Communicable diseases intelligence (2018)最新文献

The reference laboratories of the Australian Meningococcal Surveillance Programme (AMSP) report data on the number of cases of invasive meningococcal disease (IMD) confirmed by laboratory testing using culture and molecular based techniques. Data contained in quarterly reports are restricted to a description of case numbers of IMD by jurisdiction and serogroup, where known and expanded in 2024 to include antimicrobial resistance data for ceftriaxone, penicillin, ciprofloxacin and rifampicin. A full analysis of laboratory confirmations of IMD in each calendar year are contained in the AMSP annual reports.

Since 1993, the Australian Paediatric Surveillance Unit (APSU) has been conducting prospective national surveillance of rare conditions in Australian children, including communicable diseases and complications of communicable diseases. In 2024, fifteen communicable diseases and complications were under APSU surveillance: acute flaccid paralysis (AFP); congenital cytomegalovirus (cCMV) infection; dengue; severe acute hepatitis; neonatal/infant herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection, juvenile-onset recurrent respiratory papillomatosis (JoRRP); severe complications of influenza (Flu); Japanese encephalitis virus infection; paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS); Q fever; congenital rubella infection/syndrome; congenital varicella syndrome; and neonatal varicella infection. A total of 1,350 paediatricians and other child health specialists received the monthly APSU report card (97% electronically) in 2024. A total of 237 notifications were received, with 174 confirmed as incident cases after excluding duplicates, errors and prevalent (historic) cases not previously reported. The incident cases included: Flu (n = 34) - one child died and only two children had received influenza vaccination; JoRRP (n = 1); NVI (n = 1); cCMV (n = 26); HSV (n = 8) - neurological sequelae were common; perinatal exposure to HIV (n = 15) - no cases of mother-to-child transmission identified; and rare emerging diseases dengue (n = 4) and PIMS-TS (n = 2). The non-polio AFP rate of ≥ 1 case per 100,000 children aged < 15 years was again achieved. The APSU continues to be an important mechanism for obtaining enriched data on rare communicable diseases and their complications in Australian children, to better understand disease burden, and the effects of health interventions, over time.

Objective: The primary aim of this paper is to describe the outbreak investigation and public health response to a cluster of mpox cases that occurred in Southeast Queensland; and to investigate transmission dynamics to inform contact management.

Background: The transmission of mpox in Australia has continued to circulate among the men who have sex with men community, since the declaration of the global outbreak of clade IIb in 2022. In May 2024, an outbreak investigation was carried out following the admission of an mpox case to a Queensland hospital, which precipitated a response coordinated by two metropolitan public health units (Metro North and Metro South) in Brisbane.

Methods: A prospective cohort study was conducted to follow up attendees of an intimate group event over a 21-day period. From 21 event attendees, 16 were able to be contacted by public health clinicians, and were included in the cohort. Case histories and their respective contacts were identified and classified as high, medium or low risk. Descriptive statistics were conducted, and relative risk was determined for developing infection after attendance at the group event, when accounting for the level of vaccination against mpox. Whole genome sequencing was performed on collected pathology specimens, and phylogenetic analysis was conducted to support epidemiological investigations.

Findings: A total of ten cases of mpox were detected, among a cohort of 16 males with differing levels of vaccination. Transmission of mpox occurred exclusively among high-risk contacts; no transmission was observed to medium- or low-risk contacts. Laboratory investigations revealed that all cases were of human MPXV clade IIb. Complete vaccination was a protective factor against development of mpox (relative risk = 0.33; 95% confidence interval: 0.06-1.88), compared with partial or no vaccination, after attendance at the high-risk exposure event. This outbreak resulted in 34 contacts, of which one high-risk contact became a secondary case. Findings from this investigation suggest there is less urgency for follow-up of household contacts and other medium- and low-risk contacts of mpox, compared with high-risk contacts. Fostering a rapport during telephone interviews with cases and contacts was found to be crucial to the overall attainment of accurate case histories, highlighting the need for the development of trust when interacting with members of priority groups. This outbreak investigation describes a comprehensive public health response attributed to the coordination of a range of public health workers in the Southeast Queensland area.

