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The world is changing: both a conventional and a vaccine passport are now needed to travel internationally. Mask mandates, and social distancing are the new norm in a rapidly changing society. These measures were put in place to control the spread of the highly infectious and often fatal COVID-19, caused by a viral agent, a microorganism, a zoonosis, and the cause of death for over 6 million people around the world. Considering this, maintaining biosecurity is important around the world to ensure public health. Biosecurity in New Zealand supposes that people including young people understand different pests and diseases that can harm public health. This qualitative study was conducted to gauge the biosecurity knowledge of 171 young people (14-15-year-olds). Young people were tested on their knowledge about biosecurity related plants, animals, and microorganisms. This paper reports specifically on the results of knowledge of microorganisms of young people. Results show that negative anthropocentric views dominate adolescents understanding of microorganisms and anthropomorphism is widely used to explain microorganism activity. An educational programme, targeted at developing a conceptual understanding about microorganisms starting at primary education may help develop a more educated global citizen, one versed in understanding the biology of microorganisms.

The COVID-19 crisis has led to widespread temporary school closures and a deep economic recession. School closures have threatened children's ability to learn and later return to school well prepared. The impact of the economic recession is going to be even more devastating: first for students, but also for the ability of some Catholic schools to maintain their enrollment and remain sustainable financially in countries where they do not benefit from government support. This paper, the first in a set of two, looks at some of the likely impacts of the COVID-19 crisis on Catholic Schools in developed countries with a particular focus on the United States, a country not only hard hit by the crisis but also where Catholic schools are especially vulnerable to downturns. While Catholic schools may be able to respond to the immediate challenge of school closures among others through distance learning options, their ability to maintain enrollment during the economic downturn is less clear. How schools will respond to the twin challenges of ensuring learning during school closures and beyond, and remaining affordable for families at a time of economic stress, may affect whether they are able to maintain their comparative advantage. A key aim of the paper is to make Catholic school teachers and leaders aware of some of the discussions on how to respond to the crisis, and provide links to online resources that may be useful. [For Part II of the series, see EJ1278501.]

This article examines tensions that professionals in healthcare settings in low-to-middle income countries (LMICs) face in the evolving field around surveillance of antimicrobial resistance (AMR). Few public health problems are of greater global importance today than AMR, that poses a threat to our ability to treat infections. In this context, the microbiology laboratory occupies a prominent place and the knowledge field of microbiology is expanding. In this study, we interviewed twenty-three (n = 23) professionals with expertise on AMR and public health systems to synthesise knowledge on strengthening AMR surveillance in LMICs. By drawing on a practice approach [Schatzki, T. R. 2001. "Practice Theory." In "The Practice Turn in Contemporary Theory" (1-14), edited by T. R. Schatzki, K. Knorr-Cetima, and E. von Savigny. New York: Routledge.] combined with socio-cultural and cultural-historical theories (CHAT) [Engeström, Y. 1987. "Learning by Expanding: An Activity-Theoretical Approach to Developmental Research." Helsinki: Orienta-Konsultit] the analysis reveals seven tensions between elements of the systems and discusses how such tensions serve to frame implications for implementing a capacity strengthening programme. The analysis shows that the novelty of the AMR as well as being a multi-disease and multisectoral by nature challenges existing forms of professional practice in healthcare settings. It also suggests that AMR requires to be dealt with through inter-professional and inter-sectoral approaches, while maintaining a focus across the local, national, and global systems, which is essential for initiatives that are set to address challenges to global health.

In the Hebrew story, King Solomon was asked to decide which of two "harlots" was the mother of an infant. His proposal to divide the baby between them revealed who could recognise the child's best interests. This ancient story has resonance for early childhood education, for although our curriculum holds the wellbeing of children at its core, the wisdom of Solomon is needed to navigate the inconvenient truth that early childhood education can be detrimental to the health of young children.

Background: Research on biosecurity is important as New Zealand's agricultural export-driven economy is susceptible to biosecurity threats. Because New Zealand is reliant on the primary industries to drive its economy, bovine diseases such as foot and mouth could have a devastating effect on the economy. Purpose: Making sure that the general public are aware of the importance of maintaining biosecurity is crucial in order to protect New Zealand's economy, human health, the environment, and social and cultural values. New Zealand Year 9 students' knowledge of biosecurity was gauged as these students represented the next generation of individuals tasked to maintain biosecurity in New Zealand. Design: A qualitative approach using the interpretive mode of inquiry was used to investigate the knowledge about biosecurity with New Zealand Year 9 students. Questionnaires and interviews were the data collection tools. Sample: One hundred and seventy-one students completed a questionnaire that consisted of Likert-type questions and open-ended questions. Nine students were interviewed about their knowledge. Results: The findings showed that New Zealand Year 9 students lacked specific knowledge about unwanted plants, animals and microorganisms. These students saw illicit drug plants as unwanted plants and mainly saw possums as unwanted animals in New Zealand. Their knowledge about unwanted microorganisms in New Zealand was dominated by human-disease-causing microbes. A lack of knowledge of biosecurity issues in New Zealand was seen as the major factor in these students limited understanding of biosecurity. Conclusions: Based on these findings, it can be said that knowledge of an issue is critical in enabling individuals to develop an understanding about biosecurity. Explicit teaching of biosecurity-related curriculum topics could provide New Zealand Year 9 students with an opportunity to develop knowledge about biosecurity in New Zealand.

The February 2011 Canterbury earthquake was a dramatic reminder of the need for schools to have emergency management plans in place. A number of other disaster and hazard events have historically caused New Zealand schools to close temporarily, and often within a short time frame. At such times principals must act decisively and communicate clearly with their communities in complex and difficult circumstances, carrying risk for student well-being. Here we present two hazard-specific New Zealand case studies, pandemic (H1N1) and adverse weather (snowstorm) -- both precipitating instances of temporary school closure. Lessons taken from the case studies offer an opportunity for management staff to reflect on how to best plan for and manage environmental hazards precipitating temporary school closure in order to mitigate immediate and long-term risk to pupils and the wider school community. (Contains 14 notes.)

