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The initial serology samples were negative for endemic NT flaviviruses (Japanese encephalitis, MVE and Kunjin viruses) (Box). Following the 2022 national outbreak of Japanese encephalitis across the southern and eastern states of Australia,[[1]] the NT conducted a retrospective audit of NT patients with encephalitis presenting between October 2020 and March 2022. Keywords: Encephalitis; viral; Arbovirus infections; Infectious diseases; Communicable diseases; Serology; Public health; Vaccination EN Encephalitis viral Arbovirus infections Infectious diseases Communicable diseases Serology Public health Vaccination 253 254 2 09/20/23 20230915 NES 230915 Clinical record We present the case of a patient with Japanese encephalitis who was identified by a retrospective audit. [Extracted from the article]

Background: Rheumatic heart disease (RHD) poses a major disease burden among disadvantaged populations globally. It results from acute rheumatic fever (ARF), a complication of Group A Streptococcal (GAS) infection. These conditions are acknowledged as diseases of poverty, however the role of specific social and environmental factors in GAS infection and progression to ARF/RHD is not well understood. The aim of this systematic review was to determine the association between social determinants of health and GAS infection, ARF and RHD, and the effect of interventions targeting these. Methodology: We conducted a systematic literature review using PubMed, the Cochrane Library and Embase. Observational and experimental studies that measured: crowding, dwelling characteristics, education, employment, income, nutrition, or socioeconomic status and the relationship with GAS infection, ARF or RHD were included. Findings for each factor were assessed against the Bradford Hill criteria for evidence of causation. Study quality was assessed using a standardised tool. Principle findings: 1,164 publications were identified. 90 met inclusion criteria, comprising 91 individual studies. 49 (50.5%) were poor quality in relation to the specific study question. The proportion of studies reporting significant associations between socioeconomic determinants and risk of GAS infection was 57.1%, and with ARF/RHD was 50%. Crowding was the most assessed factor (14 studies with GAS infection, 36 studies with ARF/RHD) followed by socioeconomic status (6 and 36 respectively). The majority of studies assessing crowding, dwelling characteristics, education and employment status of parents or cases, and nutrition, reported a positive association with risk of GAS infection, ARF or RHD. Crowding and socioeconomic status satisfactorily met the criteria of a causal association. There was substantial heterogeneity across all key study aspects. Conclusion: The extensive literature examining the role of social determinants in GAS infection, ARF and RHD risk lacks quality. Most were observational, not interventional. Crowding as a cause of GAS infection and ARF/RHD presents a practical target for prevention actions. [ABSTRACT FROM AUTHOR]

Keywords: Streptococcus; Epidemiology; Renal dialysis EN Streptococcus Epidemiology Renal dialysis 544 545 2 11/14/22 20221115 NES 221115 Invasive group A streptococcal (iGAS) disease is an important cause of morbidity and mortality in the Northern Territory, particularly among people who require dialysis.1 iGAS disease has been notifiable in the NT since 2011,2 and nationally since July 2021.3 Since November 2014, people undergoing haemodialysis in the Top End region of the NT during the wet season (November-April) have routinely received antibiotic prophylaxis for melioidosis (supervised oral trimethoprim-sulfamethoxazole [TMP/SMX] 160/800 mg after dialysis, three times per week),4 which may also prevent iGAS disease.5 We therefore reviewed the incidence of iGAS disease in the NT over ten years and assessed the impact of TMP/SMX prophylaxis on its incidence among people undergoing dialysis. The recent listing of iGAS disease as nationally notifiable is an important step toward reducing the burden of GAS-related disease in Australia. Wet season iGAS disease incidence among Top End people receiving haemodialysis but not prescribed TMP/SMX at diagnosis was 1122 (95% CI, 412-2441) cases per 100 000 patients. [Extracted from the article]

However, we are concerned about the statement that the 30-day risk of iGAS disease for contacts of someone with an index infection is about 2000-fold higher than background risk. Household transmission of invasive group A Streptococcus infections in England: a population-based study, 2009, 2011 to 2013. [Extracted from the article]