The National Neisseria Network (NNN), Australia, established in 1979, comprises reference laboratories in each state and territory. Since 1981, the NNN has reported data for the Australian Gonococcal Surveillance Programme (AGSP), on antimicrobial susceptibility profiles for Neisseria gonorrhoeae isolated from each jurisdiction for an agreed group of agents. The antibiotics reported represent current or potential agents used for the treatment of gonorrhoea, and include ceftriaxone, azithromycin, ciprofloxacin and penicillin. More recently, gentamicin and tetracycline are included in the AGSP Annual Report. Ceftriaxone, combined with azithromycin, is the recommended treatment regimen for gonorrhoea in Australia. Historically, there were substantial geographic differences in susceptibility patterns across the country, with certain remote regions of the Northern Territory and Western Australia having low gonococcal antimicrobial resistance rates. In these regions, an oral treatment regimen comprising amoxycillin, probenecid, and azithromycin was recommended. However, since January 2023, increasing reports of penicillin-resistant N. gonorrhoeae in the Northern Territory have changed treatment recommendations to align with the majority of Australia.1 Additional data on other antibiotics are reported in the AGSP Annual Report. The AGSP has a programme-specific quality assurance process.

Background: Legionnaires' disease causes severe pneumonia. Outbreaks are infrequent in Australia, with cooling water systems (CWS) regulated to reduce risk. In summer 2024, a Legionella pneumophila serogroup 1 (Lp1) outbreak was detected in visitors to the Sydney central business district (CBD). We investigated to identify cases and to control the source.

Methods: Case-patients were detected through routine laboratory notifications and classified as per surveillance case definitions. Case-patients were interviewed to determine symptoms, and environmental exposures 2-10 days prior to symptom onset. We mapped exposures sites and walking routes to identify areas for investigation. CWS in shared exposure areas were inspected and tested for Legionella. Historical results from routine CWS testing were reviewed. Genomic sequencing was performed on environmental and patient isolates. Clinician and public alerts were issued, and CBD building managers were reminded to maintain CWS.

Results: The investigation identified 15 legionellosis case-patients: two had Lp1 positive sputum cultures, 14 were hospitalised, and six required intensive care. All case-patients visited the CBD during the period 12-26 December 2023. Between 3-12 January 2024, testing was performed on 166 CWS across 118 CBD sites, and on three water fountains. Lp1 was cultured from one CWS. Genomic sequencing from five environmental and two clinical isolates showed a probable link. The positive CWS was decontaminated but continued to have Lp1 detected, possibly due to ongoing dust contamination, necessitating additional maintenance. Weeks later, a case-patient diagnosed in Europe, who had visited key exposure locations in the CBD during 21-23 December 2023, was epidemiologically linked to the outbreak; this took the total number of case-patients to 16.

Conclusion: Our investigation indicated that a contaminated CWS may have been the source of this outbreak, with contamination potentially precipitated by nearby construction. This emphasises the importance of strengthening Australian CWS regulations to reduce Lp1 outbreak risk, and of timely reporting under International Health Regulations to identify additional outbreak cases.

Invasive group A streptococcal disease (iGAS) was made a notifiable condition in Australia in July 2021 and in Victoria in February 2022. The North Eastern Public Health Unit (NEPHU) in metropolitan Melbourne began managing iGAS cases in May 2023 with little prior knowledge of local epidemiology. Case numbers in NEPHU increased by 139% from 64 in 2022 to 153 in 2023. The incidence rate increased from 3.5 per 100,000 population in 2022 to 8.4 per 100,000 population in 2023. The case fatality rate in NEPHU during this period was 6.9%, with almost half of all deaths among individuals aged 70 years and above. Chronic conditions were commonly reported in the cases' clinical histories, with 29% of NEPHU cases reporting an underlying illness. International trends of increased incidence of iGAS have been reflected in the NEPHU catchment, albeit with only two years of surveillance data. Monitoring trends in iGAS is an ongoing priority for NEPHU, to better understand disease patterns within the catchment area and to inform public health actions.