Understanding how bovine tuberculosis (TB) is maintained in wildlife reservoirs is critical for the management of this disease impacting cattle in many countries. For the primary wildlife reservoir of the disease in New Zealand, the brushtail possum (Trichosurus vulpecula), transmission of this contagious bacterial disease among possums is often assumed to be linked to home range overlap. Identifying drivers of possum home range, and home range overlap between individuals, is thus important for informing wildlife reservoir TB management in New Zealand. We monitored four sub-populations of free-living possums in New Zealand native forests during 10 consecutive months using live trapping, to give the first direct insight into how the frequency and area of overlaps alters with density, sex and age. A total of 832 individuals were captured (average 9.3, range from 1 to 40 captures per animal with a median value of 7) and 35,820 home range overlaps were recorded. Both the number and area of overlaps were significantly associated with age class, with 66.6% of overlaps occurring between adults, 30% between adults and juveniles, and only 3.4% between juveniles. Overall, adult males showed significantly higher numbers of overlaps than expected, while adult and juvenile females showed significantly lower numbers of overlaps than expected and no differences were observed in juvenile males. In addition, males exhibited more and larger overlaps than females. The number and size of overlaps per individual decreased with increasing local population density. Understanding shared areas of activity among individuals can provide insights into the interactions occurring and potential pathways for diseases transmitted by contact such as TB. These results can inform to develop effective strategies for the control of diseases carried and dispersed by possums. [ABSTRACT FROM AUTHOR]

Despite widespread vaccination rates, we are living with high transmission rates of SARS‐CoV‐2. Although overall hospitalisation rates are falling, the risk of serious infection remains high for patients who are immunocompromised because of haematological malignancies. In light of the ongoing pandemic and the development of multiple agents for treatment, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID‐19 management in patients with haematological disorders. It is our recommendation that both patients with haematological malignancies and treating specialists be educated regarding the preventive and treatment options available and that patients continue to receive adequate vaccinations, keeping in mind the suboptimal vaccine responses that occur in haematology patients, in particular, those with B‐cell malignancies and on B‐cell‐targeting or depleting therapy. Patients with haematological malignancies should receive treatment for COVID‐19 in accordance with the severity of their symptoms, but even mild infections should prompt early treatment with antiviral agents. The issue of de‐isolation following COVID‐19 infection and optimal time to treatment for haematological malignancies is discussed but remains an area with evolving data. This position statement is to be used in conjunction with advice from infectious disease, respiratory and intensive care specialists, and current guidelines from the National COVID‐19 Clinical Evidence Taskforce and the New Zealand Ministry of Health and Cancer Agency Te Aho o Te Kahu COVID‐19 Guidelines. [ABSTRACT FROM AUTHOR]

Measles is a highly contagious and vaccine-preventable disease that poses a global health threat. While Australia, New Zealand, and Pacific Island Countries have made progress in eliminating endemic measles, they remain at risk of importations from returning residents or travelers. In 2019, Australia experienced outbreaks mostly caused by infected returning residents, while New Zealand had a large outbreak that spread to Samoa. The COVID-19 pandemic has disrupted global progress towards measles eradication, leading to a resurgence in cases. To mitigate the risk of measles, vaccination, disease awareness, correct confirmatory tests, and prompt response are crucial. Preventing cases through vaccination and effective public health measures can save lives and contribute to the global goal of measles elimination. [Extracted from the article]

New Zealand's endemic reptile fauna is highly threatened and pathogens causing infectious diseases may be a significant risk to already endangered species. Here, we investigate Cryptosporidium infection in captive endemic New Zealand reptiles. We found two mammal-related Cryptosporidium species (C. hominis and C. parvum) and six subtypes from three gp60 families (Ib, Ig and IIa) in 12 individuals of captive endemic Tuatara, Otago and Grand skinks, and Jewelled and Rough geckos. Cryptosporidium serpentis was identified in two Jewelled geckos using 18S. In New Zealand, C. hominis and C. parvum are associated with infections in humans and introduced domestic animals but have also been recently found in wildlife. Our finding of Cryptosporidium infection in endemic reptiles can help inform strategies to monitor the conservation of species and manage potential introductions of pathogens to in-situ and ex-situ populations. [ABSTRACT FROM AUTHOR]

The ongoing COVID-19 pandemic has created unprecedented social, financial, and moral disruptions across the globe despite global efforts to reduce the transmission of the novel coronavirus. Currently, vaccinating populations against COVID-19 has emerged as the most sustainable strategy to help countries recover from the socioeconomic effects of COVID-19 while protecting public health. To meet vaccination targets, some countries have adopted policies that rely on varying levels of coercion. This paper analyses the ethical implications of coercive vaccination policies implemented in Singapore and Italy, which impose barriers to accessing healthcare on the unvaccinated. These two cases are compared to the vaccine mandate in New Zealand, which did not restrict access to healthcare for the unvaccinated. This analysis draws on key considerations from Kass' ethical framework for assessing public health intervention. This analysis is relevant to countries considering similar policies to increase vaccination uptake for infectious diseases. Since healthcare is a fundamental good, a critical question is whether imposing barriers to accessing healthcare services is an ethically justifiable consequence of the choice to remain unvaccinated. [ABSTRACT FROM AUTHOR]

