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Introduction: Students comprised the majority of early cases of influenza A(H1N1)pdm09 in Melbourne, Australia. Students and school settings were targeted for public health interventions following the emergence of pH1N1. This study was conducted to describe changes in social contacts among the earliest confirmed student cases of pH1N1 in Melbourne, Australia, to inform future pandemic control policy and explore transmission model assumptions. Methods: A retrospective cross-sectional behavioural study of student cases with laboratory-confirmed pH1N1 between 28 April and 3 June 2009 was conducted in 2009. Demographics, symptom onset dates and detailed information on regular and additional extracurricular activities were collected. Summary measures for activities were calculated, including median group size and median number of close contacts and attendance during the students’ exposure and infectious periods or during school closures. A multivariable model was used to assess associations between rates of participation in extracurricular activities and both school closures and students’ infectious periods. Results: Among 162 eligible cases, 99 students participated. Students reported social contact in both curricular and extra-curricular activities. Group size and total number of close contacts varied. While participation in activities decreased during the students’ infectious periods and during school closures, social contact was common during periods when isolation was advised and during school closures. Discussion: This study demonstrates the potential central role of young people in pandemic disease transmission given the level of non-adherence to prevention and control measures. These finding have public health implications for both informing modelling estimates of future pandemics and targeting prevention and control strategies to young people.

Little is known about the impact of drug resistance on recurrence in TB. We conducted a cohort study to measure the impact of multi-drug resistance (MDR) on TB recurrence over nine years in Henan Province China. We reviewed medical records and conducted field interviews of 100 MDR and 150 non-MDR TB patients who were treated between 2001 and 2002. We compared long-term recurrence rates, risk factors, and outcomes in 2010 for 234 individuals who could be followed up. About one third (29.5%, 69/234) suffered recurrence after completion of treatment. The overall recurrence rate was 35/1,000 patient-years (PY), with a much higher rate (65/1,000 PY) among MDR-TB patients. MDR (HR: 2.75; CI: 1.58-4.79) and patient annual household income less than 10,000 Yuan (HR: 2.05; CI 1.11-3.80) were associated with recurrence. The mean time for recurrence among MDR-TB patients was 5.7 years, compared to 7.2 years among non-MDR-TB patients. Among the recurrence group members, 61.3% died, and 18.8% had failed treatments. We believe that the high TB recurrence rate after 9 years suggests that a high cure rate cannot accurately predict long-term outcome. We recommend that TB surveillance and control should be strengthened with a focus on MDR-TB and directly observed treatment, to reduce TB recurrence and transmission of MDR-TB.

BACKGROUND: We conducted a cohort study to compare the characteristics of MDR-TB with non-MDR-TB patients and to measure long term (9-year) mortality rate and determine factors associated with death in China. METHODS: We reviewed the medical records of 250 TB cases from a 2001 survey to compare 100 MDR-TB patients with 150 non-MDR-TB patients who were treated in 2001-2002. Baseline attributes extracted from the records were compared between the two cohorts and long-term mortality and risk factors were determined at nine-year follow-up in 2010. RESULTS: Among the 234 patients successfully followed up, 63 (26.9%) were female and 171 (73.1 %) were male. MDR-TB patients had poorer socioeconomic status compared to non-MDRTB. Nine years after the diagnosis of TB, 69 or 29.5 % of the 234 patients had died (32 or 21.6 % of non-MDR-TB versus 37 or 43.0 % of MDR-TB) and the overall mortality rate was 39/1000 per year (PY) (27/1000 PY among non-MDR versus 63/1000 PY among MDR-TB). Factors associated with death included: MDR status (hazard ratio (HR): 1.86; CI: 1.09-3.13), limited education of primary school or lower (HR: 2.51; CI 1.34-4.70) and received TB treatment during the nine-year period (HR 1.82; 95 % CI 1.02-3.26). CONCLUSIONS: MDR-TB was a strong predictor for poor long-term outcome. High quality diagnosis and treatment must be ensured. Greater reimbursement or free treatment may be needed to provide access for the poor and vulnerable populations, and to increase treatment compliance.

