First documented gymnasium cluster of COVID-19 with whole genome sequencing in Australia.

Background: Transmission of coronavirus disease 2019 (COVID-19) has been demonstrated in fitness settings internationally. We report the first documented case of transmission of COVID-19 in a gymnasium in Australia in 2020. Methods: Case finding and case interviews were conducted among attendees in a Western Sydney gymnasium, Australia. Whole genome sequencing using an amplicon-based approach was performed on all SARS CoV-2 polymerase chain reaction positive samples detected through surveillance. Results: We show that five cases of COVID-19 were linked to the gymnasium, with transmission occurring on 7 July 2020, when the index case transmitted the infection to four other gymnasium attendees through the sharing of an enclosed space. Conclusions: There is an ongoing risk of transmission of COVID-19 within gymnasium environments and they are justifiably classified as a 'high-risk' venue. There may be a need to expand ventilation and space requirements to prevent transmission of COVID-19 in such settings in the context of severe COVID-19 variants or to prevent respiratory disease transmission in general.

Enabling Multicentric Participatory Disease Surveillance for Global Health Enhancement: Viewpoint on Global Flu View.

Participatory surveillance (PS) has been defined as the bidirectional process of transmitting and receiving data for action by directly engaging the target population. Often represented as self-reported symptoms directly from the public, PS can provide evidence of an emerging disease or concentration of symptoms in certain areas, potentially identifying signs of an early outbreak. The construction of sets of symptoms to represent various disease syndromes provides a mechanism for the early detection of multiple health threats. Global Flu View (GFV) is the first-ever system that merges influenza-like illness (ILI) data from more than 8 countries plus 1 region (Hong Kong) on 4 continents for global monitoring of this annual health threat. GFV provides a digital ecosystem for spatial and temporal visualization of syndromic aggregates compatible with ILI from the various systems currently participating in GFV in near real time, updated weekly. In 2018, the first prototype of a digital platform to combine data from several ILI PS programs was created. At that time, the priority was to have a digital environment that brought together different programs through an application program interface, providing a real time map of syndromic trends that could demonstrate where and when ILI was spreading in various regions of the globe. After 2 years running as an experimental model and incorporating feedback from partner programs, GFV was restructured to empower the community of public health practitioners, data scientists, and researchers by providing an open data channel among these contributors for sharing experiences across the network. GFV was redesigned to serve not only as a data hub but also as a dynamic knowledge network around participatory ILI surveillance by providing knowledge exchange among programs. Connectivity between existing PS systems enables a network of cooperation and collaboration with great potential for continuous public health impact. The exchange of knowledge within this network is not limited only to health professionals and researchers but also provides an opportunity for the general public to have an active voice in the collective construction of health settings. The focus on preparing the next generation of epidemiologists will be of great importance to scale innovative approaches like PS. GFV provides a useful example of the value of globally integrated PS data to help reduce the risks and damages of the next pandemic.

FluTracking: Weekly online community-based surveillance of influenza-like illness in Australia, 2019 Annual Report.

Abstract: FluTracking provided evidence for an early, long, but moderate influenza season in the Australian community compared to prior years. Influenza-like illness (ILI) activity in 2019 peaked earlier (week ending 16 June) than any season on record in FluTracking data. ILI attack rates were above average early in the 2019 season (peak of 2.2%), and the duration of peak activity was longer than most prior years. However, ILI attack rates were lower than the five-year average in the latter half of the season. FluTracking participants reported higher vaccination coverage in 2019 (73.3%) compared with 2018 (65.7%), with the most notable increase in children aged less than five years (69.3% in 2019, compared to 55.6% in 2018). The total 2019 count of laboratory notifications (312,945) was higher than prior years (2007 onwards), and the peak weekly count of 18,429 notifications in 2019 was also higher than all prior years, except 2017. FluTracking makes a comparison to another surveillance system each year. The peak weekly percentage of calls to HealthDirect that were influenza-related was higher in 2019 (12.8%) than for 2014-2018 (range of 8.2-11.4% for peak week of activity each year). FluTracking participants reported a 2.5 times increase in influenza testing from 2018 to 2019 and a 1.5 times increase from 2017. Although 2019 was of higher activity and severity than 2018, Flutracking data indicates that 2019 was a lower activity and severity season than 2017, and notifications and influenza-related calls were heightened by increased community concern and testing.

High Attack Rate of Severe Acute Respiratory Syndrome Coronavirus 2 B.1.1.529 Among 2-Dose Vaccinated Populations in 2 Indoor Entertainment Setting Outbreaks.