Objectives: The traditional polio model depicts a positive relationship between the disease and socioeconomic status (SES), with higher SES associated with exposure to the poliovirus beyond infancy/early childhood and a higher mortality rate. This study uses occupation data from non‐Māori New Zealand death registrations and the Census to assess evidence for differential mortality by SES during the polio epidemics of 1916, 1924–25, and 1936–37. Materials and Methods: Polio deaths were classified by father's occupation using the Caversham Project scheme, which includes nine collapsible urban occupational strata and codes rural occupations separately. Evidence for differential mortality and differences in age at death between rural and urban areas and among urban occupational strata was assessed using nonparametric Mann–Whitney U, Kruskal–Wallis, Jonckheere‐Terpstra, and chi‐square tests. Results: There was limited evidence of either differential mortality or differences in age at death among collapsed urban strata, mainly in 1924/25, only partially meeting the expectations of the traditional polio model. For 1916 only, the rural group had a higher proportion of deaths (χ2 (1, n = 95) = 8.341, p = 0.0039, φ = 0.30)) and higher age at death (U = 828.00, p = 0.026, r = −0.23). Discussion: These results suggest that rural New Zealand was more isolated from poliovirus infection prior to 1916, but thereafter rural and urban groups faced more similar exposure patterns and mortality—at least among non‐Māori. The degree to which occupational categories reflect conditions of exposure requires further research. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship (AMS) is essential to preserve the efficacy of antimicrobials by slowing the development of resistance. AMS ward rounds are a well‐described methodology for optimising and ensuring judicious use of antimicrobials. Pharmacists are valuable members of AMS teams because they possess skills and knowledge that can be used to optimise antimicrobial prescribing. Pharmacists often practice in AMS roles without formal training in this area. Aim: To identify a method which yields the highest number of patients for review, to assess the types of recommendations commonly made, and to assess the rate of uptake of these recommendations, as made by a junior pharmacist. Method: The investigation was carried out at Auckland City Hospital in Grafton, Auckland, New Zealand, over nine weeks between December 2020 and February 2021. Three different methods were utilised for patient identification: automated dispensing reports, pharmacist referral, and random medical record review. Results: Approximately 20 hours were spent and 293 patient records reviewed. Of these, 103 patients had a prescribed antimicrobial which met the criteria for review, 52 recommendations were made, and 35 (67%) of these were actioned by the primary medical team. The medical record review yielded the highest number of patients for review, followed by automated reports, then pharmacist referral. Of the 52 recommendations, the most commonly made recommendation was to stop unnecessary antimicrobials (n = 26), followed by optimising the dosing regimen (n = 9), and intravenous‐to‐oral switch (n = 7). Conclusions: The medical record review identified the highest number of patients for review. The high uptake of recommendations suggests that pharmacists do not need extensive training in AMS to achieve successful outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Pathogen genomics, where whole genome sequencing technologies are used to produce complete genomic sequences of pathogens, is being increasingly used for infectious disease surveillance and outbreak response. Although proof-of-concept studies have highlighted the viability of using pathogen genomics in public health, few studies have investigated how end-users utilize pathogen genomics in public health. We describe a protocol for a study that aims to identify key factors that influence the use of pathogen genomics to inform public health responses against infectious diseases in Australia and New Zealand., Methods: We will use qualitative comparative analysis (QCA), a case-oriented methodology that systematically compares and analyses multiple cases (or 'units of analysis'), to identify multiple pathways leading to the use of pathogen genomics results in public health actions. As part of the process, we will develop a rubric to identify and define the use of pathogen genomics and individual factors affecting this process. Simultaneously, we will identify cases where pathogen genomics has been used in public health across Australia and New Zealand. Data for these cases will be collected from document review of publicly available and confidential documents and semi-structured interviews with technicians and end-users and summarized in a case report. These case reports will form the basis for scoring each case on the extent of the use of pathogen genomics data and the presence or absence of specific factors such as the ease of extracting essential information from pathogen genomics reports and perceptions toward pathogen genomics. Using the scores, cases will be analyzed using QCA techniques to identify pathways leading to the use of pathogen genomics data. These pathways will be interpreted alongside the cases to provide rich explanations of the use of pathogen genomics in public health., Discussion: This study will improve our understanding of the key factors that facilitate or hinder the use of pathogen genomics to inform public health authorities and end-users. These findings may inform ways to enhance the use of pathogen genomics data in public health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ong, Zulfiqar, Glass, Kirk, Astbury, Ferdinand and on behalf of the AusPathoGen Program.)

Background: This study compares the health gains, costs, and cost-effectiveness of hundreds of Australian and New Zealand (NZ) health interventions conducted with comparable methods in an online interactive league table designed to inform policy. Methods: A literature review was conducted to identify peer-reviewed evaluations (2010 to 2018) arising from the Australia Cost-Effectiveness research and NZ Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programmes, or using similar methodology, with: health gains quantified as health-adjusted life years (HALYs); net health system costs and/or incremental cost-effectiveness ratio; time horizon of at least 10 years; and 3% to 5% discount rates. Results: We identified 384 evaluations that met the inclusion criteria, covering 14 intervention domains: alcohol; cancer; cannabis; communicable disease; cardiovascular disease; diabetes; diet; injury; mental illness; other non-communicable diseases; overweight and obesity; physical inactivity; salt; and tobacco. There were large variations in health gain across evaluations: 33.9% gained less than 0.1 HALYs per 1000 people in the total population over the remainder of their lifespan, through to 13.0% gaining > 10 HALYs per 1000 people. Over a third (38.8%) of evaluations were cost-saving. Conclusions: League tables of comparably conducted evaluations illustrate the large health gain (and cost) variations per capita between interventions, in addition to cost-effectiveness. Further work can test the utility of this league table with policy-makers and researchers. [ABSTRACT FROM AUTHOR]

Objective: To describe antibiotic treatment durations that pediatric infectious diseases (ID) and critical care clinicians usually recommend for bloodstream infections in critically ill children. Design: Anonymous, online practice survey using five common pediatric-based case scenarios of bloodstream infections. Setting: Pediatric intensive care units in Canada, Australia and New Zealand. Participants: Pediatric intensivists, nurse practitioners, ID physicians and pharmacists. Main outcome measures: Recommended treatment durations for common infectious syndromes associated with bloodstream infections and willingness to enrol patients into a trial to study treatment duration. Results: Among 136 survey respondents, most recommended at least 10 days antibiotics for bloodstream infections associated with: pneumonia (65%), skin/soft tissue (74%), urinary tract (64%) and intra-abdominal infections (drained: 90%; undrained: 99%). For central vascular catheter-associated infections without catheter removal, over 90% clinicians recommended at least 10 days antibiotics, except for infections caused by coagulase negative staphylococci (79%). Recommendations for at least 10 days antibiotics were less common with catheter removal. In multivariable linear regression analyses, lack of source control was significantly associated with longer treatment durations (+5.2 days [95% CI: 4.4–6.1 days] for intra-abdominal infections and +4.1 days [95% CI: 3.8–4.4 days] for central vascular catheter-associated infections). Most clinicians (73–95%, depending on the source of bloodstream infection) would be willing to enrol patients into a trial of shorter versus longer antibiotic treatment duration. Conclusions: The majority of clinicians currently recommend at least 10 days of antibiotics for most scenarios of bloodstream infections in critically ill children. There is practice heterogeneity in self-reported treatment duration recommendations among clinicians. Treatment durations were similar across different infectious syndromes. Under appropriate clinical conditions, most clinicians would be willing to enrol patients into a trial of shorter versus longer treatment for common syndromes associated with bloodstream infections. [ABSTRACT FROM AUTHOR]