Background: Estimates of the burden of illness acquired from food inform public health policy and prioritize interventions. A key component of such estimates is the proportion of illnesses that are acquired by foodborne transmission. In view of the shortage of requisite data, these proportions are commonly obtained through a process known as expert elicitation. We report findings from an elicitation process used to assess the importance of the foodborne transmission route for nine pathogens in Australia, circa 2010. Materials and Methods: Eleven experts were asked to estimate the proportion of illness acquired by five transmission routes: food, environmental, water, person, and zoonotic, together with a 90% certainty interval for foodborne transmission. Foodborne estimates and intervals from each expert were combined using both modified triangular and Program Evaluation and Review Technique (PERT) distributions, in @Risk version 6, to generate final distributions from which median estimates and 95% Credible Intervals (CrI) were calculated. Results: Shiga toxin-producing Escherichia coli (STEC) was the only pathogen believed to have an important zoonotic transmission route, while norovirus, hepatitis A virus, non-STEC pathogenic E. coli, and Shigella spp. were all thought to be primarily spread from person to person. Foodborne transmission was the main route for Clostridium perfringens (98%, CrI: 84-100), Listeria monocytogenes (98%, CrI: 86-100), nontyphoidal Salmonella spp. (72%, CrI: 50-87), and Campylobacter spp. (77%, CrI: 60-90). Foodborne estimates using the modified triangular distribution had wider CrI than these calculated using the PERT distribution. Conclusions: Foodborne proportions for most pathogens in this study were the same or lower than those estimated circa 2000 in Australia, with the greatest decline for non-STEC pathogenic E. coli. Inclusion of certainty intervals from experts helps to quantify the precision of foodborne proportions. A decline i

Objective: To evaluate the impact of a fruit and vegetable subsidy program on short-term health outcomes of disadvantaged Aboriginal children.Design, setting and participants: A before-and-after study involving clinical assessments, health record audits and blood testing of all children aged 0–17 years (n = 167) from 55 participating families at baseline and after 12 months at three Aboriginal community-controlled health services in New South Wales. All assessments were completed between December 2008 and September 2010.Intervention: A weekly box of subsidised fruit and vegetables linked to preventive health services and nutrition promotion at an Aboriginal Medical Service.Main outcome measures: Change in episodes of illness, health service and emergency department attendances, antibiotic prescriptions and anthropometry.Results: There was a significant decrease in oral antibiotics prescribed (− 0.5 prescriptions/year; 95% CI, − 0.8 to − 0.2) during 12 months of participation in the program compared with the 12 months before the program. The proportion of children classified as overweight or obese at baseline was 28.3% (38/134) and the proportion in each weight category did not change (P = 0.721) after 12 months. A small but significant increase in mean haemoglobin level (3.1 g/L; 95% CI, 1.4–4.8 g/L) was shown, although the proportion with iron deficiency (baseline, 41%; follow-up, 37%; P = 0.440) and anaemia (baseline, 8%; follow-up, 5%; P = 0.453) did not change significantly.Conclusion: This fruit and vegetable subsidy program was associated with improvements in some indicators of short-term health status among disadvantaged Aboriginal children. A controlled trial is warranted to investigate the sustainability and feasibility of healthy food subsidy programs in Australia.

Background: The Victorian Government Department of Health funded a diphtheria, tetanus and acellular pertussis vaccine for parents of infants from June 2009 to June 2012 as part of a cocooning strategy for the control of pertussis. The aim of this study w

Aim: The aim of this study was to determine the proportion of children less than 12 months of age presenting to Hunter New England (HNE) emergency departments (EDs) during 2009 who were overdue for immunisations and identify factors associated with overdue status. Methods: The immunisation status of all children aged between 3 months and 1 year (120-365 days) who presented at an HNE ED between 1 January and 31 December 2009 was determined using Australian Childhood Immunisation Register (ACIR) 30-day overdue reports. The ED dataset and ACIR reports were linked using a deterministic method. Results: Six per cent (253/4218) of children who attended an HNE ED in 2009 were overdue for immunisation and 28.1% (71/253) presented multiple times while overdue. There was a median delay of 77 days from their first presentation while overdue until they no longer appeared on the ACIR 30-day overdue report. Children who presented while overdue were more likely to present multiple times to EDs (RR = 1.45; P = 0.0025), be in a life-threatening triage category (P = 0.012) and present at tertiary referral hospitals (P < 0.001). Conclusions: Important missed immunisation opportunities occurred in HNE EDs and may occur in other EDs in Australia. Half of the children who presented to Hunter New England emergency departments while overdue for immunisation remained overdue for greater than 77 days following their presentation. Opportunities exist in EDs and paediatric inpatient wards for ensuring that all children are protected against vaccine-preventable diseases.

