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Antenatal inactivated influenza (IIV) and pertussis-containing vaccines (dTpa) offer protection against severe respiratory infections for pregnant women and infants6 months of age. Both vaccines are recommended in pregnancy; however, little is known about temporal or jurisdictional trends and predictors of uptake.To identify gaps and predictors of IIV and/or dTpa vaccinations in Australian pregnancies from 2012 to 2017.We conducted a probabilistically linked, multi-jurisdictional population-based cohort study, drawing from perinatal data collections and immunisation databases. We used a generalised linear mixed model with a random effect term to account for clustering of multiple pregnancies within mothers, to calculate vaccination uptake, and identify predictors of uptake by maternal demographic, pregnancy, and health characteristics.Of 591 868 unique pregnancies, IIV uptake was 15%, dTpa 27% and 12% received both vaccines. Pertussis vaccinations in First Nations pregnancies were 20% lower than non-Indigenous pregnancies; dTpa was strongly associated with IIV uptake (risk ratio (RR): 8.60, 95% CI 8.48-8.73). This trend was temporally and jurisdictionally consistent. First Nations women were more likely to have had IIV in pregnancy before the introduction of dTpa in the pregnancy program: (RR: 1.48, 95% CI 1.40-1.57), but less likely after dTpa implementation (RR: 0.78, 95% CI 0.76-0.80).Inequity in vaccine uptake between First Nations and non-Indigenous pregnancies, and dismal rates of vaccination in pregnancy overall need urgent review, particularly before the next influenza pandemic or pertussis outbreak. If antenatal dTpa is driving IIV uptake, changes in antenatal healthcare practices are needed to ensure vaccines are offered equitably and optimally to protect against infection.

Background The Western Pacific Region (WPR) is exposed each year to seasonal influenza and is often the source of new influenza virus variants and novel pathogen emergence. National influenza surveillance systems play a critical role in detecting emerging viruses, monitoring influenza epidemics, improving public disease awareness and promoting pandemic preparedness, but vary widely across WPR countries. The aim of this study is to improve existing influenza surveillance systems by systematically comparing selected WPR influenza surveillance systems. Methods Three national influenza surveillance systems with different levels of development (Australia, China and Malaysia) were compared and their adherence to World Health Organization (WHO) guidance was evaluated using a structured framework previously tested in several European countries consisting of seven surveillance sub-systems, 19 comparable outcomes and five evaluation criteria. Based on the results, experts from the Asia-Pacific Alliance for the Control of Influenza (APACI) issued recommendations for the improvement of existing surveillance systems. Results Australia demonstrated the broadest scope of influenza surveillance followed by China and Malaysia. In Australia, surveillance tools covered all sub-systems. In China, surveillance did not cover non-medically attended respiratory events, primary care consultations, and excess mortality modelling. In Malaysia, surveillance consisted of primary care and hospital sentinel schemes. There were disparities between the countries across the 5 evaluation criteria, particularly regarding data granularity from health authorities, information on data representativeness, and data communication, especially the absence of publicly available influenza epidemiological reports in Malaysia. This dual approach describing the scope of surveillance and evaluating the adherence to WHO guidance enabled APACI experts to make a number of recommendations for each country that included but were not limited to introducing new surveillance tools, broadening the use of specific existing surveillance tools, collecting and sharing data on virus characteristics, developing immunization status registries, and improving public health communication. Conclusions Influenza monitoring in Australia, China, and Malaysia could benefit from the expansion of existing surveillance sentinel schemes, the broadened use of laboratory confirmation and the introduction of excess-mortality modelling. The results from the evaluation can be used as a basis to support expert recommendations and to enhance influenza surveillance capabilities.

