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Leptospirosis, an emerging zoonotic disease caused by Leptospira spirochetes, has many pathogenic serovars endemic to northern Australia. The disease has potential for significant pulmonary, renal and hepatic dysfunction. Early case detection and timely antimicrobial therapy can reduce morbidity and mortality. Clusters of cases have been associated with workplace exposures such as abattoirs. Whilst water-based sporting and recreational activities are established individual risk factors; they are not typically recognised as clusters. This case series highlights the potential for cluster events linked to recreational 4-wheel driving. Following periods of heavy rain, this activity runs the risk of the vehicle becoming bogged – a state often requiring manual recovery. Leptospirosis is a notifiable disease in Queensland. Following a positive disease notification, detailed anamnesis, confirmation of exposure source and follow up of contacts is undertaken. Diagnosis with paired serology and microscopic agglutination titres (MAT) determines the causative serovar. Matching serovars across cases with a single exposure adds weight to a cluster event. In 2021, a cluster of four Leptospirosis cases was associated with a single exposure event in north Queensland involving recreational 4-wheel driving. The index case presented with a febrile illness and acute renal dysfunction two weeks following exposure. The clinical diagnosis of Leptospirosis was confirmed serologically with positive IgM serology and MAT titres for Australis serovar. From the primary case a further seven exposures were identified. Three of these tested positive for Leptospirosis (Australis serovar), two returned a negative result and two were unable to be contacted. Of the four cases, three had significant symptoms and were only identified as potential cases following investigation of the first case. The fourth case had significant delay in diagnosis as a result. Further review of disease notifications demonstrated a similar cluster of three leptospirosis cases from a single point exposure of recreational 4-wheel driving in 2019. Recreational 4-wheel driving and vehicle recovery may result in potential Leptospirosis exposure, especially following heavy rainfall. Improved recognition of the risk of cluster events has implications for case finding and preventing potential severe complications. Consideration of prophylactic therapy for linked exposures may be appropriate. [ABSTRACT FROM AUTHOR]

This article describes the public health response to an outbreak of meningococcal B disease, linked to a secondary school in Far North Queensland. Tropical Public Health Services in Cairns were notified of three cases of meningococcal disease in the same week in May 2022. The cases occurred in individuals who all attended, or worked in, the same secondary school. All cases were serogroup B and shared the same molecular genotype. The public health response included prompt provision of information, distribution of clearance antibiotics and two doses of MenB-4C vaccine to the entire staff and student population. Antibiotic coverage and vaccination coverage were achieved in 99% and 85% of the student population respectively. Following the intervention, no further cases were detected in the region during the subsequent nine months., (© Commonwealth of Australia CC BY-NC-ND)

Toxigenic diphtheria is rare in Australia with generally fewer than 10 cases reported annually; however, since 2020, there has been an increase in toxin gene-bearing isolates of Corynebacterium diphtheriae cases in North Queensland, with an approximately 300% escalation in cases in 2022. Genomic analysis on both toxin gene-bearing and non-toxin gene-bearing C. diphtheriae isolated from this region between 2017 and 2022 demonstrated that the surge in cases was largely due to one sequence type (ST), ST381, all of which carried the toxin gene. ST381 isolates collected between 2020 and 2022 were highly genetically related to each other, and less closely related to ST381 isolates collected prior to 2020. The most common ST in non-toxin gene-bearing isolates from North Queensland was ST39, an ST that has also been increasing in numbers since 2018. Phylogenetic analysis demonstrated that ST381 isolates were not closely related to any of the non-toxin gene-bearing isolates collected from this region, suggesting that the increase in toxigenic C. diphtheriae is likely due to the expansion of a toxin gene-bearing clone that has moved into the region rather than an already endemic non-toxigenic strain acquiring the toxin gene.

Background: Threatened preterm labour is a common reason for medical transfer from remote communities; however, many transferred women do not deliver preterm. A tool for prediction of preterm birth such as fetal fibronectin may reduce transfers and related social and economic costs., Aim: To review the use of fetal fibronectin testing in women transferred for threatened preterm labour from Cape York to Cairns Hospital between 2011 and 2015 and determine the role testing could play in reducing transfers and associated costs., Materials/methods: Records from the Royal Flying Doctor Service and Cairns Hospital were accessed. Women transferred solely for threatened preterm labour were included in the study. Fetal fibronectin testing, hospital admission, outpatient stays and birth outcome data were collated and analysed. Costs were assigned using the National Hospital Cost Data Collection, round 19., Results: Forty-seven women were included in the study; however, only 20 underwent fetal fibronectin testing. Transfer of 30 women who had either a negative test or were not tested but delivered at term resulted in 41 inpatient nights and 443 excess outpatient nights, costing an estimated AU$57 408. Aeromedical transfers were estimated to cost a further $151 500., Conclusion: Adherence to clinical guidelines and greater availability and use of fetal fibronectin testing in Cape York have the potential to reduce aeromedical transfers for threatened preterm labour. Substantial inpatient and excess outpatient stays could be avoided with associated reduction in health system and social costs. Strategies to improve adherence to guidelines and increase access to testing are required., (© 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)