We estimated attack rates of severe acute respiratory syndrome coronavirus 2 Omicron (B.1.1.529) infection among people attending a nightclub and a graduation ball where >95% had at least 2 vaccine doses. Attack rates were 295 of 535 (55.1%) and 102 of 189 (54.0%), respectively (mean, 5 days postevent). At the ball, attack rates increased with time since vaccination: 12.5% among those vaccinated 1-2 months previously and 68.0% among those vaccinated ≥3 months previously; such differences were not found at the nightclub. Recent vaccination prevents Omicron infection, but is time and setting dependent, emphasizing the importance of nonpharmaceutical public health measures in addition to vaccine booster doses to maximize protection in high-risk contexts.

Influenza outbreaks in aged care facilities in New South Wales in 2017: impact and lessons for surveillance.

INTRODUCTION: A record number of influenza outbreaks in aged care facilities (ACFs) in New South Wales (NSW) during 2017 provided an opportunity to measure the health impact of those outbreaks and assess the quality of routinely available surveillance data. METHODS: Data for all ACF influenza outbreaks in NSW in 2017 were extracted from the Notifiable Conditions Information Management System. The numbers of outbreaks, residents with influenza-like illness (ILI), hospital admissions and deaths were assessed. For each outbreak the attack rate; duration; timeliness of notification; resident and staff influenza vaccination coverage; and antiviral use for treatment or prophylaxis were analysed. Data were considered for NSW in total and separately for seven of the state's local health districts. Data completeness was assessed for all available variables. RESULTS: A total of 538 ACF outbreaks resulted in 7,613 residents with ILI, 793 hospitalisations and 338 deaths. NSW outbreaks had a median attack rate of 17% and median duration of eight days. Data completeness, which varied considerably between districts, limited the capacity to accurately consider some important epidemiological and policy issues. DISCUSSION: Influenza outbreaks impose a major burden on the residents and staff of ACFs. Accurate assessment of the year-to-year incidence and severity of influenza outbreaks in these facilities is important for monitoring the effectiveness of outbreak prevention and management strategies. Some key data were incomplete and strategies to improve the quality of these data are needed, particularly for: the number of influenza-related deaths among residents; resident and staff vaccination coverage prior to outbreaks; and recorded use of antiviral prophylaxis.

Impact of funding on influenza vaccine uptake in Australian children.

Objectives and importance of study: Young children are at higher risk for serious influenza outcomes but, historically, Australian children aged less than 5 years have had low seasonal influenza vaccine uptake. In 2018, most Australian jurisdictions implemented funded influenza vaccine programs targeted at improving vaccine uptake in this age group. Our aim was to determine how successful these programs were at improving self-reported seasonal influenza vaccine uptake at the community level by comparing vaccination rates in each Australian jurisdiction before and after the introduction of funded vaccines for children aged 6 months to less than 5 years, as well as other age groups. STUDY TYPE: Volunteer observational cohort study. METHODS: Flutracking is an email-based surveillance tool for influenza-like illness that collects information about symptoms and influenza vaccination. We used historical data from 2014 to 2017 to estimate baseline vaccination status before funding of childhood influenza vaccines was introduced. We compared self-reported vaccine uptake in children younger than 5 years, children aged 5-17 years and adults (18-64 years, and 65 years and older) in 2018 and 2019 by state or territory. Mixed effects logistic regressions were used to measure the association between vaccination and a number of predictors, including whether the child was eligible for free vaccines, and whether adults resided with children or not. RESULTS: We found large increases in vaccine uptake for children younger than 5 years in 2018 in all jurisdictions except Western Australia (where vaccines were already funded) and the Northern Territory (where funded vaccines were not introduced until 2019) that coincided with vaccine policy changes. Self-reported vaccination rates for young children in 2018 increased 2.7-4.2-fold in jurisdictions that funded the vaccine (compared with the previous, unfunded period). Being eligible for the funded vaccine was associated with much higher odds (odds ratio [OR] 4.75; 95% confidence interval [CI] 4.57, 4.79) of a young child being vaccinated. Older children and adults younger than 65 years were also more likely to receive the vaccine following policy changes. CONCLUSION: The seasonal influenza vaccine is an important protective measure for those at risk of serious outcomes, including young children. Flutracking data demonstrates that government-funded vaccines can lead to an almost five-fold increase in self-reported vaccine uptake of the targeted age group, as well as previously unreported flow-on effects to older children. This suggests that funded vaccines for young children may encourage caregivers to also vaccinate themselves and their older children.