Since the introduction of Neisseria gonorrhoeae nucleic acid amplification tests (NG-NAATs) into routine clinical use, false-positive results caused by cross-reaction with non-gonococcal Neisseria species have been an issue, particularly in specimens from the pharynx. Therefore, since 2005 in Australia, a confirmatory assay has been recommended, with a positive result issued only when both assays are concordant. At the request of the Public Health Laboratory Network (PHLN) Australia, the National Neisseria Network (NNN) met to review the 2015 PHLN NG-NAATs Guidelines in October 2024, in the context that some later generation N. gonorrhoeae NAATs have claims for testing pharyngeal samples without the need for supplemental testing for confirmation. Adequacy of performance in this context was considered by the NNN as a positive predictive value of 95% in line with World Health Organization guidance. Based on the 2024 review, it is recommended that: • Supplementary testing continue to be performed for all non-urogenital (pharyngeal and rectal) samples. • Supplementary testing be at the discretion of individual laboratories, based on local validation data demonstrating adequate performance based on WHO recommendations, for urogenital samples. Additional testing should continue to be considered when testing low-risk populations.

This report summarises Australia's spontaneous surveillance data for adverse events following immunisation (AEFI) for COVID-19 vaccines given in 2022 reported to the Therapeutic Goods Administration (TGA). The TGA strongly promoted and facilitated adverse event reporting in preparation for and during the COVID-19 vaccine rollout as a core component of the most intensive vaccine safety monitoring ever conducted in Australia. There were 18,398 AEFI reports for COVID-19 vaccines administered in 2022, corresponding to an annual AEFI reporting rate of 89.6 per 100,000 doses of COVID-19 vaccines administered. The annual AEFI reporting rate for non-COVID-19 vaccines in 2022 was 18.8 per 100,000 doses administered to people of all ages. Overall, the most frequently reported symptoms were adverse events consistent with the expected side effects from vaccines, as reported in clinical trials. These were classified as 'gastrointestinal nonspecific symptoms and therapeutic procedures', headache, chest pain, myalgia and pyrexia. The most frequently reported adverse events of special interest were myocarditis and/or pericarditis, followed by thrombosis and thromboembolism, and anaphylaxis. Of all COVID-19 vaccine AEFI reports, 160 (0.9%) included a fatal outcome, of which over 60% were in people aged ≥ 60 years. Of these 160 reports, only one was assessed by a Vaccine Safety Investigation Group (VSIG) as a death likely to be causally linked to vaccination. This report confirms the value of spontaneous post-marketing vaccine pharmacovigilance, especially in the context of new vaccines using novel technologies and a near whole-of-population pandemic vaccination program. Ongoing safety monitoring continued to review and respond to reports of rare, unexpected conditions, such as myocarditis/pericarditis, with investigations resulting in changes to vaccine recommendations and product information. Overall, COVID-19 vaccine safety monitoring continued to demonstrate a reassuring safety profile for these vaccines, especially among children and adolescents aged 11 years and below, in whom COVID-19 vaccines were used for the first time in 2022 in Australia.

Having been declared polio-free by the World Health Organization (WHO) in 2000, Australia remains at risk of poliovirus importation until the virus is eradicated globally. Australia monitors for poliovirus by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the WHO. Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System, and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2024, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 2.04 non-polio AFP cases per 100,000 children, thereby meeting the WHO's performance criterion for a sensitive surveillance system. Non-polio enteroviruses including enterovirus A71 were identified from clinical specimens collected from 14 AFP cases. Australia also performs enterovirus and wastewater surveillance to complement the clinical surveillance system focussed on children. In 2024, there were 21 different non-polio enterovirus types detected in 764 clinical specimens referred for enterovirus typing, while an ambiguous vaccine-derived poliovirus type 2 was detected through wastewater surveillance. In 2024, there were 99 cases of wild poliovirus reported from the two remaining endemic countries, Afghanistan and Pakistan. Another 319 cases of poliomyelitis due to circulating vaccine-derived poliovirus were reported across 21 countries.

In late 2023, an outbreak report of acute post-streptococcal glomerulonephritis (APSGN) in the Torres Strait documented seven confirmed cases and one probable case. This prompted an island-wide mass drug administration of oral trimethoprim/sulfamethoxazole to children aged 12 months to 17 years of age, possibly the first of its kind in response to an APSGN outbreak. In early 2024, an APSGN outbreak was declared with one confirmed and two probable cases, in the nearby Northern Peninsula Area of Cape York. The public health response to this outbreak included screening all children between 12 months and < 17 years of age for skin sores and sore throats, with treatment provided as deemed clinically appropriate. Both outbreaks reported nil further cases in the four months following each response. The relative merits of the different approaches will be discussed.