Infectious diseases are recognized as one of the greatest global threats to biodiversity and ecosystem functioning. Consequently, there is a growing urgency to understand the speed at which adaptive phenotypes can evolve and spread in natural populations to inform future management. Here we provide evidence of rapid genomic changes in wild Australian blacklip abalone (Haliotis rubra) following a major population crash associated with an infectious disease. Genome scans on H. rubra were performed using pooled whole genome resequencing data from commercial fishing stocks varying in historical exposure to haliotid herpesvirus‐1 (HaHV‐1). Approximately 25,000 single nucleotide polymorphism loci associated with virus exposure were identified, many of which mapped to genes known to contribute to HaHV‐1 immunity in the New Zealand pāua (Haliotis iris) and herpesvirus response pathways in haliotids and other animal systems. These findings indicate genetic changes across a single generation in H. rubra fishing stocks decimated by HaHV‐1, with stock recovery potentially determined by rapid evolutionary changes leading to virus resistance. This is a novel example of apparently rapid adaptation in natural populations of a nonmodel marine organism, highlighting the pace at which selection can potentially act to counter disease in wildlife communities. [ABSTRACT FROM AUTHOR]

Contact tracing for infectious diseases can be partially automated using mobile applications. However, the success of these tools is dependent on significant uptake and frequent use by the public. This study explored the barriers and facilitators to the New Zealand (NZ) general public's use of the COVID-19 contact NZ COVID Tracer app. Adults (≥18 years, N = 373) in NZ. Qualitative and quantitative data were gathered from a nation-wide online survey. App use and frequency of use were presented as descriptive statistics. Qualitative data were analyzed thematically. 31% reported using the app frequently, 24% used it sometimes, 21% had installed but not used it, and 24% had not installed it. Barriers to use include technical issues, privacy and security concerns, forgetfulness and a lack of support from businesses. The perceived risk of contracting COVID-19, government recommendations and communications, and the importance of contact tracing facilitated use. Technical, user, business, and government factors influenced the public's use of a COVID-19 contact tracing app. The development of apps requiring minimal user effort and initial user testing may improve uptake. Enabling environments and better risk communication may improve uptake of similar community-driven contact tracing apps during future pandemics. [ABSTRACT FROM AUTHOR]

Adequate maternal vaccination coverage is critical for the prevention and control of infectious disease outbreaks such as pertussis, influenza, and more recently COVID-19. To guide efforts to increase vaccination coverage this study examined the extent of vaccination coverage in pregnant New Zealand women over time by area-level deprivation and ethnicity. A retrospective cohort study was used consisting of all pregnant women who delivered between 01 January 2013 and 31 December 2018, using administrative health datasets. Outcomes were defined as receipt of influenza or pertussis vaccination in any one of the relevant data sources (National Immunisation Register, Proclaims, or Pharmaceutical collection) during their eligible pregnancy. Ethnicity was prioritised as Māori (NZ indigenous), Pacific, Asian, and Other or NZ European and deprivation was defined using New Zealand Index of Multiple Deprivation (IMD). Between 2013 and 2018, Asian women had the highest maternal vaccination coverage (36%) for pertussis, while Māori and Pacific women had the lowest, 13% and 15% respectively. Coverage of pertussis vaccination during pregnancy in low deprivation Māori women was 24% and 28% in Pacific women. This is in comparison to 30% and 25% in high deprivation Asian and European/Other women, respectively. Similar trends were seen for influenza. Between 2013 and 2018 maternal vaccination coverage increased for pertussis and influenza. Despite this coverage remains suboptimal, and existing ethnic and deprivation inequities increased. There is an urgent need to focus on equity, to engage and support ethic communities by creating genuinely accessible, culturally appropriate health services. [ABSTRACT FROM AUTHOR]

To investigate an adaptive management approach to the deployment of emergency vaccination as an additional measure to stamping out (SO) during simulated outbreaks of foot-and-mouth disease (FMD) in New Zealand. A simulation modelling (n=6000 simulations) approach was used. The study population comprised all known farms in New Zealand with FMD-susceptible livestock. Each simulation started with infection seeded into a single randomly selected farm. Each outbreak was randomly assigned to one of four control strategies, comprising SO only; trigger-based vaccination (TRV) where SO was augmented with vaccination if an early decision indicator trigger operating between Days 11–35 of the response indicated a large outbreak was developing; SO plus vaccination started randomly on Days 11–35 of the response (VACr); and SO plus vaccination with a fixed start on Day 21 of the response (VACf). Other parameters, such as the number of personnel available were also varied randomly. Generalised additive models (GAM) were used to evaluate variables associated with the number of infected premises (IP) and epidemic duration. The mean number of IP was 29 (median 9, min 1, max 757), while epidemics lasted on average 26.9 (median 18, min 1, max 220) days. These excluded 303 extreme outbreaks larger than the UK 2001 FMD epidemic (2,030 cases). Univariable analysis of the pooled vaccination results vs. SO, showed that vaccination significantly reduced the number of IP (p<0.001) and outbreak duration (p<0.001). GAM of large outbreaks revealed that only the TRV strategy was significantly protective compared to SO alone, reducing the odds of a large outbreak by 22% (OR=0.78; 95% CI=0.63–0.96). The number of veterinarians was non-linearly associated with large outbreaks, with low numbers increasing the odds of a large outbreak, but above 200 veterinarians, the odds reduced. Time to first detection was also non-linearly associated with large outbreaks, with detections <13 days protective and longer detection times increasing the odds of a large outbreak. GAM of long outbreaks showed similar findings, except that all three vaccination strategies significantly reduced duration. Overall, the TRV strategy resulted in the smallest and shortest epidemics. An adaptive management approach that deployed vaccination in response to a trigger when a large outbreak was developing outperformed SO and reduced the odds of large or long outbreaks more than the other two vaccination strategies, although the differences between the three vaccination strategies were statistically small. This study provides highly relevant insights into the dynamics of disease establishment and spread that will guide New Zealand's readiness for responding to highly infectious disease incursions such as FMD. [ABSTRACT FROM AUTHOR]