High COVID-19 attack rate among attendees of wedding events in Bali, Indonesia, March 2020.

BACKGROUND: Large gatherings are associated with the spread of coronavirus 2019 disease (COVID-19); however, transmission dynamics are not well understood. We investigated a cluster of COVID-19 cases in returning Australian residents who attended wedding events in Bali, Indonesia, during 15- 21 March 2020. Attendees participated in various social events and were in close proximity, providing multiple opportunities for transmission. METHODS: We conducted a retrospective cohort study of the 41 attendees, of whom 17 participated in a structured interview that included history of illness, risk exposures and event attendance. We obtained data for the remaining 24 participants through corroborative histories and public health unit case investigations. RESULTS: COVID-19 was identified in 56% of attendees (23/41), with illness onset between 21 March and 2 April 2020. One secondary case was identified in a household contact of an attendee. The median age of cases was 31 years (range 3-64). One case was hospitalised and did not require critical care. There were no deaths. No cases occurred among six attendees who left prior to the actual wedding day. Guests attended multiple events and participated in high-risk transmission behaviours such as shaking hands, kissing, dancing, sharing drinks and sharing shisha (water pipes). Attack rates ranged from 64% to 87% for different exposures. We could not identify a single risk exposure that accounted for all cases; it is therefore likely there were multiple episodes of transmission. CONCLUSION: Our investigation identified a high attack rate of COVID-19 among a cohort of wedding event attendees. Attendees engaged in close physical contact, shared drinks and shisha, and were in close proximity during the wedding events, which may have contributed to the high attack rate. This outbreak highlights the significant role social events can play in transmission of COVID-19 and underscores why it is important to limit gatherings and close physical contact to control the spread of the virus.

Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study.

BACKGROUND: School closures have occurred globally during the COVID-19 pandemic. However, empiric data on transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among children and in educational settings are scarce. In Australia, most schools have remained open during the first epidemic wave, albeit with reduced student physical attendance at the epidemic peak. We examined SARS-CoV-2 transmission among children and staff in schools and early childhood education and care (ECEC) settings in the Australian state of New South Wales (NSW). METHODS: Laboratory-confirmed paediatric (aged ≤18 years) and adult COVID-19 cases who attended a school or ECEC setting while considered infectious (defined as 24 h before symptom onset based on national guidelines during the study period) in NSW from Jan 25 to April 10, 2020, were investigated for onward transmission. All identified school and ECEC settings close contacts were required to home quarantine for 14 days, and were monitored and offered SARS-CoV-2 nucleic acid testing if symptomatic. Enhanced investigations in selected educational settings included nucleic acid testing and SARS-CoV-2 antibody testing in symptomatic and asymptomatic contacts. Secondary attack rates were calculated and compared with state-wide COVID-19 rates. FINDINGS: 15 schools and ten ECEC settings had children (n=12) or adults (n=15) attend while infectious, with 1448 contacts monitored. Of these, 633 (43·7%) of 1448 had nucleic acid testing, or antibody testing, or both, with 18 secondary cases identified (attack rate 1·2%). Five secondary cases (three children; two adults) were identified (attack rate 0·5%; 5/914) in three schools. No secondary transmission occurred in nine of ten ECEC settings among 497 contacts. However, one outbreak in an ECEC setting involved transmission to six adults and seven children (attack rate 35·1%; 13/37). Across all settings, five (28·0%) of 18 secondary infections were asymptomatic (three infants [all aged 1 year], one adolescent [age 15 years], and one adult). INTERPRETATION: SARS-CoV-2 transmission rates were low in NSW educational settings during the first COVID-19 epidemic wave, consistent with mild infrequent disease in the 1·8 million child population. With effective case-contact testing and epidemic management strategies and associated small numbers of attendances while infected, children and teachers did not contribute significantly to COVID-19 transmission via attendance in educational settings. These findings could be used to inform modelling and public health policy regarding school closures during the COVID-19 pandemic. FUNDING: NSW Government Department of Health.

Defining, controlling and analysing Indigenous data: commitment to historical consistency or commitment to Australian Aboriginal and Torres Strait Islander peoples?

