Communicable diseases intelligence (2018)最新文献

Background: The HOTspots surveillance and response program monitors antimicrobial resistance (AMR) in selected bacterial pathogens across three jurisdictions in northern Australia. In 2022, the program collected data from 164 community healthcare clinics and 50 hospitals to assess AMR trends and geographic variations.

Methods: Data on resistance rates for methicillin-resistant Staphylococcus aureus (MRSA) and for Escherichia coli (E. coli) were analysed. Geographic regions were compared to identify variations in AMR across the Northern Territory, northern Western Australia and northern Queensland. Resistance rates were compared between community clinics and hospitals.

Findings: In 2022, there were 56,003 clinical isolates submitted to HOTspots. Geographic variation was evident in S. aureus methicillin resistance, with MRSA accounting for 14.4% of S. aureus isolates in the east, 53.1% in central northern Australia and 46.3% in western northern Australia. Clindamycin-resistant MRSA was highest in the Northern Territory (21.7%) compared to Western Australia (16.1%) and Queensland (5.9%), limiting treatment options for community-acquired MRSA. Ceftriaxone-resistant E. coli also varied geographically, with resistance rates ranging from 3.9% in the east to 23.4% in central and 10.1% in the west. High rates of ceftriaxone resistance were observed in both community clinics (10.6%) and hospitals (16.3%). Nitrofurantoin-resistant E. coli remained low (0.2%) and stable over the past five years.

Interpretation: HOTspots data are critical for informing local antibiotic guidelines and aiding clinical decision-making. This detailed surveillance captures geographic and healthcare-setting-specific variations in AMR, which can improve regional treatment strategies across northern Australia, with a focus on the Northern Territory, which had previously lacked comprehensive surveillance.

Abstract: Acute post-streptococcal glomerulonephritis (APSGN) is an immune-mediated kidney condition, typically affecting children. While the incidence has declined in urban Australia, APSGN remains a major concern in rural and remote communities, particularly among First Nations children. This study describes the epidemiology of APSGN in the Torres Strait and Cape York region of Far North Queensland (FNQ) over a three-year period, from January 2022 to December 2024, which spanned pre- and post-mandatory public health notification of APSGN in Queensland. Cases were initially identified through electronic medical record alerts and later augmented by clinical notification when APSGN became notifiable in Queensland in October 2023. Over the three years of our study period, there were 75 confirmed, probable and possible cases identified, including outbreaks on Waiben (Thursday Island) and New Mapoon. The median age of cases was six years (interquartile range: 4-9 years), with 92% of cases occurring in children under 15, all from First Nations backgrounds. The 63 confirmed and probable cases in children under 15 represent an incidence within this population of 390 cases per 100,000 person-years (95% confidence interval: 294-486 per 100,000 person-years), ostensibly the highest documented rate globally. In the modern era, the burden of this preventable disease for FNQ First Nations children is the highest in the world. Progress will only be made by addressing the underlying social determinants of health, including childhood disadvantage and household crowding.

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections, especially in infants and young children globally. Despite its impact, RSV testing and epidemiological data remain limited, particularly in regional Australia. Central Queensland, with its subtropical climate, provides a unique setting in which to study RSV trends, testing patterns, and associated hospital burden.

Methods: This study used hospital-based data to analyse RSV-related hospitalisations and testing from Central Queensland. Data were collected retrospectively between 2018 and 2021 and prospectively between 2022 and 2023. Eligible cases included individuals presenting to or admitted at any hospitals in Central Queensland with laboratory-confirmed RSV or RSV-related diagnoses based on ICD-10-AM codes. The analysis focused on RSV-related hospital admissions and hospitalisation outcomes. Incidence rate ratios (IRR) for hospitalisation rates between the two periods were calculated.

Results: Between 2018 and 2023, there were 1,279 RSV-related hospitalisations, with 53.2% of cases being male. Infants under 12 months accounted for the highest proportion of admissions (38.4%). RSV-related hospitalisations peaked during the prospective study period, rising from 123 in 2018 to 357 in 2023. The hospitalisation rate among infants was significantly higher in the prospective study period compared to the retrospective study period (IRR: 2.2; 95% confidence interval [95% CI]: 1.8-2.6; p < 0.001). The Indigenous population had a significantly higher hospitalisation rate than the non-Indigenous population over the whole study period (IRR: 3.1; 95% CI: 2.7-3.6; p < 0.001). The median length of stay was two days, with 20.6% of those hospitalised requiring ventilation, 2.2% needing intensive care unit (ICU) support, and 0.9% of hospitalisations resulting in death. Mortality was highest among those aged 60 years and above (91.7%). Although infants under 12 months had the lowest RSV testing rates (9.8%), they had the highest test positivity rate (16.4%).

Conclusions: RSV admissions have been under-reported due to limited testing. Increased awareness and widespread testing during prospective surveillance revealed a significant rise in RSV-related admissions. These findings underscore the need for enhanced RSV testing, improved resource allocation, and expanded immunisation efforts to effectively manage the burden of RSV.

