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.

Undetected serovars: leptospirosis cases in the Cairns region during the 2021 wet season.

Background: Leptospirosis infection can lead to serious renal and cardiopulmonary complications and can be fatal. Following heavy rainfall and localised flooding in early 2021, Tropical Public Health Services in Cairns were alerted to an increase in leptospirosis cases in the region, with notifications almost three times higher than usual by mid-February. An epidemiological investigation was undertaken. Methods: Leptospirosis notification data were obtained from the Queensland Notifiable Conditions System. Confirmed and probable cases residing in the Cairns region, with an onset date between 1 January and 31 May 2021, were included in the investigation. Case demographics, pathology results, symptoms, hospital stay information and presumed exposure sources were obtained from Queensland Health records; local rainfall data was obtained from the Australian Bureau of Meteorology. Case characteristics and rainfall were compared to the prior ten-year period and the distribution of cases by week of onset, address, exposure source and infecting serovar analysed. Results: A total of 43 leptospirosis cases were notified between January and May 2021, the highest number recorded for the region since 2011. Presumed exposure sources were available for 40 cases (93.0%), with 33 cases (82.5%) exposed occupationally, including 25 cases working on banana farms. Infecting Leptospira serovars were identified for five cases (11.6%), with four infected with serovar Australis and one with serovar Zanoni. Limited information about the specific exposure sites for each case and a low serovar detection rate hampered the ability to confirm the presence or absence of a leptospirosis outbreak. While heavy rainfall is likely to have contributed to the spike in cases, no factors were identified as clearly associated with the increase. Conclusions: A number of pathways are proposed to improve the collection of exposure site data and the identification of infecting serovars, in order to strengthen local leptospirosis surveillance and the ability to detect outbreaks in the Cairns region.

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'.