The Australian Bureau of Statistics (ABS) Standard Indigenous Question (SIQ) uses a question about 'origin' to collect data on Aboriginal and Torres Strait Islander people. A 2014 review found strong support among Aboriginal and Torres Strait Islander stakeholders for a question focusing on cultural identity, rather than origin. However the ABS retained the origin question to preserve data continuity. In contrast, an Australian influenza-like illness surveillance system, FluTracking, has included the question: "Do you identify as Aboriginal or Torres Strait Islander?" for the past 8 years. Brief consultations found that Aboriginal health professionals and academics preferred the 'identify' question as a more accurate descriptor of social realities of Aboriginal and Torres Strait communities. Statistical collections could adapt to improve the quality of Aboriginal and Torres Strait Islander data, and seek to reflect reality, not define it.

Flutracking: Weekly online community-based surveillance of influenza-like illness in Australia, 2017 Annual Report

Flutracking participation continued to grow, with a total of 33,947 participants in 2017 (a 9.5% increase from 2016). The majority of participants completed their survey within 24 hours of the email being sent (average 72.5% responses received in 24 hours). Overall, the rate of influenza-like illness (ILI) in 2017 was higher and remained elevated for a longer period compared to previous years except for the 2009 pandemic. Flutracking placed the severity and magnitude of the influenza season into historical context. Following the highest number of laboratory-notified influenza cases on record (2.8-fold increase from 2016), Flutracking data demonstrated a large increase in the percent of participants with fever and cough that were tested for influenza (2.9% to 5.0% for 2016 and 2017 respectively) and thus determined it was increased laboratory testing that contributed to the substantial increase in influenza notifications. Flutracking participants with fever and cough that were tested for influenza have increased each year from 2013 to 2017 at the national level, with a large increase from 2016 (2.9%) to 2017 (5.0%). The peak weekly fever and cough attack rate occurred in mid-August, with 4.1% ILI in the unvaccinated, compared to 3.1% in vaccinated Flutrackers. In the peak four weeks of ILI, 12.3% of participants experienced an episode of fever and cough. Divergence between the vaccinated and unvaccinated participants' ILI percentages was highest during the week ending 6 August 2017 (4.1% in the unvaccinated group and 2.7% in the vaccinated group). The timing of the ILI peak amongst Flutracking participants was consistent with peak notifications of laboratory-confirmed influenza.

Flutracking weekly online community survey of influenza-like illness annual report, 2016

Flutracking is a national online community influenza-like illness (ILI) surveillance system that monitors weekly ILI attack rates and seriousness of disease in the Australian community. This article reports on the 2016 findings. From 2015 to 2016 there was an 11.4% increase in participants to 30,998 completing at least one survey with a peak weekly response of 27,094 participants and a minimum weekly response of 26,123. The 2016 Flutracking national weekly percentage of participants with fever and cough peaked in late August at 2.7%, one week earlier than the national counts of laboratory confirmed influenza peaked. A lower percentage of participants took 2 or more days off from work or normal duties and sought medical advice in 2016 (peak level 1.6% and 1.0% respectively) compared with 2015 (peak level 2.0% and 1.3% respectively). Flutracking fever and cough peaked in the same week as death rates for influenza and pneumonia recorded by the NSW Registry of Births, Deaths and Marriages. The percentage of participants aged 0 to 14 years with cough and fever was higher than all other age groups in 2016. Overall, Flutracking surveillance demonstrated that the attack rates and seriousness of disease for the 2016 season at the community level were lower than 2015 and 2014.

Insights From Flutracking: Thirteen Tips to Growing a Web-Based Participatory Surveillance System.

Flutracking is a weekly Web-based survey of influenza-like illness (ILI) in Australia that has grown from 400 participants in 2006 to over 26,000 participants every week in 2016. Flutracking monitors both the transmission and severity of ILI across Australia by documenting symptoms (cough, fever, and sore throat), time off work or normal duties, influenza vaccination status, laboratory testing for influenza, and health seeking behavior. Recruitment of Flutrackers commenced via health department and other organizational email systems, and then gradually incorporated social media promotion and invitations from existing Flutrackers to friends to enhance participation. Invitations from existing participants typically contribute to over 1000 new participants each year. The Flutracking survey link was emailed every Monday morning in winter and took less than 10 seconds to complete. To reduce the burden on respondents, we collected only a minimal amount of demographic and weekly data. Additionally, to optimize users' experiences, we maintained a strong focus on "obvious design" and repeated usability testing of naïve and current participants of the survey. In this paper, we share these and other insights on recruitment methods and user experience principles that have enabled Flutracking to become one of the largest online participatory surveillance systems in the world. There is still much that could be enhanced in Flutracking; however, we believe these principles could benefit others developing similar online surveillance systems.