An integrated public health response to an outbreak of Murray Valley encephalitis virus infection during the 2022-2023 mosquito season in Victoria.

Introduction: Murray Valley encephalitis virus (MVEV) is a mosquito-borne flavivirus known to cause infrequent yet substantial human outbreaks around the Murray Valley region of south-eastern Australia, resulting in significant mortality. Methods: The public health response to MVEV in Victoria in 2022-2023 included a climate informed pre-season risk assessment, and vector surveillance with mosquito trapping and laboratory testing for MVEV. Human cases were investigated to collect enhanced surveillance data, and human clinical samples were subject to serological and molecular testing algorithms to assess for co-circulating flaviviruses. Equine surveillance was carried out via enhanced investigation of cases of encephalitic illness. Integrated mosquito management and active health promotion were implemented throughout the season and in response to surveillance signals. Findings: Mosquito surveillance included a total of 3,186 individual trapping events between 1 July 2022 and 20 June 2023. MVEV was detected in mosquitoes on 48 occasions. From 2 January 2023 to 23 April 2023, 580 samples (sera and CSF) were tested for flaviviruses. Human surveillance detected 6 confirmed cases of MVEV infection and 2 cases of "flavivirus-unspecified." From 1 September 2022 to 30 May 2023, 88 horses with clinical signs consistent with flavivirus infection were tested, finding one probable and no confirmed cases of MVE. Discussion: The expanded, climate-informed vector surveillance system in Victoria detected MVEV in mosquitoes in advance of human cases, acting as an effective early warning system. This informed a one-health oriented public health response including enhanced human, vector and animal surveillance, integrated mosquito management, and health promotion.

"They said we're all in it together, but we were kind of separated": barriers to access, and suggestions for improving access to official information about COVID-19 vaccines for migrants in Australia.

BACKGROUND: Vaccination is a cornerstone of public health measures to mitigate the burden of COVID-19 infection. Equitable access to information is necessary to ensure all members of society can make an informed decision about COVID-19 vaccines. We sought to investigate barriers that migrants living in Australia faced in accessing official information about COVID-19 vaccines and identify potential solutions. METHODS: This study used a descriptive qualitative study design. Seventeen adults living in Australia and born in the World Health Organization's Eastern Mediterranean Region participated in a semi-structured interview conducted via telephone. Participants were recruited using advertising through social media platforms. The interviews were conducted between December 2021 and February 2022. All interviews were audio-recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. In this study official information was defined as information provided by Australian Health system. RESULTS: Barriers to accessing official information about COVID-19 vaccines were related to unmet language needs, methods of dissemination, and mistrust in official sources of information. To overcome barriers, participants suggested improving the quality and timeliness of language support, using diverse modes of dissemination, working with members of migrant communities, providing opportunities for two-way communication, communicating uncertainty, and building a broader foundation of trust. CONCLUSION: Information about COVID-19 vaccines during different stages of the vaccination program should be provided in migrants' languages at the same time that it is available in English using a variety of methods for dissemination. The acceptability of official information can be improved by communicating uncertainty, acknowledging people's concerns about the safety and effectiveness of COVID-19 vaccines and providing opportunities for two-way communication. People's trust in official sources of health information can be improved by working with migrant communities and recognising migrants' contributions to society. The findings of this study may improve managing the response to COVID-19 and other health emergencies in Australia and in other similar societies.

Interrupted time series segmented regression analysis for detecting waterborne disease outbreaks by syndromic surveillance.

