Communicable diseases intelligence (2018)最新文献

Abstract: An outbreak of salmonellosis occurred in August 2024 after consuming wild hunted kangaroo in a remote area of the Northern Territory (NT), Australia. We conducted an outbreak investigation via telephone and face-to-face interviews, using a standardised questionnaire that recorded symptoms and exposures to foods and activities prior to onset of symptoms. A confirmed outbreak case was defined as anyone with laboratory confirmed Salmonella Muenchen infection who was part of a group of people who shared meals on 25-26 August 2024. A probable outbreak case was defined as anyone who was part of a group of people who shared meals on 25-26 August 2024 and subsequently experienced diarrhoea, in the absence of a laboratory test. Of the seven members of the group who shared meals, all became ill (attack rate 100%); three were confirmed cases and four were probable cases. The median age was 32 years (range 23-65 years); six (86%) were male. The median incubation period was 24 hours (range 6-30 hours). The most commonly reported symptoms were diarrhoea (100%, 7/7) and abdominal pain (86%, 6/7). Two cases were admitted to hospital, both for an overnight stay; all recovered. All seven cases consumed the same meal - a single, locally hunted and butchered kangaroo. Contamination likely occurred due to unsafe butchering, storage, transportation and insufficient cooking of the meat. This outbreak highlights the risks of contamination of game meat (in this case kangaroo) with Salmonella. Those preparing hunted meat should wash hands and knives regularly while butchering an animal to avoid contamination; should store butchered meat below 5 °C to avoid bacterial growth and cook foods thoroughly to kill microbes. We estimate that the cost to society of this outbreak was 9,810 Australian dollars.

Abstract: Leptospirosis is a zoonosis caused by exposure to Leptospira excreted into the environment by rodents or other mammals. A notification of a case of leptospirosis in an adult male with no history of travel or exposure to livestock or rodents triggered an environmental health investigation of his workplace, a local golf course. We hypothesised that a water splash in the eye from a creek running through the golf course, which occurred after a period of heavy rainfall, had led to Leptospira exposure, likely on the basis of contamination of the creek water by rodent urine. Testing of environmental water samples detected pathogenic Leptospira DNA in ten of eleven samples, although cultures were negative. However, we had difficulty interpreting this finding as we found Leptospira DNA in ten of 14 environmental samples in inner and eastern Sydney remote from the workplace, and these were not associated with notified human cases. When we reviewed the 53 human leptospirosis cases notified over the twenty-year period 2003-2022 in residents of metropolitan Sydney, of the 49 cases with Leptospira exposure information, 46 had recognised sources of exposure: travel overseas (27) or to tropical northern Australia (5); rural exposure often to livestock and/or rodents (12); work in an abattoir (1); and involvement in a raspberry farm outbreak (1). Only three, including the case described, acquired infection in suburban Sydney. Acquisition of human leptospirosis is a rare event in suburban Sydney; true cases without a travel or occupational exposure history may be under-recognised by clinicians. However, with increasing biodiversity loss and where climate change results in heavier rainfall and more frequent floods, it is likely that human leptospirosis will become more common in urban as well as endemic settings.

Abstract: 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.

Abstract: A 71-year-old Australian-born man with previous extended travel to the Philippines presented with bilateral lymphoedema, fevers and rigors. Examination of a nocturnal blood film revealed microfilariae of Wuchereria bancrofti, confirming a diagnosis of Bancroftian filariasis. This case highlights the challenges of diagnosing and managing lymphatic filariasis in non-endemic regions.

Abstract: The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in Neisseria gonorrhoeae for more than 40 years. In 2023, a total of 10,105 isolates from patients in the public and private sectors, in all jurisdictions, were tested for in vitro antimicrobial susceptibility by standardised methods. Nationally, in 2023, the AGSP captured antimicrobial susceptibility data for 25% of all gonococcal infection notifications. The current treatment recommendation for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. In 2023, of N. gonorrhoeae isolates tested, 0.22% (22/10,105) met the WHO criterion for ceftriaxone decreased susceptibility (DS), defined as a minimum inhibitory concentration (MIC) value ≥ 0.125 mg/L. Resistance to azithromycin was reported in 4.5% of N. gonorrhoeae isolates, proportionally stable since 2019. There were 27 isolates (0.27%) with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) reported in Australia: Victoria (13), New South Wales (11), non-remote Western Australia (2) and Queensland (1). This is the highest number ever detected and reported in a twelve-month period by the AGSP. In 2023, penicillin resistance was found in 30.7% of gonococcal isolates, and ciprofloxacin resistance in 60.3%, although there was considerable variation by jurisdiction. In some remote settings, penicillin remains recommended as part of an empiric therapy strategy. However, in 2023, in remote Northern Territory, five penicillin-resistant isolates were reported; and in remote Western Australia, 14.1% of gonococcal isolates (10/71) were penicillin resistant. In addition, there were eight ciprofloxacin-resistant isolates reported from remote Northern Territory; ciprofloxacin resistance rates have increased in remote Western Australia (16/71; 22.5%). This increase in penicillin-resistant Neisseria gonorrhoeae in the Northern Territory has effected a change in gonococcal treatment recommendations.