Abstract: As part of its role in the World Health Organization's (WHO) Global Influenza Surveillance and Response System (GISRS), the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne received a record 15,014 human influenza-positive samples during 2023. Viruses were analysed for their antigenic, genetic, and antiviral susceptibility properties. Selected viruses were propagated in qualified cells or embryonated hens' eggs for potential use in seasonal influenza virus vaccines. During 2023, influenza A(H1N1)pdm09 and influenza B/Victoria viruses predominated, accounting for 37% and 28% respectively of all viruses received, compared to 12% for influenza A(H3N2). The majority of A(H1N1)pdm09, A(H3N2) and influenza B viruses analysed at the Centre were found to be antigenically and genetically similar to the respective WHO recommended vaccine strains for the southern hemisphere in 2023. Of 5,531 samples tested for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir, seven A(H1N1)pdm09 viruses showed highly reduced inhibition against oseltamivir.

Abstract: Nationwide surveillance of Creutzfeldt-Jakob disease (CJD) and other human prion diseases is performed by the Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR). National surveillance encompasses the period since 1 January 1970, with prospective surveillance occurring from 1 October 1993. Over this prospective surveillance period, considerable developments have occurred in pre-mortem diagnostics; in the delineation of new disease subtypes; and in heightened awareness of prion diseases in healthcare settings. Surveillance practices of the ANCJDR have evolved and adapted accordingly. This report summarises the activities of the ANCJDR during 2023. Since the ANCJDR began offering diagnostic cerebrospinal fluid (CSF) 14-3-3 protein testing in Australia in September 1997, the annual number of referrals has steadily increased. In 2023, a total of 651 domestic CSF specimens were referred for diagnostic testing and 83 persons with suspected human prion disease were formally added to the national register. As of 31 December 2023, just under half of the 83 suspect case notifications (41) remain classified as 'incomplete'; 10 cases were classified as 'definite' and 28 as 'probable' prion disease; three cases were excluded through neuropathological examination and one was removed from the register as 'unlikely CJD' after clinical evaluation. For 2023, fifty-three percent of all suspected human-prion-disease-related deaths in Australia underwent neuropathological examination. No cases of variant or iatrogenic CJD were identified.

Introduction: An outbreak of gastrointestinal illness was investigated, affecting six events where attendees consumed food catered by a single catering business, in the Australian Capital Territory (ACT).

Methods: Event attendees and the catering business were surveyed using tailored food questionnaires developed in REDCap and administered on-line. Descriptive analyses were conducted for all event attendees and employees of the business, and non-fatal productivity loss estimates calculated. Retrospective cohort studies were conducted for events that occurred on two specific days. A food safety inspection was undertaken of the catering business, and food and environmental samples were collected for microbiological analysis. Faecal specimens were collected from symptomatic event attendees.

Results: A total of 82.2% of event attendees (129/157) completed a survey, of whom 49.6% (64/129) reported gastrointestinal illness resulting in an estimated non-fatal productivity loss of AUD $23,700. Univariate analysis of data collected from events on 16 November identified that illness was significantly associated with consumption of vegetarian rice paper rolls (risk ratio [RR]: 1.6; 95% confidence interval [95% CI]: 1.0-3.0; p = 0.04). Multiple foods were significantly associated with illness from events that occurred on 17 November 2022. On multivariable analysis, vegetarian rice paper rolls were associated with illness on 16 November 2022 (RR: 1.7; 95% CI: 1.01-2.8; p = 0.046); however no individual food categories were significantly associated with illness on 17 November 2022. Seven faecal specimens were positive for norovirus. While no food handlers reported illness prior to the outbreak, one food handler reported that their child had had gastroenteritis in the preceding week. Environmental Health inspection of the catering business identified inadequate handwashing facilities. Microbiological testing of seven food samples produced two marginal results: coagulase positive Staphylococcus in a sandwich egg mix and a high standard plate count in the roast beef.

Discussion: This gastroenteritis outbreak was determined to be due to norovirus. The infection source was suspected to be an asymptomatic food handler and inadequate food handling controls allowing contamination of certain foods. This study demonstrates the importance of effective hand hygiene and food handling practices at all times, given that asymptomatic individuals can excrete and transmit norovirus and these outbreaks can be large and costly.

Background: With optimal antenatal and perinatal care and immunisation, the risk of perinatal transmission of hepatitis B virus (HBV) approaches zero. However, it can be logistically challenging to deliver this care to culturally and linguistically diverse populations and to those individuals who are living in remote Australian communities. This study examined the management of pregnant women with chronic hepatitis B (CHB) and their children in Far North Queensland (FNQ). It was hoped that this would identify the successes and limitations of the current FNQ HBV programme which was established in June 2017.

Methods: We used the Queensland notifiable diseases register to identify every female of childbearing age (13-45 years) living in FNQ with CHB during the study period 1 January 2013 - 31 December 2023. We identified the children born to these women during the study period and assessed whether their care was concordant with current Australian HBV management guidelines.