Aotearoa New Zealand's pandemic communication approach amidst the COVID-19 (C19) has been applauded around the world. The New Zealand government's border controls and other measures in response to C19 impacted refugees at the margins and prevented people from accessing support services and healthcare. The sanctioned power to 'care' thus became a performative form of power for silencing through the dismissing of voices of refugees as being irrelevant. Experiences of refugees at the margins are constructed amid the erasure of community voices in dominant approaches to health. What was missing from the dominant discourses was the voice of the refugees, who had gone through painful experiences of displacement and resettlement. How did the refugee communities at the margins of Aotearoa New Zealand navigate through the prevailing structural impediments to health during the pandemic? In this study, we use a culture- centred analysis to centre the structural context of disenfranchisement during the COVID-19 lockdown. Drawing on in-depth interviews with refugee participants, we attend to how health is negotiated in the midst of the COVID-19 outbreak and lockdown response at the margins. Infectious diseases such asC19 lay bare the structural determinants that create health and well-being challenges among refugee communities in New Zealand. The narratives point out that the one-size-fits-all approach of the government left behind refugees at the margins during the C19 in the public health efforts. [ABSTRACT FROM AUTHOR]

Epidemiological studies of communicable diseases increasingly use large whole-genome sequencing (WGS) datasets to explore the transmission of pathogens. It is important to obtain an initial overview of datasets and identify closely related isolates, but this can be challenging with large numbers of isolates and imperfect sequencing. We used an ad hoc whole-genome multi locus sequence typing method to summarise data from a longitudinal study of Staphylococcus aureus in a primary school in New Zealand. Each pair of isolates was compared and the number of genes where alleles differed between isolates was tallied to produce a matrix of "allelic differences". We plotted histograms of the number of allelic differences between isolates for: all isolate pairs; pairs of isolates from different individuals; and pairs of isolates from the same individual. 340 sequenced isolates were included, and the ad hoc shared genome contained 445 genes. There were between 0 and 420 allelic differences between isolate pairs and the majority of pairs had more than 260 allelic differences. We found many genetically closely related S. aureus isolates from single individuals and a smaller number of closely-related isolates from separate individuals. Multiple S. aureus isolates from the same individual were usually very closely related or identical over the ad hoc shared genome. Siblings carried genetically similar, but not identical isolates. An ad hoc shared genome approach to WGS analysis can accommodate imperfect sequencing of the included isolates, and can provide insights into relationships between isolates in epidemiological studies with large WGS datasets containing diverse isolates. [ABSTRACT FROM AUTHOR]

This commentary considers the ways in which spatialised metaphors were mobilised within a larger narrative in the quest to eliminate COVID‐19 in Aotearoa/New Zealand. In doing so, it examines the links between language and socio‐political discourse, focusing on tropes that invoke and engage with geographies of everyday life. The foundational contention is that, to a large extent, language constructs our lived reality. After reviewing scholarship linking language and disease, the commentary turns to a case study of New Zealand's response to COVID‐19. The public health goal was to instil caution and protective practices in the population at large as a defence against transmission. The role of narrative and metaphor in daily press conferences from the Prime Minister and Director General of Health through March and April 2020 is examined by drawing on evidence from media reporting. Three key metaphors are considered: bubbles, levels, and the team, with each metaphor having spatialised implications in the popular imagination. The commentary considers perceptual and behavioural implications of this strategic use of metaphor. I speculate on the ways in which language has an agency such that, until the widespread availability of vaccine, an infectious disease can be restricted through mobilising the population. [ABSTRACT FROM AUTHOR]

Background: ICU-specific tables of antimicrobial susceptibility for key microbial species ('antibiograms'), antimicrobial stewardship (AMS) programmes and routine rounds by infectious diseases (ID) physicians are processes aimed at improving patient care. Their impact on patient-centred outcomes in Australian and New Zealand ICUs is uncertain.Objectives: To measure the association of these processes in ICU with in-hospital mortality.Methods: The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and Critical Care Resources registry were used to extract patient-level factors, ICU-level factors and the year in which each process took place. Descriptive statistics and hierarchical logistic regression were used to determine the relationship between each process and in-hospital mortality.Results: The study included 799 901 adults admitted to 173 ICUs from July 2009 to June 2016. The proportion of patients exposed to each process of care was 38.7% (antibiograms), 77.5% (AMS programmes) and 74.0% (ID rounds). After adjusting for confounders, patients admitted to ICUs that used ICU-specific antibiograms had a lower risk of in-hospital mortality [OR 0.95 (99% CI 0.92-0.99), P = 0.001]. There was no association between the use of AMS programmes [OR 0.98 (99% CI 0.94-1.02), P = 0.16] or routine rounds with ID physicians [OR 0.96 (99% CI 0.09-1.02), P = 0.09] and in-hospital mortality.Conclusions: Use of ICU-specific antibiograms was associated with lower in-hospital mortality for patients admitted to ICU. For hospitals that do not perform ICU-specific antibiograms, their implementation presents a low-risk infection management process that might improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 (COVID‐19) is a contagious disease that is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Health care workers are at risk of infection from aerosolisation of respiratory secretions, droplet and contact spread. There are a number of procedures that represent a high risk of aerosol generation during cardiothoracic surgery. It is important that adequate training, equipment and procedures are in place to reduce that risk. Recommendations: We provide a number of key recommendations, which reduce the risk of aerosol generation during cardiothoracic surgery and help protect patients and staff. These include general measures such as patient risk stratification, appropriate use of personal protective equipment, consideration to delay surgery in positive patients, and careful attention to theatre planning and preparation. There are also recommended procedural interventions during airway management, transoesophageal echocardiography, cardiopulmonary bypass, chest drain management and specific cardiothoracic surgical procedures. Controversies exist regarding the management of low risk patients undergoing procedures at high risk of aerosol generation, and recommendations for these patients will change depending on the regional prevalence, risk of community transmission and the potential for asymptomatic patients attending for these procedures. Changes in management as a result of this statement: This statement reflects changes in management based on expert opinion, national guidelines and available evidence. Our knowledge with regard to COVID‐19 continues to evolve and with this, guidance may change and develop. Our colleagues are urged to follow national guidelines and institutional recommendations regarding best practices to protect their patients and themselves. Endorsed by: Australian and New Zealand Society of Cardiac and Thoracic Surgeons and the Anaesthetic Continuing Education Cardiac Thoracic Vascular and Perfusion Special Interest Group. [ABSTRACT FROM AUTHOR]

