[show abstract][hide abstract] ABSTRACT: This report describes a respiratory illness outbreak amongst a group of over 700 World Youth Day 2008 pilgrims staying at a basic accommodation venue for 1 week in July 2008. At this venue, 1 group of pilgrims was accommodated as a large group in a gymnasium and another group was sub-divided into smaller groups and accommodated in classrooms. Following confirmation of an influenza B outbreak by influenza point of care testing, control measures were promptly implemented. Isolation of cases, improved hand, respiratory and general hygiene, establishment of a mobile tent health facility at the accommodation venue, and the use of oseltamivir for the treatment of cases and prophylaxis of high risk contacts were implemented and the outbreak was brought under control within the week. Overall, 20% of pilgrims met the case definition for an influenza-like illness and 36% had an onset prior to arrival at the venue. The attack rate for those with onset while at the venue was significantly higher amongst pilgrims accommodated in the gymnasium than those staying in the classrooms. Findings from this study highlight the importance of early detection, the rapid implementation of control measures and appropriate prescribing of antivirals to manage influenza outbreaks. The findings also highlight the benefits of accommodating individuals in smaller groups within basic accommodation venues in the context of mass gatherings.
[show abstract][hide abstract] ABSTRACT: Influenza intelligence in New South Wales (NSW), Australia is derived mainly from emergency department (ED) presentations and hospital and intensive care admissions, which represent only a portion of influenza-like illness (ILI) in the population. A substantial amount of the remaining data lies hidden in general practice (GP) records. Previous attempts in Australia to gather ILI data from GPs have given them extra work. We explored the possibility of applying automated data extraction from GP records in sentinel surveillance in an Australian setting.The two research questions asked in designing the study were: Can syndromic ILI data be extracted automatically from routine GP data? How do ILI trends in sentinel general practice compare with ILI trends in EDs?
We adapted a software program already capable of automated data extraction to identify records of patients with ILI in routine electronic GP records in two of the most commonly used commercial programs. This tool was applied in sentinel sites to gather retrospective data for May-October 2007-2009 and in real-time for the same interval in 2010. The data were compared with that provided by the Public Health Real-time Emergency Department Surveillance System (PHREDSS) and with ED data for the same periods.
The GP surveillance tool identified seasonal trends in ILI both retrospectively and in near real-time. The curve of seasonal ILI was more responsive and less volatile than that of PHREDSS on a local area level. The number of weekly ILI presentations ranged from 8 to 128 at GP sites and from 0 to 18 in EDs in non-pandemic years.
Automated data extraction from routine GP records offers a means to gather data without introducing any additional work for the practitioner. Adding this method to current surveillance programs will enhance their ability to monitor ILI and to detect early warning signals of new ILI events.
BMC Public Health 01/2011; 11:435. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: An important approach to protecting infants against pertussis is to provide a booster vaccination to close contacts, however this strategy requires a good understanding of infection sources to be effective. The objective of this study was to identify the most important sources of transmission of pertussis infection to infants, regardless of hospitalisation status. Standardised interviews were conducted during routine follow-up calls with the parent or guardian of laboratory confirmed pertussis cases less than 12 months of age notified to 3 Sydney metropolitan public health units during a pertussis outbreak from January to May 2009. All contacts with a coughing illness or laboratory confirmed pertussis during the 3 weeks prior to onset of illness in the index case, were recorded. A source of infection could not be identified for 29 infants (31%) and a total of 86 known or suspected sources were identified for the other 66 infants. The most frequently identified sources were siblings (36%) and parents (24%), followed by other family members (21%), friends (13%), and settings outside the home such as medical centres (6%). Of 20 siblings aged 3 or 4 years, 16 (80%) were sources of infection, compared with 14 of the 44 (32%) other siblings less than 18 years of age. During this epidemic siblings were more important sources of infant infection than parents. Siblings aged 3 and 4 years of age were particularly important transmitters of pertussis infection to infants. Minimising pertussis infection in 3 and 4 year olds may be an important measure to prevent infant infection.
[show abstract][hide abstract] ABSTRACT: Influenza outbreaks during mass gatherings have been rarely described, and detailed virologic assessment is lacking. An influenza outbreak occurred during World Youth Day in Sydney, Australia, July 2008 (WYD2008). We assessed epidemiologic data and respiratory samples collected from attendees who sought treatment for influenza-like illness at emergency clinics in Sydney during this outbreak. Isolated influenza viruses were compared with seasonal influenza viruses from the 2008 influenza season. From 100 infected attendees, numerous strains were identified: oseltamivir-resistant influenza A (H1N1) viruses, oseltamivir-sensitive influenza A (H1N1) viruses, influenza A (H3N2) viruses, and strains from both influenza B lineages (B/Florida/4/2006-like and B/Malaysia/2506/2004-like). Novel viruses were introduced, and pre-WYD2008 seasonal viruses were amplified. Viruses isolated at mass gatherings can have substantial, complex, and unpredictable effects on community influenza activity. Greater flexibility by public health authorities and hospitals is required to appropriately manage and contain these outbreaks.
[show abstract][hide abstract] ABSTRACT: Extended tunnelled roadways requiring ventilation via exhaust stacks are an increasingly common solution to traffic congestion around the world. In response to community concerns about adverse health effects associated with emissions from a new road tunnel exhaust stack, despite no demonstrable change in local ambient air quality, we conducted a cross sectional study to test for an association between exposure to the exhaust stack emissions and the presence of eye, nose and throat symptoms.
Stack emissions were modelled and categorised into areas of high, medium and low levels of exposure to emissions. A telephone interview survey was conducted in these three zones. Multivariate analysis was undertaken using Cox Proportional Hazards modelling to estimate prevalence ratios between zones for eye, nose and throat symptoms.
The prevalence of eye, nose and throat symptoms in the study area were 50 percent, 67 percent and 33 percent respectively and did not differ between the exposure zones. The presence of these symptoms was associated with a measure of reported "environmental worry".
The study did not demonstrate a community wide health impact associated with modelled emissions but is unable to exclude the possibility of sensitive individuals being adversely affected.
Environmental Health 02/2008; 7:46. · 2.71 Impact Factor
[show abstract][hide abstract] ABSTRACT: BackgroundCommercial fishing in Sydney Harbour (SH) was banned in February 2006 as a result of high dioxin levels in some SH seafood. Because of concerns by some fishers about their own dioxin levels, testing of serum dioxin levels was offered to SH commercial fishers and their families.ObjectivesAims of this study were to describe blood dioxin levels of SH fishers and family members; compare these levels to background Australian levels and international data; analyze association between intake of SH seafood and dioxin levels; and assess whether blood dioxin levels were useful to inform ongoing care of SH fishers.MethodsNSW Department of Health conducted clinics at which 112 fishers and family members gave blood for analysis of dioxin levels. Dioxin exposure was assessed through a questionnaire. Seafood dioxin levels were provided by the NSW Department of Environment and Climate Change.ResultsFor the fishers (n = 26), median TCDD and total TEQ levels were 27.3 and 62.4 pg g−1 lipid, respectively. For the whole group (n = 112), median TCDD and total TEQ levels were 9.3 and 26.1 pg g−1 lipid, respectively. Age was the strongest predictor of increased dioxin levels (p < 0.01), and consumption of SH seafood was also strongly associated (p = 0.01).ConclusionsSerum dioxin levels in the SH fisher cohort were higher than Australian background levels, but comparable with other international high fish-eating communities, and lower than occupationally and accidentally exposed cohorts. High TCDD levels in commonly eaten seafood by the SH fishers confirms this as the likely exposure source.