Communicable diseases intelligence (2018)最新文献

Abstract: In July 2023, a carbapenemase-producing Klebsiella pneumoniae (CPKP) with New Delhi metallo-beta-lactamase (NDM-5) and oxacillinase (OXA-48) carbapenemase genes was detected in the urine sample of a patient. A similar CPKP organism had previously been isolated from a surveillance rectal swab of an admitted patient, prompting an outbreak investigation. A confirmed case was defined as any suspected case in which a species of Enterobacterales was isolated from a clinical or surveillance specimen (infection or colonisation) exhibiting an NDM-5 or OXA-48 CPE gene or both, irrespective of phenotypic susceptibility. A descriptive epidemiological investigation was conducted to describe the investigation, infection prevention and control responses, and public health intervention carried out. Three confirmed cases of CPKP were identified, including the index case; 62 contacts were identified, of which 13 contacts were screened. CPKP transmission occurred between two patients on contact transmission-based precautions in separate single ensuite rooms. Despite being in the same ward, the patients did not share medical teams but shared nursing teams and ancillary staff. This study emphasises the importance of strict adherence to infection prevention and control practices and contact transmission-based precautions for patients admitted with carbapenemase-producing Enterobacterales.

Background: In Australia, gonococcal infection notification rates are increasing with reinfections representing a substantial proportion of infections. Understanding the local epidemiology of gonococcal infections and reinfections and the risk factors for reinfection can assist with the design of targeted interventions. This study aimed to describe the epidemiology of gonococcal infections and reinfections between 2017 and 2022 in the Australian Capital Territory (ACT), and to examine the risk factors for reinfection.

Methods: Data for gonococcal infections notified in the ACT between 2017 and 2022 were described. The epidemiological characteristics of individuals with a single infection and reinfection were compared using a case-case study design.

Results: There were 1,886 gonococcal infection notifications during the study period. Of these, 20.4% were reinfections (n = 385). Of 1,501 individuals, 1,254 (83.5%) had a single infection and 247 (16.5%) had a reinfection. Between 2017 and 2022, the annual gonococcal infection notification rate per 100,000 population increased from 59.98 to 80.14 and the proportion of reinfections from 4.0% to 26.8%. Compared with those with a single infection, individuals with a reinfection had significantly greater odds of being male, of having a same-sex sexual exposure, of using HIV pre-exposure prophylaxis at diagnosis, and of having been diagnosed at a sexual health/family planning clinic. Individuals with a reinfection had significantly greater odds of being in the 25-34, 35-44 and 45-54 years age groups than in the 14-24 years age group. The odds of anatomical site of first infection being only the rectum, only the throat, or at more than one site, compared with urogenital only, were significantly greater for those with a reinfection.

Conclusion: Gonococcal reinfections contribute substantially to gonococcal infection notifications in the ACT. Targeted interventions are needed to prevent gonococcal reinfections among at-risk groups, particularly among men who have sex with men, people who use HIV pre-exposure prophylaxis, and individuals accessing sexual health/family planning services.

Summary: The coronavirus disease 2019 (COVID-19) pandemic has highlighted that preparedness for and responsiveness to pandemics requires public health platforms and processes which are nimble and evidence-based and a research ecosystem which is rapidly responsive to the evolving needs of society and decision-makers. The national BEAT COVID-19 research consortium was funded in 2020 by the Snow Medical Research Foundation (Snow Medical). Its Expert Advisory Committee met with the consortium post-pandemic to summarise the research undertaken and to consider lessons learned through the research response to COVID-19 in Australia. The panel observed that philanthropy offered an important 'kick-starter' funding mechanism for urgent research, which facilitated leveraging of additional funds. It further agreed that research requirements for strengthening Australia's pandemic preparedness and response include: (1) development of a national health and medical research strategy for pandemic research; (2) long-term investment in pre-established research partnerships and networks; (3) systemic procedural improvements, e.g. in ethics, governance and resource allocation; (4) responsive funding mechanisms including philanthropy; and (5) integration of research outputs into health practice and decision-making, as illustrated in Figure 1.

Abstract: This editorial summarises a set of three new standards developed by Food Standards Australia New Zealand, which respectively address food safety requirements for the commodities of berries, leafy vegetables, and melons.

Abstract: During the SARS-CoV-2 Delta (B.1.617.2) variant outbreak, from August to October 2021 in the Australian Capital Territory (ACT), the number of new cases 'in the community for part of their infectious period' was publicly reported daily. We describe the stratification tool used during the outbreak to determine presumptive risk of community transmission from cases, and present the results of a contemporaneous validation of each case's risk against their onward transmission detected by routine surveillance. After case interview, epidemiologists identified the most likely source of infection for each new case and used the stratification tool to classify the case as either no, low, or high risk of community transmission. Each case notified between 12 August and 14 September 2021 was matched to its recipient case(s) to determine how well the tool predicted transmission risk. Household transmissions were excluded. Of the 530 notified cases stratified, 159 (29.3%) were cases who transmitted to a recipient case. Of the 59 cases who were the source of community transmission, 66% (38/59) were undertaking high-risk activities not associated with permitted essential work at the time. Only six source cases stratified as low risk or no risk transmitted SARS-CoV-2 to those outside their own household. The tool was essential in the rapid determination of community transmission risk in the ACT, and validation of the tool against detected onward transmission provided evidence for the effectiveness of public health restrictions. In the early stages of outbreaks of diseases for which transmissibility has not yet been established, the validation of such a stratification tool relies on high quality case investigation data, but may help to understand transmission dynamics and to inform interventions.