Background: Infectious diseases (ID) physicians perform a pivotal role in directing the response to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Aim: To assess the impact of SARS‐CoV‐2 on workload and the perceptions of ID physicians regarding the national response in Australia and New Zealand in the pre‐pandemic. Methods: A survey of ID physicians in Australia and New Zealand was undertaken from 3 to 10 March 2020. Respondents were asked to estimate time spent on SARS‐CoV‐2‐related activities in February and report their agreement with statements on a 5‐point Likert scale ranging from 'strongly agree' to 'strongly disagree'. We also asked about the intended use of investigational agents. Results: There were 214 respondents (36% of 600 eligible participants). The median workload due to SARS‐CoV‐2‐related activities was 34% of one full‐time equivalent (interquartile range 18–68%). Less than a quarter (50, 23%) of respondents had experience managing cases, while 33% (70) had experience preparing during similar pandemics. Nevertheless, 88% (188/213) believed they were well informed when giving testing and management advice, and 45% (95/212) believed their national response was well coordinated. Additionally, 41% (88/214) were worried about becoming infected through occupational exposure. Over half (116, 54%) the respondents intended to use lopinavir/ritonavir in confirmed cases of COVID‐19 with severe disease. Conclusions: ID physicians spent a large proportion of time on SARS‐CoV‐2‐related activities. Increased staffing is required to avoid burnout. Importantly, ID physicians feel well informed when giving advice. A national body should be established to co‐ordinate response. Treatment efficacy trials are needed to clarify the utility of unproven treatments. [ABSTRACT FROM AUTHOR]

Cryptosporidium is one of the most common causes of diarrhoea around the world. Successful management and prevention of this infectious disease requires knowledge of the diversity of species and subtypes causing human disease. We use sequence data from 2598 human faecal samples collected during an 11-year period (2009–2019) to better understand the impact of different species and subtypes on public health and to gain insights into the variation of human cryptosporidiosis in New Zealand. Human cryptosporidiosis in New Zealand is caused by a high diversity of species and subtypes. Six species cause human disease in New Zealand: C. hominis, C. parvum, C. cuniculus, C. erinacei, C. meleagridis and C. tyzzeri. Sequence analysis of the gp60 gene identified 16 subtype families and 101 subtypes. Cryptosporidium hominis IbA10G2 and C. parvum IIaA18G3R1 were the most frequent causes of human cryptosporidiosis with 27% and 29% of infections, respectively. Cryptosporidium hominis presented a peak of notified human cases during autumn (March–May) whereas most cases of human cryptosporidiosis caused by C. parvum are found during the calving and lambing season in spring (September–November). We also reported some subtypes that have been rarely detected in other countries such as IbA20G2 and IIoA13G1 and a low prevalence of the hypertransmissible and virulent IIaA15G2R1. This study provides insight into the variability of cryptosporidiosis in New Zealand essential for disease management and surveillance to prevent the introduction or spread of new species and subtypes in the country. [ABSTRACT FROM AUTHOR]

Near-term forecasting of infectious disease incidence and consequent demand for acute healthcare services can support capacity planning and public health responses. Despite well-developed scenario modelling to support the Covid-19 response, Aotearoa New Zealand lacks advanced infectious disease forecasting capacity. We develop a model using Aotearoa New Zealand's unique Covid-19 data streams to predict reported Covid-19 cases, hospital admissions and hospital occupancy. The method combines a semi-mechanistic model for disease transmission to predict cases with Gaussian process regression models to predict the fraction of reported cases that will require hospital treatment. We evaluate forecast performance against out-of-sample data over the period from 2 October 2022 to 23 July 2023. Our results show that forecast performance is reasonably good over a 1-3 week time horizon, although generally deteriorates as the time horizon is lengthened. The model has been operationalised to provide weekly national and regional forecasts in real-time. This study is an important step towards development of more sophisticated situational awareness and infectious disease forecasting tools in Aotearoa New Zealand., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Plank et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infection in young children worldwide. RSV is increasingly associated with severe respiratory disease in people aged >65 years. The heterogeneous landscape of RSV in Australia and New Zealand makes generalisation of results from global studies to local contexts difficult. Given the changing landscape of RSV, we aimed to examine the existing literature on the burden of RSV disease and identify evidence gaps in Australia and New Zealand., Study Design: Scoping review., Methods: We designed a scoping review protocol and searched the Web of Science and Scopus databases for eligible peer-reviewed publications. Data from eligible studies were charted and summarised in tabular and narrative form., Results: Of the 153 eligible publications identified, 123 investigated RSV disease in a hospital setting and six in primary care. Only six studies reported the economic burden of disease, all of which estimated direct healthcare costs associated with treatment and/or hospitalisation; no studies quantified the indirect costs or costs to families., Conclusions: In this scoping review, we describe the effect of RSV disease in several high-risk populations, including children and adults. An improved understanding of the RSV burden of disease, both in primary care settings and economically, within the local context will assist with the implementation of preventative strategies, including vaccination programmes. Future studies to determine the true burden of RSV-associated morbidity, mortality and economic burden across the entire patient journey and among different healthcare settings will help prioritise emerging RSV therapeutics., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Understanding the epidemiology of infectious diseases in a host population is a major challenge in forestry. Radiata pine plantations in New Zealand are impacted by a foliar disease, red needle cast (RNC), caused by Phytophthora pluvialis. This pathogen is dispersed by water splash with polycyclic infection affecting the lower part of the tree canopy. In this study, we extended an SI (Susceptible-Infectious) model presented for RNC to analyse the key epidemiological drivers. We conducted two experiments to empirically fit the extended model: a detached-needle assay and an in vivo inoculation. We used the detached-needle assay data to compare resistant and susceptible genotypes, and the in vivo inoculation data was used to inform sustained infection of the whole plant. We also compared isolations and real-time quantitative PCR (qPCR) to assess P. pluvialis infection. The primary infection rate and the incubation time were similar for susceptible and resistant genotypes. The pathogen death rate was 2.5 times higher for resistant than susceptible genotypes. Further, external proliferation of mycelium and sporangia were only observed on 28% of the resistant ramets compared to 90% of the susceptible ones. Detection methods were the single most important factor influencing parameter estimates of the model, giving qualitatively different epidemic outputs. In the early stages of infection, qPCR proved to be more efficient than isolations but the reverse was true at later points in time. Isolations were not influenced by the presence of lesions in the needles, while 19% of lesioned needle maximized qPCR detection. A primary infection peak identified via qPCR occurred at 4 days after inoculation (dai) with a secondary peak observed 22 dai. Our results have important implications to the management of RNC, by highlighting the main differences in the response of susceptible and resistant genotypes, and comparing the most common assessment methods to detect RNC epidemics. [ABSTRACT FROM AUTHOR]