Introduction: Pathogens can enter the drinking water supply and cause gastroenteritis outbreaks. Such events can affect many people in a short time, making them a high risk for public health. In Australia, the Victoria State Government Department of Health is deploying a syndromic surveillance system for drinking water contamination events. We assessed the utility of segmented regression models for detecting such events and determined the number of excess presentations needed for such methods to signal a detection. Methods: The study involved an interrupted time series study of a past lapse in water treatment. The baseline period comprised the four weeks before the minimum incubation period of suspected pathogens, set at two days post-event. The surveillance period comprised the week after. We used segmented linear regression to compare the count of gastroenteritis presentations to public hospital emergency departments (EDs) between the surveillance and baseline periods. We then simulated events resulting in varying excess presentations. These were superimposed onto the ED data over fifty different dates across 2020. Using the same regression, we calculated the detection probability at p < 0.05 for each outbreak size. Results: In the retrospective analysis, there was strong evidence for an increase in presentations shortly after the event. In the simulations, with no excess presentations (i.e., with the ED data as is) the models signalled 8% probability of detection. The models returned 50% probability of detection with 28 excess presentations and 100% probability of detection with 78 excess presentations. Conclusions: The transient increase in presentations after the event may be attributed to microbiological hazards or increased health-seeking behaviour following the issuing of boil water advisories. The simulations demonstrated the ability for segmented regressions to signal a detection, even without a large excess in presentations. The approach also demonstrated high specificity and should be considered for informing Victoria's syndromic surveillance system.

Factors associated with COVID-19 booster vaccine willingness among migrants from the Eastern Mediterranean living in Australia: a cross-sectional study.

BACKGROUND: Migrants have been disproportionally affected by COVID-19 in Australia. Vaccination against COVID-19 is a key pillar of Australia's public health response, but little is known about the willingness to receive booster vaccinations among migrants. This study aimed to assess the factors associated with a willingness to receive a COVID-19 booster vaccine among migrants living in Australia born in the World Health Organization's Eastern Mediterranean Region (EMRO). METHODS: A cross-sectional survey was conducted from September to November 2021 (n = 300). Participants were questioned on booster vaccine willingness, sociodemographic characteristics, COVID-19 vaccine information needs and sources, and perceptions of COVID-19 vaccines. Univariate and multivariate logistic regression were used to assess factors associated with booster willingness. RESULTS: Most respondents (87%) had received two doses of COVID-19 vaccine, of which 81% were willing to receive a booster dose. About half of the participants reported high or very high needs for receiving information about "COVID-19 vaccines' safety monitoring in Australia", "COVID-19 vaccines protection against illness", "Safety of COVID-19 vaccines used in Australia", and "The Australian COVID-19 vaccination program". People who were willing to receive a boost dose had significantly higher self-estimated knowledge of COVID-19 vaccines, confidence in COVID-19 vaccines and trust in the Australian government's vaccine recommendations, and perceived COVID-19 as a greater risk compared to those who were unsure/hesitant. Both groups reported similar perceptions of their personal risks from COVID-19 but diverged on their views of COVID-19 as a broader health problem. There were no statistically significant differences between the two groups in terms of channels used to find information about COVID-19 vaccines. Factors associated with willingness to receive a COVID-19 booster vaccine in the multivariate logistic regression were age (aOR 1.07 95% CI 1.02-1.12), and no exposure to concerning news about COVID-19 vaccines (aOR 3.71 95% CI 1.51-9.09). CONCLUSION: Vaccine acceptance and reported booster willingness was high. The results suggest the news and information seen may impact willingness to receive booster doses, even among those who have already received doses of COVID-19 vaccine. Addressing vaccine concerns and transparent communication about uncertainty should be a priority in the current and in future pandemics.

Exploring the temporal patterns and crisis-related risk factors for population displacement in Somalia (2016-2018).