Abstract: In 2022, five cases of diphtheria were identified in and around Wujal Wujal, a discrete Aboriginal community in Far North Queensland. This prompted a mass diphtheria vaccination campaign in the community which increased the proportion of residents aged ≥ 14 years receiving a diphtheria containing vaccine in the prior twelve months from 5% to 74%. No further cases were detected in the subsequent twenty-two months.

Abstract: We describe here the impact of managing coronavirus disease 2019 (COVID-19) outbreaks, during January-August 2022, in residential aged care facilities (RACFs) in Central Queensland, Australia, following the deployment of a public health rapid response team (PHRRT, comprising a medical officer, a communicable disease nurse, and an epidemiologist) from a regional public health unit (PHU). Our existing vaccine preventable diseases surveillance framework was used in identifying any symptomatic resident, triggering a PHRRT response. We found that the Hospital in the Home (HiTH) admission and death events were significantly lower after the introduction of the PHRRT than in the outbreaks that occurred before. Based on our experience with a PHRRT-led approach in mitigating the burden of outbreaks, we recommend regular reflection on optimising resources and practices in RACFs. Effective communication from PHUs can improve the RACFs' preparedness and capacity to respond, and can inform the best practice model to protect the highly susceptible elderly residents and their staff.

Abstract: From 1 January 2020 to 31 December 2021, thirty-eight institutions across Australia submitted data to the Australian Group on Antimicrobial Resistance (AGAR) from patients aged < 18 years (AGAR-Kids). Over the two years, 1,679 isolates were reported from 1,611 patients. This AGAR-Kids report aims to describe the population of children and adolescents with bacteraemia reported to AGAR and the proportion of resistant isolates. Overall, there were 902 gram-negative isolates reported: 800 Enterobacterales, 61 Pseudomonas aeruginosa and 41 Acinetobacter spp. Among the Enterobacterales, 12.9% were resistant to third generation cephalosporins; 11.6% to gentamicin/tobramycin; and 11.2% to piperacillin-tazobactam. In total, 14.5% of Enterobacterales were multi-drug resistant (MDR). Only 3.3% of P. aeruginosa were resistant to carbapenems and 4.9% were MDR. Resistance in Acinetobacter spp was uncommon. Of 607 Staphylococcus aureus isolates, 12.9% were methicillin-resistant (MRSA). Almost half of S. aureus isolates from the Northern Territory were MRSA. In S. aureus, resistance to erythromycin was 13.2%; 12.4% to clindamycin; and 5.3% to ciprofloxacin. Resistance to all antibiotics tested was higher in MRSA. Overall, 6.5% of S. aureus were MDR, of which 65% were MRSA. Almost three-quarters of the 170 Enterococcus spp. reported were E. faecalis, and half were from patients < 1 year old. Ampicillin resistance in enterococci was 19.6%. Eight isolates were vancomycin resistant and three isolates were teicoplanin resistant. Five E. faecium isolates were classified as MDR. This AGAR-Kids report highlights clear differences in the geographic distribution of pathogens and resistance profiles across Australia.

Abstract: The Northern Territory (NT) has the highest rates of sexually transmitted infections (STI) in Australia; however, the local prevalence of Mycoplasma genitalium (M. genitalium) has not been previously determined. This study was designed to review M. genitalium detection, to determine the regional NT prevalence and macrolide resistance rates. In our study the NT background prevalence of M. genitalium is 13%, with the highest detection rates occurring in central Australia and in correctional facility inmates. Symptomatic patients attending sexual health clinics have a positivity rate of 12%, but very high macrolide resistance. The decision to screen for M. genitalium should be based on several factors, including the prevalence of the infection in the local population; the availability of effective treatments; and the potential benefits and risks of detection and therapy.

Abstract: This study determined the hepatitis B e antigen (HBeAg) status of people living with chronic hepatitis B (CHB) in Far North Queensland (FNQ), Australia and their age of HBeAg loss. It was hoped that this would provide data to explain the stark difference in the incidence of hepatocellular carcinoma (HCC) between Aboriginal and Torres Strait Islander individuals living with CHB in FNQ, a finding that has been hypothesised to relate to differences in hepatitis B virus genotype. We identified every FNQ resident with CHB, determined their country of birth, their HBeAg status, the age they lost HBeAg and whether they identified as an Aboriginal, a Torres Strait Islander or a non-Indigenous individual. We then ascertained whether these demographic and virological variables were correlated. Of 1,474 individuals living with CHB in FNQ, 278 (19%) were Aboriginal, 507 (34%) were Torres Strait Islanders and 689 (47%) were non-Indigenous. Aboriginal individuals were less likely to be HBeAg positive (26/278, 9%) than Torres Strait Islander (91/507, 18%) and non-Indigenous (126/689, 18%) individuals, p < 0.0001. Aboriginal individuals lost HBeAg at an earlier age (median (interquartile range): 30 (23-39) years) than Torres Strait Islander (38 (29-49) years) and non-Indigenous (36 (29-47) years) individuals, p < 0.0001. Aboriginal individuals with CHB in FNQ are more likely to be HBeAg negative than Torres Strait Islander and non-Indigenous individuals and lose HBeAg at a younger age. This provides a biological basis for local clinicians' observation that Aboriginal individuals with CHB in FNQ are at a lower risk of HCC and data to support the principle of genotype-based care in the region.