Did new treatments contribute to a decrease in melanoma deaths?

Melanoma is one of the most common cancers diagnosed in New Zealand, and New Zealand has one of the highest rates of melanoma incidence and mortality in the world. Monitoring by Environmental Health Intelligence NZ (EHINZ) has found a recent sharp decline in melanoma mortality rates in New Zealand. Since 2014 and 2015 (with 376 and 378 melanoma deaths, respectively), melanoma deaths have declined to 362 deaths in 2016, 308 deaths in 2017, and 296 deaths in 2018. We believe that two new PD-1 inhibitor drug treatments introduced in New Zealand in 2016-nivolumab (Opdivo, BMS) and pembrolizumab (Keytruda, MSD)-may have contributed to this decrease in melanoma mortality. Other factors are unlikely to have had such a major effect, with the drop unlikely due to random variation, and no major changes in melanoma registrations or melanoma thickness at diagnosis over the past decade. While our monitoring of the time trend is descriptive only, and cannot attribute causality, it does suggest a recent decrease in melanoma mortality rates at the population level. These national-level statistics reflect both what might be expected in the New Zealand situation with the introduction of PD-1 inhibitor treatments, based on clinical trials, and what oncologists are seeing at an individual level. Further studies could investigate this observational finding, to confirm whether PD-1 inhibitor drug treatments are having an impact on melanoma mortality and survival rates in New Zealand.

Social Vulnerability Indicators for Flooding in Aotearoa New Zealand.

Social vulnerability indicators are a valuable tool for understanding which population groups are more vulnerable to experiencing negative impacts from disasters, and where these groups live, to inform disaster risk management activities. While many approaches have been used to measure social vulnerability to natural hazards, there is no single method or universally agreed approach. This paper proposes a novel approach to developing social vulnerability indicators, using the example of flooding in Aotearoa New Zealand. A conceptual framework was developed to guide selection of the social vulnerability indicators, based on previous frameworks (including the MOVE framework), consideration of climate change, and a holistic view of health and wellbeing. Using this framework, ten dimensions relating to social vulnerability were identified: exposure; children; older adults; health and disability status; money to cope with crises/losses; social connectedness; knowledge, skills and awareness of natural hazards; safe, secure and healthy housing; food and water to cope with shortage; and decision making and participation. For each dimension, key indicators were identified and implemented, mostly using national Census population data. After development, the indicators were assessed by end users using a case study of Porirua City, New Zealand, then implemented for the whole of New Zealand. These indicators will provide useful data about social vulnerability to floods in New Zealand, and these methods could potentially be adapted for other jurisdictions and other natural hazards, including those relating to climate change.

The Importance of Using Public Health Impact Criteria to Develop Environmental Health Indicators: The Example of the Indoor Environment in New Zealand.

Developing environmental health indicators is challenging and applying a conceptual framework and indicator selection criteria may not be sufficient to prioritise potential indicators to monitor. This study developed a new approach for prioritising potential environmental health indicators, using the example of the indoor environment for New Zealand. A three-stage process of scoping, selection, and design was implemented. A set of potential indicators (including 4 exposure indicators and 20 health indicators) were initially identified and evaluated against indicator selection criteria. The health indicators were then further prioritised according to their public health impact and assessed by the five following sub-criteria: number of people affected (based on environmental burden of disease statistics); severity of health impact; whether vulnerable populations were affected and/or large inequalities were apparent; whether the indicator related to multiple environmental exposures; and policy relevance. Eight core indicators were ultimately selected, as follows: living in crowded households, second-hand smoke exposure, maternal smoking at two weeks post-natal, asthma prevalence, asthma hospitalisations, lower respiratory tract infection hospitalisations, meningococcal disease notifications, and sudden unexpected death in infancy (SUDI). Additionally, indicators on living in damp and mouldy housing and children's injuries in the home, were identified as potential indicators, along with attributable burden indicators. Using public health impact criteria and an environmental burden of disease approach was valuable in prioritising and selecting the most important health impacts to monitor, using robust evidence and objective criteria.

Estimated infant intake of persistent organic pollutants through breast milk in New Zealand.