Background: A large outbreak of hepatitis A affected individuals in several Australian states in 2009, resulting in a 2-fold increase in cases reported to state health departments compared with 2008. Two peaks of infection occurred (April-May and September-November), with surveillance data suggesting locally acquired infections from a widely distributed food product. Methods: Two case-control studies were completed. Intensive product trace-back and food sampling was undertaken. Genotyping was conducted on virus isolates from patient serum and food samples. Control measures included prophylaxis for close contacts, public health warnings, an order by the chief health officer under the Victorian Food Act 1984, and trade-level recalls on implicated batches of semidried tomatoes. Results: A multijurisdictional case-control study in April-May found an association between illness and consumption of semidried tomatoes (odds ratio [OR], 3.0; 95% CI 1.4-6.7). A second case-control study conducted in Victoria in October-November also implicated semidried tomatoes as being associated with illness (OR, 10.3; 95% CI, 4.7-22.7). Hepatitis A RNA was detected in 22 samples of semidried tomatoes. Hepatitis A virus genotype IB was identified in 144 of 153 (94%) patients tested from 2009, and partial sequence analysis showed complete identity with an isolate found in a sample of semidried tomatoes. Conclusions. The results of both case-control studies and food testing implicated the novel vehicle of semidried tomatoes as the cause of this hepatitis A outbreak. The outbreak was extensive and sustained despite public health interventions, the design and implementation of which were complicated by limitations in food testing capability and complex supply chains.

Background: Shiga toxin-producing Escherichia coli (STEC) are an important cause of gastroenteritis in Australia and worldwide and can also result in serious sequelae such as haemolytic uraemic syndrome (HUS). In this paper we describe the epidemiology of STEC in Australia using the latest available data. Methods. National and state notifications data, as well as data on serotypes, hospitalizations, mortality and outbreaks were examined. Results: For the 11 year period 2000 to 2010, the overall annual Australian rate of all notified STEC illness was 0.4 cases per 100,000 per year. In total, there were 822 STEC infections notified in Australia over this period, with a low of 1 notification in the Australian Capital Territory (corresponding to a rate of 0.03 cases per 100,000/year) and a high of 413 notifications in South Australia (corresponding to a rate of 2.4 cases per 100,000/year), the state with the most comprehensive surveillance for STEC infection in the country. Nationally, 71.2% (504/708) of STEC infections underwent serotype testing between 2001 and 2009, and of these, 58.0% (225/388) were found to be O157 strains, with O111 (13.7%) and O26 (11.1%) strains also commonly associated with STEC infections. The notification rate for STEC O157 infections Australia wide between 2001-2009 was 0.12 cases per 100,000 per year. Over the same 9 year period there were 11 outbreaks caused by STEC, with these outbreaks generally being small in size and caused by a variety of serogroups. The overall annual rate of notified HUS in Australia between 2000 and 2010 was 0.07 cases per 100,000 per year. Both STEC infections and HUS cases showed a similar seasonal distribution, with a larger proportion of reported cases occurring in the summer months of December to February. Conclusions: STEC infections in Australia have remained fairly steady over the past 11 years. Overall, the incidence and burden of disease due to STEC and HUS in Australia appears comparable or lower than si

People with chronic hepatitis B (CHB) are a major source of incident hepatitis B virus (HBV) infection. The Department of Health in Victoria, Australia, recommends household contacts of CHB cases to be screened and funds hepatitis B vaccination for those

An outbreak of gastrointestinal illness was identified among attendees at a large community barbeque at a Sydney sports club on 30 January 2009. A retrospective cohort study was initiated, and attendees were identified through hospital emergency department gastroenteritis presentations, snowball recruitment through known cases, responders to linguistically specific press, and those returning to the venue the next week. A symptom and food history was collected from attendees, and stool samples were provided for microbiological investigation. An environmental investigation and trace back of implicated foods was also undertaken. Attendance estimates at the barbeque ranged from 100 to 180, and the food was prepared by a family that was not registered as a food business. Seventy one of the 87 attendees identified met the case definition. Thirty attendees (42%) had laboratory confirmed Salmonella Typhimurium phage-type 108/170, all with the same multilocus variable number of tandem repeat analysis typing. Burden of illness was high with 76% of cases seeking medical attention and 18% admitted to hospital. Microbiological evidence confirmed that a number of food items were contaminated with Salmonella Typhimurium 108/170, with the raw egg mayonnaise used in a Russian salad being the most likely primary food vehicle (adjusted odds ratio=10.3 [95% confidence interval 1.79-59.5]). Further, having Russian salad on the plate even if it was not consumed increased the relative risk of illness, thus suggesting that other food items may have been contaminated when they came into contact with it on the plate. This Salmonella outbreak highlighted the risks associated with the improper handling of food in private residences, which are then sold at a large public event.

