Several confirmed and probable zoonotic cases of toxigenic Corynebacterium ulcerans, Queensland, Australia.

Background: Toxigenic Corynebacterium ulcerans is an emerging zoonosis globally, causing both cutaneous and respiratory diphtheria-like illness. In Queensland, human infection with toxigenic C. ulcerans is rare, with only three cases reported before October 2015. This case series describes five subsequent cases of toxigenic C. ulcerans in Queensland with links to companion animals. Methods: All data were collected as part of routine public health response, and strains were whole genome sequenced for further characterisation. Household contacts were screened, treated with appropriate antibiotics, and received a diphtheria toxoid-containing vaccine if more than five years had elapsed since their last dose. Findings: No epidemiological or genomic links could be established between any of the five patients, including between the two cases notified from the same locality within eight days of each other. The C. ulcerans strains from Cases Two, Four and Five were closely related to the strains isolated from their respective pets by whole genome sequencing. Domestic dogs were identified as the most likely mode of transmission for Cases One and Three; however, this was unable to be laboratory confirmed, since Case One's dog was treated with antibiotics before it could be tested, and Case Three's dog was euthanised and cremated prior to case notification. Interpretation: These are the first reported Australian cases of this emerging zoonosis with links to companion animals. These cases demonstrate the likely transmission route between companion animals and humans, with no evidence of human-to-human transmission. The existing requirement in the Queensland Health Public Health Management Guidelines, of restrictions on cases and some contacts while awaiting swab results, is currently under review.

An outbreak of shiga toxin-producing Escherichia coli infection associated with a school camp.

In November 2008, a case of Shiga toxin-producing Escherichia coli (STEC) infection was reported to the Brisbane Southside Public Health Unit. The case had participated in a school camp. Subsequent investigations confirmed 5 other asymptomatic cases among camp attendees or visitors. Examination of the camp water supply identified that most water sources had high levels of E. coli and did not meet the Australian Drinking Water Guidelines with STEC isolated from 2 water sources. This outbreak highlights the emerging issue of asymptomatic carriage of STEC and the importance of thorough maintenance and attention to drinking water supplies in the rural and school camp setting.

Outbreaks of Salmonella Typhimurium phage type 197 of multiple genotypes linked to an egg producer.

This paper describes outbreaks of Salmonella Typhimurium phage type 197 (STm197) linked to eggs from the farm of a single egg producer. Epidemiological and microbiological investigations (genotyping by multiple locus variable number tandem repeats analysis [MLVA]) identified outbreaks of STm197 with the same or closely-related MLVA profiles in a series of restaurants across Brisbane over 2 months. Environmental health investigations revealed that these restaurants were supplied with eggs from the same egg producer and that cross-contamination may have contributed to the outbreak. Environmental swabs taken from restaurant kitchens and the farm of the egg producer identified a number of salmonellas including STm197, many with MLVA profiles matching or closely related to the human strains from outbreak cases. A case-to-case comparison study showed a significant association between illness with 1 MLVA type and attending a restaurant during the 5 days before onset of illness (odds ratio [OR] 8.1, 95% confidence interval [CI] 1.8, 35.4). MLVA has become a valuable tool for S. Typhimurium surveillance and outbreak investigation. This outbreak further justifies the Commonwealth Government's decision to develop a draft national primary production and processing standard for eggs and egg products to address food safety risks posed by cracked and dirty eggs.

Reduction in invasive meningococcal disease in Queensland: a success for immunisation.

Since 2003, the Australian government has funded a conjugate serogroup C meningococcal vaccine for those aged over 1 year and born since 1 January 1984. This summary of the epidemiology of invasive meningococcal disease (IMD) in Queensland assesses the effect that the vaccination program has had on IMD notifications. In Queensland, IMD cases are notified to the Notifiable Conditions System by clinicians and laboratories. Additional surveillance data are collected by population health units from relatives of the case, the case and medical practitioners. In 2005, Queensland recorded its lowest number of cases and lowest incidence of IMD since statewide surveillance began. This remained low in 2006. The serogroup C rate in Queensland also declined to its lowest in 2006. The pattern of age specific incidence remains similar, though rates are lower in all but those aged less than 12 months. However, Indigenous rates are still twice non-Indigenous rates. The case fatality rate for IMD (all serogroups) has declined, possibly due to the reduced incidence of serogroup C and septicaemia cases. The program appears to have mostly achieved its aims of: reducing illness and death in the population at highest risk; inducing immunity in those who are vaccinated; and reducing the incidence of disease. However, there is considerable natural fluctuation in the rates of IMD and continued surveillance will be needed to monitor trends.