Clinical Manifestations and Genomic Evaluation of Melioidosis Outbreak among Children after Sporting Event, Australia.

Melioidosis, caused by the environmental gram-negative bacterium Burkholderia pseudomallei, usually develops in adults with predisposing conditions and in Australia more commonly occurs during the monsoonal wet season. We report an outbreak of 7 cases of melioidosis in immunocompetent children in Australia. All the children had participated in a single-day sporting event during the dry season in a tropical region of Australia, and all had limited cutaneous disease. All case-patients had an adverse reaction to oral trimethoprim/sulfamethoxazole treatment, necessitating its discontinuation. We describe the clinical features, environmental sampling, genomic epidemiologic investigation, and public health response to the outbreak. Management of this outbreak shows the potential benefits of making melioidosis a notifiable disease. The approach used could also be used as a framework for similar outbreaks in the future.

A complex increase in hepatitis C virus in a correctional facility: bumps in the road.

OBJECTIVE: The prevalence of hepatitis C virus (HCV) in correctional facilities in Australia among people who inject drugs is 60%, with disproportionate effects observed in Aboriginal and Torres Strait Islander people. Following the micro-elimination of HCV in a Queensland correctional facility (QCF), newly acquired cases began to increase in mid-2019. Here we discuss the public health response to increasing HCV in a QCF. METHODS: Enhanced surveillance was performed to obtain contextual outbreak data on risk factors including injecting drug use, sharing of personal hygiene equipment and do-it-yourself-tattooing. RESULTS: In the sixteen months, there were 250 notifications of new and re-infected HCV infections in prisoners in the QCF. Qualitative data revealed the leading factor in transmission to be injecting drug use. CONCLUSIONS: Drivers for increased HCV transmission in correctional facilities include boredom, waiting lists for opioid substitution programs, changes in injecting behaviours and sharing of injecting paraphernalia. Point-of-care testing combined with education and the development of a needle and syringe program may be promising ways forward for managing HCV in correctional facilities. IMPLICATIONS FOR PUBLIC HEALTH: Correctional facilities are key locations to target sexually transmitted infection (STI) and blood-borne virus (BBV) testing and treatment as well as health promotion to improve the health of inmates and the communities they return to.

Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998-2019.

During January 1998-December 2019, the annual incidence of melioidosis in Far North Queensland, Queensland, Australia, more than doubled. Because climate and prevalence of predisposing medical conditions remained stable during that time, we hypothesize that the increased incidence was caused by urban expansion and increased construction, resulting in greater exposure to Burkholderia pseudomallei.

A mass mortality event in bats caused by extreme heat: surprising public health challenges.

OBJECTIVES: We examine the public health response to an unprecedented multiple mortality event in bats following an extreme heat event. The main public health risk associated with the event and the environmental clean-up was potential human infection with Australian bat lyssavirus. We also consider the public health implications as we enter an age of climate change, vulnerability and unexpected events. Type of service: The Tropical Public Health Service of Far North Queensland worked collaboratively with the local council to coordinate a practical public health and health protection response to a mass mortality event in bats in late 2018. METHODS: A coordinated response was instigated to remove thousands of decaying bat corpses from residential areas. This occurred alongside a health education campaign advising the public to avoid handling bats. RESULTS: The combined efforts were successful; those requiring vaccination and post-exposure prophylaxis were treated appropriately and owing to a successful campaign, exposures were minimised. However, significant issues with misinformation and social media messaging were noted, alongside amateur bat carers handling sick and injured bats inappropriately, compounding the challenge for public health services. This mass mortality event has implications regarding the preparation for and management of other unexpected public health crises related to climate change. LESSONS LEARNT: It is vital that areas populated with bats be prepared for extreme heat events (EHEs). Public health units need to be prepared for the unexpected events of climate change, advocate for a 'one health' approach to public health, and work with local and national governments to become 'climate ready'.

Dominance of the tiger: The displacement of Aedes aegypti by Aedes albopictus in parts of the Torres Strait, Australia

Most of the inhabited islands in the Torres Strait region of Australia have experienced dengue outbreaks transmitted by Aedes aegypti at various times since at least the 1890s. However, another potential dengue vector, Aedes albopictus, the Asian tiger mosquito, was detected for the first time in 2005 and it expanded across most of the Torres Strait within a few years. In 2016, a survey of container-inhabiting mosquitoes was conducted in all island communities and Ae. aegypti was undetectable on most of the islands which the species had previously occupied, and had been replaced by Ae. albopictus. It is suspected that competitive displacement was responsible for the changes in species distribution. Aedes aegypti was only detected on Boigu Island and Thursday Island. Recent dengue outbreaks in the Torres Strait have apparently been driven by both Ae. albopictus and Ae. aegypti. The findings have major implications on management of dengue outbreaks in the region.

Imported zika virus infection from the cook islands into australia, 2014.

A female resident of Townsville, Queensland, Australia has been diagnosed with Zika virus infection following a recent trip to the Cook Islands. An initial serum sample collected in March, 2014 was positive by two separate Zika virus TaqMan real-time RT-PCRs and a pan-Flavivirus RT-PCR. Nucleotide sequencing and phylogenetics of the complete Cook Islands Zika virus envelope gene revealed 99.1% homology with a previous Cambodia 2010 sequence within the Asian lineage. In addition, IgG and IgM antibody seroconversions were detected between paired acute and convalescent phase sera using recombinant Zika virus serology assays. This is the first known imported case of Zika virus infection into northern Queensland where the potential mosquito vector Aedes aegypti is present and only the second such reported case diagnosed within Australia.

An outbreak of Plasmodium falciparum malaria in the Torres Strait.

This report describes the largest outbreak of Plasmodium falciparum malaria in the Torres Strait for more than 25 years. It details factors that may have contributed to the outbreak, the public health response and implications for the broader region. Eight cases of locally-acquired falciparum malaria occurred on Saibai and Dauan islands during March and April 2011. Including imports, there were 17 P. falciparum notifications between February and May 2011. Three cases of pure P. vivax malaria that might have been locally acquired have been omitted from this report. Malaria is endemic on the nearby coast of Papua New Guinea (PNG), and regularly imported to the Torres Strait where a competent vector exists in sufficient numbers to transmit the disease to the local population. The most common malaria vectors in northern Australia and Torres Strait are the Anopheles farauti complex. Factors contributing to the outbreak may include an increase in travel between the outer islands and PNG, inadequate local vector control and late or missed diagnoses of malaria. Outbreak management involved intensive case finding and treatment, vector control and health promotion. Reducing the risk of future outbreaks requires studies of vector behaviour, ecology and management, health promotion, improvements to protective infrastructure, and clinical guideline revision. Further malaria outbreaks are likely in the Torres Strait and elsewhere in northern Australia. It is important to maintain awareness and be prepared to respond rapidly.