AIM: To estimate average infant daily intake of chlorinated persistent organic pollutants (POPs) through the consumption of breast milk in New Zealand. METHOD: Breast milk of 39 first-time mothers aged 20-30 years was collected during 2007-2010 and analysed for persistent organic pollutants including dioxin-like compounds and organochlorine pesticides. The quantity of POPs consumed by infants assuming exclusive breast feeding was estimated by calculating the Estimated Daily Intake (EDI) expressed as amount consumed through breast milk per kilogram of body weight per day. RESULTS: Of all POPs quantified, the EDI of DDT (principally in the form of its metabolite p,p'-DDE) was the highest (1.6 mcg/kg/day), and above the tolerable daily intake (TDI) of 0.5 mcg/kg/day. The mean EDI for dioxin-like compounds (including PCDD/Fs and PCBs) was 19.7 pg TEQ(toxic equivalency)/kg/day, which is among the lowest reported worldwide, yet above the TDI of 1 pg TEQ/kg/day. The EDI of HCH, HCB, dieldrin, heptachlor and mirex were 32.9, 37.9, 39.4, 2.0, and 0.9 ng/kg/day respectively, all of which were below the current TDI. Age of the mother was positively associated with higher EDIs for the infant, particularly for total-TEQ and total-DDT. CONCLUISON: Infant daily intakes of chlorinated POPs through breast milk estimated for New Zealand are low or average by international comparison, and 5 times lower than 25 years ago. Future breast milk monitoring will determine whether this diminishing trend is continuing as well as providing monitoring information on other POPs.

The 2005 Wellington influenza outbreak: syndromic surveillance of Wellington Hospital Emergency Department activity may have provided early warning.

OBJECTIVES: To assess whether the Wellington Emergency Department (ED) Respiratory Syndromic Surveillance System may have provided early warning of the influenza outbreak in Wellington schools during 2005, and as a result might have provided the opportunity for an earlier or more effective public health response. METHODS: All events of respiratory syndrome, as defined by selected ICD 10 codes, were extracted from Wellington Hospital ED for the dates 1 January 2004 to 31 December 2006, and analysed using the Centers for Disease Control and Prevention (CDC) surveillance program, Early Aberration Reporting System (EARS). Daily events were analysed for total counts and by lifecycle age group. Seven day moving averages of the numbers of events were also calculated. RESULTS: This study indicated that the surveillance system may have provided early warning of a potential respiratory outbreak. Regular exceedance flags were generated nine days prior to the initial notification received by Regional Public Health (RPH). The surveillance system also provided information on the type of illness (respiratory), the groups affected (5-14 year olds), and the progression of the outbreak (peak, end). CONCLUSIONS: The surveillance system might have worked by providing early notification of the outbreak. This may have prompted RPH to earlier investigate the potential outbreak and may have led to an earlier response. IMPLICATIONS: Surveillance of Emergency Department activity may be useful for early public health response.

Cancer incidence and mortality in a New Zealand community potentially exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin from 2,4,5-trichlorophenoxyacetic acid manufacture.

OBJECTIVE: To investigate whether the rates of all cancers and four cancers (soft tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease and chronic lymphocytic leukaemia) associated with dioxin exposure are higher in New Plymouth, the site of a former 2,4,5-T manufacturing plant, than for the rest of New Zealand. METHODS: Analysis of 1970-2001 cancer data from the New Zealand Cancer Registry was undertaken for New Plymouth and the rest of New Zealand. RESULTS: There is no evidence of an increased cancer risk apart from one period (1970-74), which falls partly outside the 1962-1987 manufacturing period if 10-year latency is assumed. For 1970-74, there was an elevated risk for all cancer incidence (SIR = 111, 95% CI 104-119), and for two of the four specific cancers that are associated with dioxin exposure (non-Hodgkin's lymphoma SIR = 175, 95% CI 121-246 and chronic lymphocytic leukaemia SIR = 251, 95% CI 144-408). CONCLUSIONS AND IMPLICATIONS: The results do not suggest an increased cancer risk among the New Plymouth population related to the period of 2,4,5-T manufacture, although the study's limitations mean the possibility of an undetectable small elevation in cancer risk cannot be excluded. Although TCDD exposure in the first few years of 2,4,5-T manufacture may have contributed to cancer incidence in 1970-74, unknown exposure(s) before the start of 2,4,5-T manufacture and chance are also possible explanations.