Background: An outbreak of cutaneous sporotrichosis occurred in the Darwin region of the Northern Territory (NT) in 2014. We aimed to determine the source and risk factors associated with the outbreak and describe the clinical spectrum of cases seen.Methods: Epidemiological investigation of cases of cutaneous sporotrichosis identified through the Royal Darwin Hospital was undertaken to investigate risk factors and potential sources of infection. Data were collected through chart review and individual patient interviews. Environmental investigation followed identification of a common risk factor.Results: Nine confirmed cases of cutaneous sporotrichosis caused by Sporothrix schenckii were identified with onset of symptoms between April and July 2014. Patients were aged 29 to 70 years and seven were male (78%). Two strains of S. schenckii were identified, neither of which have been previously documented. One common risk factor was identified: all patients were occupational or recreational gardeners, with each reporting exposure to mulching hay, originating from a single NT farm. Local environmental health officers visited the farm and the owners confirmed that the implicated hay had been stored over the monsoon season and had been affected by rain. Storage of hay over the wet season was a new practice.Conclusions: This constitutes the third reported outbreak of S. schenckii sporotrichosis attributable to contaminated hay in Australia and the first outbreak of sporotrichosis in the NT. This outbreak prompted public health interventions, including distribution of information to general practitioners, farmers and suppliers in the Top End. Media reporting led to the identification and treatment of an additional case. Local practitioners should remain alert to the possibility of further occurrences of sporotrichosis. [ABSTRACT FROM AUTHOR]

Objective: To describe the burden of and trends in paediatric tuberculosis (TB) in Australia between 2003 and 2012. Design: A retrospective analysis of TB data from the National Notifiable Diseases Surveillance System (NNDSS) on TB in children (under 15 years of age) during the 10-year period, 2003–2012. Results: TB notifications in Australia during the study period included 538 children (range, 37–66 cases per year), representing 4.6% of the total TB case load during the period (range, 3.8%e5.8% each year). Place of birth was recorded for 524 patients (97.4%); of these, 230 (43.9%) were born in Australia, 294 (56.1%) overseas. The average annual notification rate was 1.31 (95% CI, 1.20e1.43) cases per 100000 child population. The rate was higher for overseas-born than for Australian-born children (9.57 [95% CI, 8.51–10.73] v 0.61 [95% CI, 0.53–0.69] cases per 100000 children. The overall rate was highest among those aged 0–4 years. The annual notification rate was three times higher for Indigenous children than for non- Indigenous Australian-born children. Of 427 patients (79.4% of total) for whom the method of case detection was recorded, 37.0% were detected by contact screening, 8.7% by post-arrival immigration screening, and 54.3% by passive case detection. Pulmonary TB was the most common diagnostic classification (64.7% of patients). The most common risk factors were close contact with a TB case and recent residence in a country with a high incidence of TB. Treatment outcomes were satisfactory; 89.4% of children had completed treatment or were cured. Conclusions: The burden of paediatric TB in Australia is low but has not changed over the past decade. The highest rates are among children born overseas, emphasising the important role of immigration screening as Australia aspires to eliminate TB. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the impact of pneumococcal polysaccharide vaccine (PPV) in older people in Australia. The incidence of invasive pneumococcal disease (IPD) from 2002 to 2011 is highlighted. The effects of 13-valent PPV (13vPPV) for infants on the reduction of IPD incidence among older people are outlined.

