Communicable diseases intelligence (2018)最新文献

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

Background: Both injecting drug use (IDU) and drug use by non-injecting routes only (non-IDU) are recognised internationally as behavioural risk factors for syphilis. In Australia, this association has predominantly been assessed in sexual health services. To generate evidence supporting regular screening and timely symptomatic testing of all at-risk populations, South Australia in 2022 commenced routine collection of drug use information for statutory syphilis surveillance.

Methods: We analysed reported IDU and non-IDU for all cases of infectious syphilis notified during the period 1 July 2022 - 30 September 2023 by demographic, clinical, and diagnosing provider characteristics. We used descriptive analyses and univariable logistic regression to compare IDU cases and non-IDU cases separately to cases reporting no drug use.

Results: There were 450 notifications during the 15-month period. Among the 92% of notifications with available information, IDU was reported for 10% of cases and non-IDU for 17%. Drug use of any kind was more common among females, cases diagnosed outside specialist services, and heterosexual and bisexual cases. Differences by city versus regional or remote location and symptom status were less notable. Only the increased odds of IDU among females (odds ratio (OR): 2.8; 95% confidence interval (95% CI): 1.2-6.3) and the increased odds of either type of drug use among cases reporting sexual partners of a different sex (IDU: OR: 2.5; 95% CI: 1.2-5.3; non-IDU: OR: 3.0; 95% CI: 1.7-5.4) and of partners of both sexes for non-IDU (OR: 3.0; 95% CI: 1.4-6.6) reached statistical significance.

Conclusion: These data demonstrate a high prevalence of IDU and non-IDU amongst syphilis cases diagnosed outside sexual health services. Females and heterosexuals report drug use more frequently than men who have sex with men (MSM). In response, the correctional and drug and alcohol sectors have been engaged to increase routine screening and primary care providers alerted to recreational drug use as a risk factor for syphilis.

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 January to 31 March 2024.

Background and methods: In March 2022, an outbreak of Japanese encephalitis virus (JEV) infection was identified in temperate south-eastern Australia, with detections in humans and animals. The unexpected emergence of JEV prompted a national public health response and a Communicable Disease Incident of National Significance was declared. JEV has previously only been identified in tropical north-eastern Australia in localised outbreaks. This article provides a descriptive analysis of the human case epidemiology of the national outbreak from 1 January 2021 to 30 June 2022.

Results: There were 42 confirmed and probable human cases of JEV identified as acquired in Australia between 1 January 2021 and 30 June 2022. Seven deaths occurred (case fatality rate: 17%). Cases were identified in five Australian jurisdictions (New South Wales, Victoria, Queensland, South Australia and the Northern Territory). The majority of cases were aged 60 years and over (55%; 23/42), with a median age of 61.5 years (range: 0-79 years; interquartile range: 45-70 years); cases were predominantly of non-Indigenous status (90%; 38/42). Sixty-seven percent (28/42) were male. Of the cases with geographical data available (n = 41), all were likely exposed to the virus in 31 unique local government areas across regional and remote Australia.

Conclusions: Cases were detected across Australia in five jurisdictions, requiring a national public health response, to detect and prevent further cases. There was widespread geographical distribution over 18 months. Given the risk of further cases and possible endemicity of JEV being established in Australia, expanded environmental and human surveillance programs are required.

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 April to 30 June 2024.

Abstract: The detection of Japanese encephalitis virus (JEV) in pigs, at four piggeries in the Murray region in February 2022, prompted a public health investigation (PHI) by the New South Wales Department of Health (NSW Health) to identify people at greatest risk of infection. The PHI included three components: a vaccination clinic and accompanying clinic questionnaire; a serological investigation; and a cross-sectional study for consenting Australian-born participants who completed an extended questionnaire after receiving their serological results. The goals were to vaccinate a presumably naïve population to reduce associated risk and to understand the seroprevalence among Australian-born piggery workers. A total of 322 farm workers and/or residents attended clinics organised by NSW Health; 311 received a JEV vaccine (96.6%); and 302 (94%) completed a clinic questionnaire. Of 178 people from whom serology was collected (55.3%), a total of 165 returned Defined Epitope Blocking enzyme-linked immunosorbent assay (DEB ELISA) results; 153/165 of those returning DEB ELISA results were Australian born. The study's cross-sectional component involved 129 participants, ten of whom were seropositive. The overall seropositivity for 153 Australian-born participants across the identified piggeries was 6.5% (95% confidence interval [95% CI]: 3.4-12.0%), suggesting that JEV was circulating in piggeries, and plausibly more broadly, within the Murray region prior to serology collection. Male sex and working on, or visiting, a farm other than their regular workplace were both associated with JEV seropositivity (odds ratio [OR]: 5.4; 95% CI: 0.94-137.1 and OR: 37; 95% CI: 0.92-22.08 respectively). JEV vaccination uptake was high among piggery workers in the Murray region. Further studies are needed to determine if piggery workers have an increased risk of developing JEV compared to people who do not work or live on JEV-affected piggeries. The reasons for the emergence of JEV in pigs in the Murray region remain unclear.

Abstract: Australia is the only high-income country where trachoma has been endemic, defined as an overall trachoma prevalence in Aboriginal and Torres Strait Islander children aged 5-9 years of 5% or more. The Australian Government funds the National Trachoma Surveillance and Reporting Unit to collate and analyse trachoma prevalence data and control strategies annually. This report presents data submitted from 2014 to 2022. In 2022, there were 87 remote communities considered at-risk of endemic trachoma, a decline of 51% since 2014 when 177 communities were considered at-risk. World Health Organization grading criteria are used to diagnose trachoma in at-risk populations. Overall prevalence, which includes estimates from all communities ever considered at-risk, fell below 5% endemicity thresholds for the first time in 2022 in Western Australia (2.9%), the Northern Territory (2.1%), New South Wales (0.5%), and in Queensland and South Australia (0.0% each). New cases of trachomatous trichiasis-a severe consequence of trachoma that causes blindness-were detected in eight out of 10,806 persons, aged 15 years and over, screened in 2022. Jurisdictional trichiasis prevalence was 0.2% in Western and South Australia and 0.0% in the Northern Territory. Australia must maintain overall trachoma and trichiasis prevalence below endemicity levels for a further two years before applying for World Health Organization validation of elimination of trachoma as a public health problem.