Results: We identified 261 women of childbearing age who had 148 live births during the study period: 93/148 children (63%) were born to First Nations Australian mothers; 58/148 (39%) were born to mothers who were born overseas; and 46/148 (31%) were born to mothers who lived in remote locations. After establishment of the FNQ HBV programme, 71/77 pregnancies (92%) had optimal antenatal HBV care; 71/77 (92%) had optimal perinatal HBV care; and 72/77 infants (94%) had complete HBV vaccination. There have been no children confirmed to be hepatitis B surface antigen (HBsAg) positive since the establishment of the FNQ HBV programme. However, only 70/148 children (47%) have had HBsAg testing.

Conclusions: Antenatal and perinatal care and infant vaccination is currently concordant with national HBV guidelines in > 90% of pregnancies in the FNQ region. There has been no confirmed mother-to-child HBV transmission since establishment of a local HBV programme, although improved child testing is necessary to substantiate this finding.

Background: High quality Indigenous status data for vaccine preventable diseases (VPDs) in the National Notifiable Diseases Surveillance System (NNDSS) is important for evaluation of immunisation programs and ultimately for improving health outcomes for Aboriginal and Torres Strait Islander peoples. We evaluated Indigenous status completeness, and factors influencing it, for VPDs in the NNDSS.

Methods: Literature review (published and grey); descriptive analysis of NNDSS data for selected VPDs over the 2010-2019 period; standardised online survey (containing closed- and open-ended questions) of key informants; semi-structured follow-up interviews.

Results: National level Indigenous status completeness for those VPDs with a Communicable Diseases Network Australia (CDNA) target of 95% was above that target for Haemophilus influenzae type b, measles, invasive meningococcal disease and invasive pneumococcal disease (IPD: < 5 and ≥ 50 years); and was within four percentage points for hepatitis A, newly acquired hepatitis B and pertussis (< 5 years). For VPDs with an 80% target, completeness was ≥ 90% for diphtheria, mumps, rubella and tetanus; ≥ 80% for IPD (≥ 5 to < 50 years); and below target for unspecified hepatitis B (54%), laboratory confirmed influenza (47%), pertussis (≥ 5 years; 60%) and rotavirus (71%). However, completeness was above 90% for all VPDs in the Northern Territory, and all except laboratory confirmed influenza (89%) in Western Australia. Key barriers to Indigenous status completeness include the absence of an Indigenous status field on most pathology request forms and limited public health authority resource capacity to follow up missing data, particularly for high incidence diseases.

Conclusions: National level Indigenous status completeness is high for most VPDs but low for others, particularly for high incidence diseases predominantly notified by laboratories. Completeness is uniformly high for all VPDs in the Northern Territory and Western Australia; however, this is due to the resource-intensive public health follow-up of all notifications and manual cross-checking of other databases when Indigenous status is missing. To more efficiently optimise Indigenous status completeness in the NNDSS across all jurisdictions, a mix of additional strategies is needed to ensure accurate identification and recording in primary care, hospital, laboratory and public health settings, and effective transfer between them.

Abstract: Following the first outbreak of Murray Valley encephalitis in Victoria, Australia, since 1974, a serological survey was conducted in 2023 and 2024 to estimate the seroprevalence of Murray Valley encephalitis virus (MVEV) antibodies among residents in the north of the state. Between October 2023 and April 2024, a total of 507 residents from 11 local government areas in northern Victoria - Mildura, Swan Hill, Campaspe, Gannawarra, Greater Bendigo, Loddon, Greater Shepparton, Moira, Wodonga, Wangaratta, and Indigo - were tested for MVEV total antibody. Seroprevalence was 2.0% (95% confidence interval: 1.1-3.6%), comparable to background levels of seropositivity prior to the 2023 outbreak. No strong associations were identified between a range of potential risk or protective factors and MVEV seropositivity. Low seroprevalence suggests that the population in this region remains immunologically vulnerable to MVEV infection. Ongoing vector control and efforts to prevent mosquito bites will be critical in preventing flavivirus transmission in northern Victoria during future mosquito seasons.

Abstract: The Australian Paediatric Surveillance Unit (APSU) has been conducting prospective national surveillance of rare communicable diseases, and complications of communicable diseases, of childhood and infancy for more than three decades. In 2023, there were 15 communicable diseases and complications of communicable diseases under APSU surveillance, which included: acute flaccid paralysis (AFP), congenital cytomegalovirus (cCMV), dengue, severe acute hepatitis (SAH), neonatal and infant herpes simplex virus (HSV) infection, perinatal exposure to human immunodeficiency virus (HIV) and paediatric HIV infection, severe complications of influenza, juvenile-onset recurrent respiratory papillomatosis (JoRRP), Q fever, congenital rubella infection/syndrome, congenital varicella syndrome (CVS) and neonatal varicella infection (NVI), as well as two new communicable diseases, which were paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and Japanese encephalitis virus (JEV) infection. The results of 2023 APSU surveillance show a marked increase in severe influenza cases for the first time in five years, with more complications associated with influenza type B. Moreover, one child died and only 6% of children received a seasonal influenza vaccine. The APSU also received reports of cases of rare emerging diseases: dengue, Q fever and PIMS-TS. Furthermore, our results show a persistence of vaccine-preventable JoRRP, mother-to-child transmission of HIV, and deaths from neonatal HSV.