Surveillance System an increase of 3.2 per cent on the total number of notifications in 2002. In 2003, the most frequently notified diseases were sexually acquired infections (38,854, 37% of total notifications), gastrointestinal diseases (24,655 notifications, 24%) and bloodborne viruses (20,825 notifications, 20%). There were 11,113 notifications of vaccine preventable diseases, 6,780 notifications of vectorborne diseases, 1,826 notification of other bacterial infections and 903 notifications of zoonotic diseases.

The adsorption of cyanobacterial hepatoxins as a function of soil properties.

Cyanobacterial hepatotoxins present a risk to public health when present in drinking water supplies. Existing removal strategies, although efficient, are not economically viable or practical for remote Australian communities and developing nations. Bank filtration is a natural process and a potential low cost, toxin removal strategy. Batch studies were conducted in 12 texturally diverse soils to examine the soil properties influencing the adsorption of the cyanobacterial hepatotoxins, microcystin-LR and nodularin. Sorption isotherms were measured. Freundlich and linear isotherms were observed for both toxins with adsorption coefficients not exceeding 2.751 kg(-1) for nodularin and 3.81 kg(-1) for microcystin. Significant positive correlations were identified between hepatotoxin sorption and clay and silt contents of the soils. Desorption of toxins was also measured in three different soils. Pure nodularin and microcystin-LR readily desorbed from all soils.

Evaluation of Australia's National Notifiable Disease Surveillance System.

The Australian National Notifiable Diseases Surveillance System (NNDSS) is a passive surveillance system that collects information on communicable diseases. The Australian Government manages NNDSS under the auspices of the Communicable Diseases Network Australia (CDNA). Data collected by each state and territory are collated, analysed and disseminated by the Australian Government Department of Health and Ageing. We report the first evaluation of NNDSS since it was established in 1991. Three primary stakeholder groups were surveyed: (a) CDNA members, (b) the National Surveillance Committee and (c) the readership of Communicable Diseases Intelligence, the primary means of data dissemination from NNDSS. The evaluation revealed that the system was acceptable, structurally simple, and that the data collected were actively used by stakeholders. However, the lack of clearly documented aims and objectives for NNDSS, inflexibility to changing needs, lack of timeliness and complexity in processes were seen as problematic. The results of this evaluation, supported by recent federal funding to enhance national biosecurity, will provide the framework for enhancing NNDSS to meet national communicable disease surveillance requirements in Australia.

Annual report of the National Influenza Surveillance Scheme, 2003.

Surveillance of influenza in Australia is based on laboratory isolation of influenza viruses, sentinel general-practitioner practices for influenza-like illness, and absenteeism data from a major national employer. In 2003, the peak in influenza activity was in August which was later than in 2002. In 2003, 3,604 laboratory-confirmed cases of influenza were notified to the National Notifiable Diseases Surveillance System, which was marginally lower than for the previous year. Ninety-four per cent of the circulating viruses were influenza A. This was the highest proportion in the last five years. Nine hundred and thirty-five isolates were antigenically analysed: 928 were A(H3), two were A(H1) strains and five were influenza B viruses. The majority (98%) of the A(H3) subtypes were A/Fujian/411/2002(H3N2)-like and have shown a significant antigenic drift. The 2003 Australian influenza vaccine contained A/Panama/2007/99, which induced 2-4-fold lower antibody response against the drifted strain. An A/Fujian/411/2002(H3N2)-like virus has been incorporated in the Australian influenza vaccine for 2004. In 2003, the influenza vaccine was given to 77 per cent of Australians aged over 65 years; the same up take as in 2002.

Clinical description of a completed outbreak of SARS in Vietnam, February-May 2003.

We investigated the clinical manifestations and course of all probable severe acute respiratory syndrome (SARS) patients in the Vietnam outbreak. Probable SARS cases were defined by using the revised World Health Organization criteria. We systematically reviewed medical records and undertook descriptive statistical analyses. All 62 patients were hospitalized. On admission, the most prominent symptoms were malaise (82.3%) and fever (79.0%). Cough, chest pain, and shortness of breath were present in approximately one quarter of the patients; 79.0% had lymphopenia; 40.3% had thrombocytopenia; 19.4% had leukopenia; and 75.8% showed changes on chest radiograph. Fever developed on the first day of illness onset, and both respiratory symptoms and radiographic changes occurred on day 4. On average, maximal radiographic changes were observed on day 10, and fevers subsided by day 13. Symptoms on admission were nonspecific, although fever, malaise, and lymphopenia were common. The complications of SARS included invasive intubation and ventilation (11.3%) and death (9.7%).

Tuberculosis notifications in Australia, 2001.

In 2001, there were 997 cases of tuberculosis (TB) reported to the National Notifiable Diseases Surveillance System, of which, 967 were new cases of TB and 30 cases were relapses. The incidence rate of TB in Australia in 2001 was 5.1 cases per 100,000 population. The highest incidence of TB was reported in people born overseas (19.3 cases per 100,000 population), followed by Indigenous Australians (9.8 cases per 100,000 population). In contrast, the incidence rate of TB in the non-Indigenous Australian-born population was 1.0 cases per 100,000 population. This pattern of TB incidence rates amongst the sub-populations of Australia has been observed for over 10 years. Eighty-six per cent of TB cases completed treatment in 2001. Treatment was unsuccessful in 7 cases and only 22 cases defaulted. The National Tuberculosis Advisory Committee has published a National Strategic Plan with performance indicators to ensure that this enviable record of TB control is maintained and improved.

Norwalk-like virus outbreak in Canberra: implications for infection control in aged care facilities.

This paper reports on an outbreak of viral gastroenteritis in three institutions (two aged care facilities and one hospital) in Canberra during the winter of 2002. Norwalk-like virus genotype II was detected in samples from staff and/or residents in all three institutions. A case series investigation was conducted amongst both staff and residents. It is likely that the outbreaks in the three institutions were linked due to transfers of infected residents from one institution to another, early in the outbreak. A total of 281 cases were identified during the outbreak, which lasted 32 days. Attack rates in the three institutions were 46.3 per cent, 52.7 per cent and 55.2 per cent respectively. Person-to-person spread and/or airborne transmission were postulated as modes of transmission in all three institutions. Infection control practices in each of the aged care institutions were of an acceptable standard for accreditation, but were inadequate to control further spread of the outbreak within and between institutions. Outbreak management plans should be a part of the infection control standards for accreditation of aged care facilities.