Infectious gastroenteritis is a common illness in Australia as elsewhere. Data from a year-long national gastroenteritis survey in 2001-2002 showed that gastroenteritis was more common in the northern and hotter part of Australia. These data were used to

Background: The Australian Government launched a mass media campaign in 2009 to raise awareness of the harms and costs associated risky drinking among young Australians. The aim of this study was to assess if young people attending a music festival who report frequent risky single occasions of drinking (RSOD) recognise the key message of the campaign, "Binge drinking can lead to injuries and regrets", compared to young people who report less frequent RSOD. Methods. A cross-sectional behavioural survey of young people (aged 16-29 years) attending a music festival in Melbourne, Australia, was conducted in January 2009. We collected basic demographics, information on alcohol and other drug use and sexual health and behaviour during the previous 12 months, and measured recognition of the Australian National Binge Drinking Campaign key message. We calculated the odds of recognition of the key slogan of the Australian National Binge Drinking Campaign among participants who reported frequent RSOD (defined as reported weekly or more frequent RSOD during the previous 12 months) compared to participants who reported less frequent RSOD. Results: Overall, three-quarters (74.7%) of 1072 participants included in this analysis recognised the campaign message. In the adjusted analysis, those reporting frequent RSOD had significantly lower odds of recognising the campaign message compared to those not reporting frequent RSOD (OR 0.7, 95% CI 0.5-0.9), whilst females had significantly greater odds of recognising the campaign message compared to males (OR 1.8, 95% CI 1.4-2.1). Conclusions: Whilst a high proportion of the target group recognised the campaign, our analysis suggests that participants that reported frequent RSOD - and thus the most important group to target - had statistically significantly lower odds of recognising the campaign message.

Rates of herpes zoster (HZ) hospitalizations, antiviral prescriptions, and New South Wales emergency-department presentations for age groups <20, 20-39, 40-59 and ≥60 years were investigated. Trends were analysed using Poisson regression to determine if

A pilot study was conducted in rural northern New South Wales from 15 July to 28 August 2009, during Australia's Protect Phase response to the Influenza A H1N1 California 7/09 pandemic. This study explored the feasibility of using administrative data, generated from the distribution of stockpiled antivirals, as a syndromic surveillance system. The purpose was to identify recently affected towns or those with increasing influenza-like illness activity to assist in rural health service operational planning. Analysis of antiviral distribution data was restricted to 113 general practices in rural parts of the Hunter New England Area Health Service. By 2 September 2009 a total of 6,670 courses of antivirals for adults, of which 455 courses were replacement orders, had been distributed to these general practices. Distribution of replacement antivirals were mapped to local government areas on a weekly basis. The syndromic surveillance system delivered timely data on antiviral distribution; used readily available software to generate visual activity maps in less than 30 minutes; proved adaptable; was of low cost; and was well received by health service planners. Full evaluation of the system's utility was limited by the relatively large initial distribution of antivirals and the brief nature of Australia's first pandemic wave. The pilot study demonstrated that a syndromic surveillance system based on distribution of supplies, such as treatment or vaccines, can support local health service operational planning during health emergencies.

OBJECTIVE: A publicly funded, universal infant pentavalent rotavirus vaccine (RV5) program was implemented in Queensland, Australia, in mid-2007. We sought to assess vaccine effectiveness (VE) of 3 doses of RV5 at preventing rotavirus and nonrotavirus acute gastroenteritis (AGE) hospitalizations in the first birth cohort and impact on hospitalizations in all age groups. METHODS: Hospitalization rates for rotavirus and nonrotavirus AGE in all age groups before and after RV5 introduction were compared. Population vaccine coverage, hospitalization data, and individual vaccination status were obtained from routinely collected, publicly funded state- and nationally based data sets. Data linkage was performed to calculate 3-dose VE for preventing hospitalization in the eligible age group. RESULTS: RV5 coverage in the first eligible birth cohort was 89.6% for at least 1 dose and 73.1% for 3 doses. Three-dose VE for preventing nonrotavirus AGE hospitalization was 62.3% to 63.9% (any/primary diagnosis) and 89.3% to 93.9% (any/primary diagnosis) for rotavirus hospitalizations. After program implementation, there were immediate and sustained reductions in rotavirus hospitalizations for those who were younger than 20 years and nonrotavirus AGE-coded hospitalizations for those who were younger than 5 years. CONCLUSIONS: RV5 is highly effective at preventing rotavirus hospitalizations in a developed country setting, confirming efficacy figures from the pivotal clinical trial. Additional direct and indirect effects are substantial and include reductions in nonrotavirus AGE hospitalizations in vaccinated age groups and rotavirus and nonrotavirus AGE hospitalization rates in older age groups.