Abstract: This document provides guidelines for tuberculosis (TB) workforce policy and development in Australia, detailing the multidisciplinary nature of the TB workforce, the roles, required skills, and priorities within that workforce, and strategies for its development. Training and development responsibilities and roles of various bodies are also detailed: the National TB Advisory Committee; jurisdictional TB programs and their administrators; the Australian Centre for Disease Control; and sundry other national and international bodies.

Congenital syphilis is a preventable yet severe condition resulting from untreated maternal syphilis. Since 2016, Australia has recorded over 95 congenital syphilis cases, with 31/95 (33%) associated with perinatal death. Syphilis serology is complex and therefore performed in designated central laboratories. In the Northern Territory, specimen transport times associated with vast geographic distances lead to delayed results in remote regions. This study evaluates the introduction of the Abbott Determine™ Syphilis TP lateral flow immunoassay (LFI) at Alice Springs Hospital (ASH) to reduce turnaround times for maternal syphilis screening. During the period 2 September - 1 December 2024, eighty-eight LFIs were performed on serum from 74 pregnant women at the ASH laboratory. LFI results were available within 24 hours for 99% of cases, with a median turnaround time of six hours compared to 61 hours for the screen done in Darwin (p < 0.001). No new syphilis cases were detected; all positive LFI results reflected past treated infections. LFI demonstrated 100% sensitivity and specificity compared to standard serology. Although syphilis LFI cannot distinguish active from past infections, it significantly improves the timeliness of screening results, reducing risks of delayed treatment and of loss to follow-up. Implementing a syphilis LFI in remote laboratory settings offers a strategy to enhance syphilis diagnosis and prevention, with broader applicability in high-burden remote regions.

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.

Introduction: Shigella is a notifiable condition in Victoria under the Public Health and Wellbeing Act. Since 24 October 2022, the South East Public Health Unit (SEPHU) has been managing these notifications for the south east region of Melbourne.

Aim: This study aimed to determine the demographics and risk factors for acquisition of shigellosis cases in the SEPHU catchment.

Methods: A review was performed of all shigellosis notifications within the SEPHU catchment during the period 1 January 1 2022 - 31 March 2023. De-identified information was collated from the Public Health Event Surveillance System (PHESS) for analysis of demographics, risk factors and antimicrobial resistance.

Results: A total of 127 cases were notified: 51 were confirmed with culture, with the remaining 76 identified as probable cases through polymerase chain reaction testing. The greatest numbers of cases were within the 0-4 and 5-9 years of age categories (each 19/127; 15%), followed by the 30-34 years age group (18/127; 14%). The highest case numbers were recorded in the local government area (LGA) of Casey (30/127; 24%) while the highest rate across the 15-month study period, of 20.2 per 100,000, was from the Stonnington LGA. The most prominent primary risk factor was travel overseas (62/127, 49%) followed by contact between men who have sex with men (MSM) (16/127, 13%). Of confirmed cases, 61% (31/51) met the criteria for classification as critical antibiotic resistance (CAR) shigellosis.

Conclusion: This review found that the LGAs with high number and rates of cases are Casey, Greater Dandenong and Stonnington. However, the risk factors for acquisition differs in these areas, indicating a need for LGA-specific education in the diverse SEPHU catchment.

Overview: We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program funded vaccines, as at 2 April 2023 for children, adolescents and adults, focusing on the calendar year 2022 and on trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs.

Children: Fully vaccinated coverage in Australian children in 2022 was 0.6-1.1 percentage points lower than in 2021 at the 12-month (93.3%), 24-month (91.0%) and 60-month (93.4%) age assessment milestones. This follows the 0.6-0.8 percentage point decrease at the 12- and 60-month milestones between the 2020 and 2021 reports, which came after eight years of generally increasing coverage. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2021 and 2022 predominantly reflect vaccinations due in 2020 and 2021, respectively, and therefore reflect impacts of the first two years of the coronavirus disease 2019 (COVID-19) pandemic. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was 1.2-2.2 percentage points lower in 2022 than in 2021 at the 12-month (90.0%), 24-month (87.9%) and 60-month (95.1%) milestones, indicating differential impacts of the pandemic. However, at the 60-month milestone, coverage in Indigenous children was 1.7 percentage points higher than in children overall. There were also clear pandemic impacts on on-time (within 30 days of recommended age) vaccination. On-time coverage of both the second dose of diphtheria-tetanus-pertussis and the first dose of measles-mumps-rubella-containing vaccines decreased progressively from mid-2020 onwards (6 and 12 percentage point falls, respectively) before recovering partially in the second half of 2022, with decreases 1.5-2.3 percentage points greater in Indigenous than non-Indigenous children, from an already close to 10 percentage points lower pre-pandemic baseline.

Adolescents: Of adolescents turning 15 years in 2022, a total of 85.3% of girls and 83.1% of boys (83.0% and 78.1% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 0.9-1.3 percentage points lower than in 2021 (2.5-3.1 percentage points for Indigenous adolescents), also reflecting pandemic impacts. It will be important to monitor coverage with the single-dose HPV vaccine schedule - which was implemented from February 2023 - to ensure that it is sustained (ideally, increasing) and equitable, given that coverage in 2022 was 5-6 percentage points lower in adolescents in socioeconomically disadvantaged and remote areas. By 31 December 2022, coverage for an adolescent dose of diphtheria-tetanus-acellular pertussis vaccine in adolescents turning 15 years in 2022 was 86.9% (82.6% for Indigenous adolescents) and