Background: Acute rheumatic fever (ARF) has largely disappeared from high-income countries. However, in New Zealand (NZ) rates remain high in indigenous (Māori) and Pacific populations. In 2011, NZ launched an intensive and unparalleled primary Rheumatic Fever Prevention Programme (RFPP). We evaluated the impact of the school-based sore throat service component of the RFPP.Methods: The evaluation used national trends of all-age first episode ARF hospitalisation rates before (2009-11) and after (2012-16) implementation of the RFPP. A retrospective cohort study compared first-episode ARF incidence during time-not-exposed (23 093 207 person-days) and time-exposed (68 465 350 person-days) with a school-based sore throat service among children aged 5-12 years from 2012 to 2016.Results: Following implementation of the RFPP, the national ARF incidence rate declined by 28% from 4.0 per 100 000 [95% confidence interval (CI) 3.5-4.6] at baseline (2009-11) to 2.9 per 100 000 by 2016 (95% CI 2.4-3.4, P <0.01). The school-based sore throat service effectiveness overall was 23% [95% CI -6%-44%; rate ratio (RR) 0.77, 95% CI 0.56-1.06]. Effectiveness was greater in one high-risk region with high coverage (46%, 95% CI 16%-66%; RR 0.54, 95% CI 0.34-0.84).Conclusions: Population-based primary prevention of ARF through sore throat management may be effective in well-resourced settings like NZ where high-risk populations are geographically concentrated. Where high-risk populations are dispersed, a school-based primary prevention approach appears ineffective and is expensive. [ABSTRACT FROM AUTHOR]

The growth of migrant communities continues to rise globally, creating unique and complex health challenges. Literature on immigrant health in New Zealand (NZ) remains scant. This integrative literature review was conducted drawing on peerreviewed research articles on immigrant health in NZ published between 2012 and 2018. The objectives were to: (i) provide a critical overview of immigrant health in NZ; (ii) identify general trends in health research conducted in NZ on immigrants; (iii) compare, contrast, and evaluate the quality of the information; (iv) develop a summary of research results and; (v) identify priorities and recommendations for future research. A search yielded more than 130 articles with 28 articles constituting the foundation of the review. This review is timely following the rapid increase in the scale, speed, and spread of immigration and its potential for changing NZ's national health patterns and priorities. This integrative review led to the four primary conclusions. Firstly, migration in NZ is a gendered phenomenon, as there has been more women and girls arriving as migrants in NZ and being at risk of poor health in comparison with their male counterparts. Secondly, studies on infectious diseases take precedence over other health problems. Thirdly, research methodologies used to collect data may not be relevant to the cultural and traditional customs of the migrant populations. Furthermore, a number of research findings implemented have failed to meet the needs of NZ migrants. Lastly, policy initiatives are inclined more towards supporting health practitioners and lack a migrant centred approach. What is already known about this topic? Despite NZ becoming more ethnically and linguistically diverse, there is limited literature on the health of migrants living in NZ. What this paper adds? This integrative literature review provides a critical overview of refugee and migrant health in NZ through reviewing and critiquing the current literature available. This paper identifies research trends, the general health of migrants in NZ, recommendations that could inform future migrant and refugee health research and health policies and initiatives to ensure effective and relevant health service provision to migrants. [ABSTRACT FROM AUTHOR]

INTRODUCTION: New Zealand experienced a major epidemic of pertussis from September 2011 to January 2014. In response to this epidemic, a pertussis-containing tetanus, diphtheria and acellular pertussis (Tdap) vaccine was funded for pregnant women of 28-38 weeks' gestation. AIM: To investigate the factors influencing women's decisions regarding having the Tdap vaccine during pregnancy. METHODS: A retrospective, self-reported postal survey of early postpartum women in Canterbury that assessed participant knowledge, beliefs, attitudes and influencing factors about the Tdap vaccine was conducted from June to October 2013. RESULTS: Of the 1883 surveys distributed, 596 women completed the survey. The main factors influencing women's decisions to accept the Tdap vaccine during pregnancy were: the desire to protect their baby, a health professional's recommendation, the threat of pertussis in the community and the fact that the vaccine was administered at no cost. Conversely, for women who did not receive the Tdap vaccine, the main factors that influenced their decisions were: they did not know the vaccine was available, fear of side-effects and doubt regarding vaccine effectiveness. CONCLUSION: A clear health professional recommendation for maternal Tdap immunisation was a significant factor influencing pregnant women and would most likely improve the uptake of the vaccine. [ABSTRACT FROM AUTHOR]

The author discusses developments with the "Internal Medicine Journal" in 2017. He tackles a meeting of the editorial board in Sydney, New South Wales regarding the journal's status and its future, changes in the editorial board, the expansion of sources of submissions to the journal, and the presence of the journal on the Internet.