COVID-19, Epidemiology, Signs and symptoms, Diagnosis, Public health, Virus diseases, Molecular medicine, Infectious diseases, Respiratory tract infections The bottom line summarises the median duration of symptoms prior to diagnosis, the median duration of symptoms, and the median time to viral clearance. Keywords: COVID-19; Epidemiology; Signs and symptoms; Diagnosis; Public health; Virus diseases; Molecular medicine; Infectious diseases; Respiratory tract infections EN COVID-19 Epidemiology Signs and symptoms Diagnosis Public health Virus diseases Molecular medicine Infectious diseases Respiratory tract infections 218 219 2 03/17/21 20210315 NES 210315 Hospitals in the Northern Territory often operate beyond capacity and serve a sparsely distributed population with rates of chronic disease and household overcrowding that are higher than in many other parts of Australia. [Extracted from the article]

Objectives: To assess the prevalence of latent tuberculosis infection (LTBI) in recently arrived refugees in the Northern Territory and to obtain comprehensive data for rates of treatment acceptance and completion for this condition.Design, Setting and Participants: Prospective data collection and follow-up of all 471 newly arrived refugees seen at the Centre for Disease Control, NT refugee health clinic from February 2006 to January 2009.Main Outcome Measures: Rates of LTBI determined by tuberculin skin testing; subsequent assessment and treatment compared with local protocols.Results: 458 of 465 eligible refugees were adequately assessed for LTBI, of whom 146 (31.9%) were diagnosed with LTBI. Older age, male sex and World Health Organization Eastern Mediterranean region of birth were associated with increased prevalences of LTBI. Of the refugees diagnosed with LTBI, 10 failed to attend for follow-up and 15 were not offered treatment. Isoniazid therapy was accepted by 93 of 121 refugees (76.9%), and 41 of these (44.1%) completed treatment. The most common reasons for discontinuation of therapy were medication-related side effects (most often gastrointestinal) and loss to follow-up. Increasing age was associated with failure to complete treatment.Conclusion: Outcomes of assessment and treatment for LTBI in newly arrived refugees in the NT are comparable to those for other target groups screened in developed countries. Loss to follow-up caused significant attrition in numbers, but complete data were obtained for a large proportion of eligible refugees. Most refugees who are offered treatment for LTBI accept, but less than half complete treatment. [ABSTRACT FROM AUTHOR]

The article discusses recommendations for the use of antiviral agents in the treatment and prevention of the H1N1 influenza virus. It notes that diagnostic tests can be used for targeted antiviral treatment at the early stage of the pandemic, but H1N1 testing is generally not recommended for patients who live in areas that have already been established with community transmission. The section cites that antiviral treatments can reduce the duration of symptoms and the incidence of lower respiratory tract infections.

Presents a retrospective/prospective review of all cases of disease due to nontuberculous mycobacteria (NTM) reported in the Northern Territory, Australia, during the period 1989-1997. Finding that Mycobacterium avium/Mycobacterium intracellulare complex (MAC) was the most common isolate and pulmonary disease the most frequent clinical presentation; Outcomes of therapy for lymphadenitis and skin/soft tissue disease and HIV-associated disseminated MAC disease.

Reports on the efficacy of Haemophilus influenzae type b (Hib) conjugate vaccines in healthy children. Introduction of Hib conjugate vaccines for routine immunization in Great Britain and the Republic of Ireland in 1992; Assessment of the clinical and immunological factors associated with vaccine failure; Need for clinical and immunological evaluation in children who develop Hib disease despite vaccination.

The article provides information on treatment for the prevention of latent tuberculosis infection (LTBI) including analysis of people in Darwin region, radiological and clinical evidence, and active tuberculosis.

A response from the authors of the article "Impact of pneumococcal polysaccharide vaccine in people aged 65 years or older," in the 2014 issue is presented.

A letter to the editor about the relationship between invasive pneumococcal disease and influenza in the Northern Territory in Australia from 2005 to 2009 is presented.

The article discusses the case of a 24-year old man who was presented with measles after returning from the World Cup in South Africa in July 2010. The patient was advised to be placed in respiratory isolation after measles virus RNA was detected. He reported having vaccinations in measles, mumps, and rubella during childhood but failed to have follow-up vaccinations. The common syndrome presented among travelers from South Africa is the systemic febrile illness. The incubation period usually takes about seven to 10 days.