Introduction: Over the past 30 years, south-central Somalia, Puntland (north-east) and Somaliland (north-west) have experienced recurring drought- and conflict-related crises. By the end of 2018, the number of internally displaced persons (IDPs) in the region had reached 2.6 million; most were displaced to larger towns under government control, where humanitarian assistance was more accessible. Understanding the drivers of crisis-related displacement can provide insight into how responses can best manage and respond to displacement to prevent downstream morbidity and mortality. We aimed to explore the temporal patterns and crisis-related risk factors for population displacement in Somalia from 2016 to 2018, a period of severe drought. Methods: We conducted an ecological study of secondary panel data stratified by district and month. The study population included all people in the region from 2016 to 2018. The outcome was defined as the number of new out-migrating internally displaced persons (IDPs) per district-month. Exposure variables included armed conflict, rainfall, food insecurity and food security services. Lags at one, two and three months were generated to explore possible delayed effects. All univariate and multivariate analyses were conducted using negative binomial regression models with mixed effects incorporating the district as a random effect. Results: From 2016 to 2018, the proportion of IDPs increased from 9% to 25% in Somalia, Puntland and Somaliland. We observed strong associations between IDP out-migration rate and failed rains at a three-month lag, food insecurity at a one-month lag, and the presence of therapeutic food services with no lag. IDP out-migration rate was not associated with armed conflict intensity, and cash- and rations-based food security services. Discussion: This study identified temporal, and socially and biologically plausible associations between key crisis-related risk factors and displacement in Somalia. The findings suggest a sequence of events spanning a few months, where failed rains and consequent food insecurity likely prompted early population out-migration to larger urban centers where humanitarian services were more accessible. The presence of therapeutics-based food security services could represent a more general correlate of crisis severity and the decision to migrate.

Does public transportation improve the accessibility of primary dental care in São Paulo, Brazil?

OBJECTIVE: Advances in geospatial technologies have recognized the role of geographic distance as a barrier to healthcare accessibility. Frequent transportation is supposed to buffer issues with distance, while infrequent services impede the uptake of care. The role of public transportation on the accessibility of health care-including oral health care-is not well elucidated in the context of megacities, such as the municipality of São Paulo, Brazil. This study aimed to compare the supply of public transportation to primary dental clinics and the population between advantaged and disadvantaged areas in São Paulo city. METHODS: A total of 4101 primary dental clinics in São Paulo city were identified and geocoded. Geographic coordinates were also retrieved for the 19 242 bus stops, 56 commuter rail stations and 64 rapid transit stations. Clinic locations and transport points were integrated with the city's 19 128 constituent census tracts-each containing sociodemographic data on the 11 252 204 residents-using Geographic Information Systems (GIS). RESULTS: Almost all clinics were located within 0.5 km of public transportation. Half of all clinics were within 0.5 km of high-frequency transport points, and three-quarters were within 1 km. Likewise, 99% of the population resided within 0.5 km of any public transportation. However, only 22% were within 0.5 km of high-frequency options, and half were within 1 km. Those within 0.5 km of high-frequency points had higher average monthly household incomes and lower illiteracy rates, with lower proportions of children and ethnic minorities, and higher proportions of older people. CONCLUSION: Clinics and populations in sociodemographically disadvantaged tracts have poorer public transportation links in São Paulo city.

The equity of access to primary dental care in São Paulo, Brazil: A geospatial analysis.

OBJECTIVES: Brazil is one of the largest countries in the world, in terms of geography and population. Most Brazilians reside in the south and south-eastern regions, with notable numbers in the regions' megacities, such as São Paulo city. Healthcare provision in such a complex environment is difficult. Thus, a clear understanding of the distribution - or rather, the maldistribution - of these services is fundamental for optimising the allocation of human and financial resources to areas of greatest privation. The present study aimed to determine the distribution of primary dental clinics in São Paulo city. METHODS: A total of 4,101 primary dental clinics in São Paulo city were identified and geocoded. Clinic locations were integrated with the city's 19,128 constituent census tracts - each containing sociodemographic data for the 11,252,204 residents - using Geographic Information Systems (GIS). RESULTS: Approximately two-thirds (64.8%) of the population resided within 0.5 km of a primary dental clinic, and a further 23.9% were within 1 km. Populations more than 1 km out were typically characterised as sociodemographically disadvantaged. Primary dental clinics were also more sparsely distributed in the city's peripheral census tracts than central census tracts. CONCLUSION: Primary dental clinics are maldistributed in São Paulo city, with disadvantaged populations having less spatial access than their advantaged counterparts.