Background: Tertiary students are at risk of acquiring infectious diseases during overseas travel as they visit low-income countries, have low perceptions of risk and are unlikely to access travel health advice. Some will visit friends and relatives abroad, a group identified as disproportionately affected by imported infections. There is no national student travel health policy in NZ. This study aimed to explore travel health training of university-based health providers; academics' practices and perceptions of travel health; reasons for travel and countries visited by NZ university students, their travel health uptake and factors affecting decision making about this.Methods: A cross-sectional study consisting of surveys sent in 2014 to university clinics, senior academics and students.Results: Surveys were completed by 251 respondents. Three of nine clinicians had only undertaken a short course in travel health. Competing resources and time constraints in health clinics were amongst the barriers to providing optimal services. Of the senior academics, only 14% were able to confirm their university collaborated with health clinics. Sixty seven percent of students were unaware that clinics provided travel health services and 19% had or intended to seek professional travel health advice.Conclusions: A national policy is warranted involving all stakeholders, utilizing innovative technologies to increase uptake of student travel health services. [ABSTRACT FROM AUTHOR]

Some strains of Cherry leaf roll virus (CLRV) are considered as quarantine pests in New Zealand. CLRV was detected in seven plant host species: Actinidia chinensis, Hydrangea macrophylla , Malus domestica , Plantago major , Ribes rubrum , Rubus idaeus and Rumex sp. collected from New Zealand between 2005 and 2012. Biological, serological and molecular techniques were compared for the detection and differentiation of CLRV isolates. The biological analysis revealed differences in symptomatology and disease severity among the isolates. The five isolates tested by ELISA were serologically related to each other using polyclonal antisera with only one out of four commercially-available antisera successfully detecting all of them. The phylogenetic analysis of sequences obtained from parts of the coat protein, polymerase and 3ʹ-untranslated regions revealed that the New Zealand CLRV isolates clustered into two closely related but distinct phylogenetic groups with some isolates grouping differently depending on the gene studied. The New Zealand CLRV isolates were clearly distinct to overseas isolates found in phylogenetic groups A, D and E. The conventional RT-PCR using primers targeting the CLRV coat protein coding region is recommended for determining sequence differences between strains. These findings will be useful in making regulatory decisions with regard to the testing requirements and the CLRV strains to be regulated in New Zealand. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of adequate, un-crowded housing as a prerequisite for good health, few large cohort studies have explored the health effects of housing conditions. The Social Housing Outcomes Worth (SHOW) Study was established to assess the relationship between housing conditions and health, particularly between household crowding and infectious diseases. This paper reports on the methods and feasibility of using a large administrative housing database for epidemiological research and the characteristics of the social housing population.Methods: This prospective open cohort study was established in 2003 in collaboration with Housing New Zealand Corporation which provides housing for approximately 5% of the population. The Study measures health outcomes using linked anonymised hospitalisation and mortality records provided by the New Zealand Ministry of Health.Results: It was possible to match the majority (96%) of applicant and tenant household members with their National Health Index (NHI) number allowing linkage to anonymised coded data on their hospitalisations and mortality. By December 2011, the study population consisted of 11,196 applicants and 196,612 tenants. Half were less than 21 years of age. About two-thirds identified as Māori or Pacific ethnicity. Household incomes were low. Of tenant households, 44% containing one or more smokers compared with 33% for New Zealand as a whole. Exposure to household crowding, as measured by a deficit of one or more bedrooms, was common for applicants (52%) and tenants (38%) compared with New Zealanders as whole (10%).Conclusions: This project has shown that an administrative housing database can be used to form a large cohort population and successfully link cohort members to their health records in a way that meets confidentiality and ethical requirements. This study also confirms that social housing tenants are a highly deprived population with relatively low incomes and high levels of exposure to household crowding and environmental tobacco smoke. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the perceptions of New Zealand secondary school nurses regarding skin infections in young people aged 14-18 years. A constructivist grounded theory method was adopted. Ten non-structured interviews were conducted with secondary school nurses working in Auckland, New Zealand, between January and July 2013. Interviews were audiotaped, transcribed and analysed using all tenets of grounded theory that included writing memos, theoretical sampling and the constant comparative method. Analysis revealed the core category Maintaining the balance, which is presented as a grounded theory model. It represents the constant state of balancing the school nurse undergoes in trying to counter the risk to the student. The nurse attempts to tip the balance in favour of action, by reducing barriers to healthcare, providing youth-friendly, affordable and accessible healthcare, and following up until resolution is achieved. The nurse is aware that failing to monitor until resolution can again tip the fulcrum back to inaction, placing the young person at risk again. It is concluded that nurses are knowledgeable about the risks present in the communities they serve and are innovative in the methods they employ to ensure satisfactory outcomes for young people experiencing skin infections. School nursing is an evolving model for delivering primary healthcare to young people in New Zealand. The grounded theory model 'Maintaining the balance' describes a model of care where nursing services are delivered where young people spend time, and the nurse is immersed in the community. This model of care may be transferable to other healthcare situations. [ABSTRACT FROM AUTHOR]

The article reports that identification of viruses considered responsible for Theiler disease in horses include Equine parvovirushepatitis and several flaviviruses, the most incriminated being equine hepacivirus.

Background The New Zealand (NZ) Government has made a strong commitment to reduce the incidence of rheumatic fever (RF) by two thirds, to 1.4 cases per 100,000, by mid-2017. We reviewed the NZ RF surveillance sector, aiming to identify potential improvements which would support optimal RF control and prevention activities. Methods This review used a recently developed surveillance sector review method. Interviews with 36 key informants were used to describe the sector, assess it and identify its gaps. Priorities for improvement and implementation strategies were determined following discussion with these key informants, with policy advisors and within the research team. Results Key improvements identified included the need for a comprehensive RF surveillance strategy, integrated reporting and an online national RF register. At a managerial level this review provided evidence for system change and built support for this across the surveillance sector. Conclusions The surveillance sector review approach can be added to the small set of tools currently available for developing and evaluating surveillance systems. This new approach is likely to prove useful as we confront the challenges of combating new emerging infectious diseases, responding to global environmental changes, and reducing health inequalities. [ABSTRACT FROM AUTHOR]