Communicable diseases intelligence (2018)最新文献

Abstract: The Australian National Neisseria Network (NNN) comprises reference laboratories in each state and territory that report data on antimicrobial susceptibility testing to an agreed group of antimicrobial agents for the Australian Gonococcal Surveillance Programme (AGSP). The AGSP data are presented quarterly in tabulated form, as well as in the AGSP annual report. This report presents national gonococcal antimicrobial resistance surveillance data from 1 July to 30 September 2024.

Abstract: Brucellosis is a rare zoonotic infection most commonly seen in parts of the Northern Hemisphere. Infections in Australia are uncommon and occur predominantly in Queensland and New South Wales due to the association with wild pig hunting activities. We describe a clustering of two cases of brucellosis in Victoria confirmed by genomic analysis but with no identified exposure. We detail the medical management, laboratory confirmation, and the public health investigation. While the source of the outbreak remains unclear, the two cases demonstrate a detailed and coordinated public health response to a rare infection with a unique geographical and temporal relationship.

Abstract: Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (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 2023, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.71 non-polio AFP cases per 100,000 children, thereby meeting the WHO's performance criterion for a sensitive surveillance system. The non-polio enteroviruses coxsackievirus A9, coxsackievirus B5, echovirus 9, echovirus 30, enterovirus A71 and enterovirus C96 were identified from clinical specimens collected from AFP cases. Australia also performs enterovirus and wastewater surveillance to complement the clinical system focussed on children. In 2023, there were twelve cases of wild poliovirus reported from the last two remaining endemic countries: Afghanistan and Pakistan. Another 23 countries reported cases of poliomyelitis due to circulating vaccine-derived poliovirus.

Abstract: The Australian Group on Antimicrobial Resistance (AGAR) performs regular period-prevalence studies to monitor changes in antimicrobial resistance in selected enteric gram-negative pathogens. From 1 January 2023 to 31 December 2023, a total of 57 hospitals across Australia participated in the Australian Gram-negative Surveillance Outcome Program (GnSOP). The 2023 survey tested 10,453 isolates, comprising Enterobacterales (9,503; 90.9%), P. aeruginosa (806; 7.7%) and Acinetobacter species (144; 1.4%), using commercial automated methods. The results were analysed using European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints (January 2024). Key resistances reported are to the third-generation cephalosporin ceftriaxone in 12.9% of Escherichia coli and in 6.9% of Klebsiella pneumoniae complex isolates. Resistance rates to ciprofloxacin were 14.5% for E. coli; 7.8% for the K. pneumoniae complex; 3.2% for the Enterobacter cloacae complex; and 7.6% for P. aeruginosa. Resistance rates to piperacillin-tazobactam were 6.0%; 9.4%; 23.3%; and 13.7% for the same four species/complexes, respectively. Thirty Enterobacterales isolates from 30 patients were shown to harbour a carbapenemase gene: ten with a bla_NDM gene (bla_NDM-1 [4], bla_NDM-5 [4], bla_NDM-7 [2]); nine with a bla_OXA-48-like gene (bla_OXA-244 [4], bla_OXA-48 [2], bla_OXA-181 [1], bla_OXA-232 [1], bla_OXA-484 [1]); eight with bla_IMP-4; two with bla_NDM-5 + a bla_OXA-181-like gene; and one with bla_KPC-2 + bla_NDM-5 + bla_OXA-181. Transmissible carbapenemase genes were also detected in two Acinetobacter baumannii complex isolates (bla_OXA-23; bla_OXA-23 + bla_OXA-58 + bla_IMP-4) and one P. aeruginosa (bla_IMP-4).

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.