Intramuscular Immune Serum Globulin (IM ISG) is recommended as post-measles exposure prophylaxis (PEP) when administered within 6days of initial exposure, with variable effectiveness in preventing measles disease. Effectiveness of IM ISG PEP in preventing clinical measles was assessed during a 2014 measles outbreak among a religious-affiliated community in British Columbia, Canada.Fifty-five self-reporting measles susceptible contacts were offered exclusively IM ISG PEP within an eligibility period best surmised to be within 6days of initial measles case exposure. Clinical outcome of IM ISG PEP recipients was determined by selective active surveillance and case self-reporting. IM ISG PEP failure was defined as onset of a measles-like rash 8-21days post-IM ISG PEP. Post-IM ISG PEP measles IgG antibody level was tested in 8 recipients. Factors associated with measles disease were analyzed.Seventeen of 55 IM ISG PEP recipients developed clinically consistent measles in the following 8-21days, corresponding to an estimated crude protective effectiveness of 69%. In school aged children 5-18years, among whom potential exposure intensity and immune status confounders were considered less likely, estimated IM ISG PEP protective effectiveness was 50%. Age25years was significantly associated with breakthrough clinical measles in bivariate analysis (p=0.0217). Among 8 tested contacts of 17 considered IM ISG PEP failures, post-IM ISG PEP measles IgG antibody levels (mean 16.3days (range 16-17days) post-PEP) were all150mIU/ml.The estimated crude IM ISG PEP protective effectiveness against measles disease within 8-21days post-ISG administration was 69%. Accuracy of this estimated protective effectiveness is vulnerable to assumptions and uncertainties in ascertaining exposure details and pre-exposure immune status. Increasing the Canadian recommended measles IM ISG PEP dose from 0.25 to 0.5ml/kg (up to 15ml maximum volume) may increase protective effectiveness.

IntroductionPregnant women and infants are at risk of severe influenza and pertussis infection. Inactivated influenza vaccine (IIV) and diphtheria-tetanus-acellular pertussis vaccine (dTpa) are recommended during pregnancy to protect both mothers and infants. In Australia, uptake is not routinely monitored but coverage appears sub-optimal. Evidence on the safety of combined antenatal IIV and dTpa is fragmented or deficient, and there remain knowledge gaps of population-level vaccine effectiveness. We aim to establish a large, population-based, multi-jurisdictional cohort of mother-infant pairs to measure the uptake, safety and effectiveness of antenatal IIV and dTpa vaccines in three Australian jurisdictions. This is a first step toward assessing the impact of antenatal vaccination programmes in Australia, which can then inform government policy with respect to future strategies in national vaccination programmes.Methods and analysis‘Links2HealthierBubs’ is an observational, population-based, retrospective cohort study established through probabilistic record linkage of administrative health data. The cohort includes births between 2012 and 2017 (~607 605 mother-infant pairs) in jurisdictions with population-level antenatal vaccination and health outcome data (Western Australia, Queensland and the Northern Territory). Perinatal data will be the reference frame to identify the cohort. Jurisdictional vaccination registers will identify antenatal vaccination status and the gestational timing of vaccination. Information on maternal, fetal and child health outcomes will be obtained from hospitalisation and emergency department records, notifiable diseases databases, developmental anomalies databases, birth and mortality registers.Ethics and disseminationEthical approval was obtained from the Western Australian Department of Health, Curtin University, the Menzies School of Health Research, the Royal Brisbane and Women’s Hospital, and the West Australian Aboriginal Health Ethics Committees. Research findings will be disseminated in peer-reviewed journals, at scientific meetings, and may be incorporated into communication materials for public health agencies and the public.

Disease due to Streptococcus pneumoniae, the pneumococcus, remains a major source of illness in older persons. Globally, it remains the most important pathogen in respiratory infection deaths. Conjugated pneumococcal vaccines are used extensively in national pediatric programs, whereas a polysaccharide vaccine is used in all age groups, but mainly in the elderly and for high-risk groups. Recent data from the Netherlands led to the licensing in many countries of conjugated pneumococcal vaccines for older persons. There are substantial differences in recommendations from various national immunization technical advisory groups, which owe at least as much to differing assessments of available studies as to differences in local epidemiology. This review examines those differences and proposes a way forward.

The manuscript by Chen and colleagues [1] suggests that, based on retrospective Australian data, 23-valent pneumococcal polysaccharide vaccine (PPV23) has a worsening cost-effectiveness profile over time and is unlikely to be cost-effective unless it provides protection against non-invasive community acquired pneumococcal pneumonia (pneumococcal CAP). At an effectiveness of about 15% against pneumococcal CAP, the PPV23 program approached cost-effectiveness [1]. In their base case, Chen and colleagues assumed zero benefit from PPV23 against pneumococcal CAP. Such an assumption is inconsistent with recent studies which suggest PPV23 effectiveness against pneumococcal CAP is non-zero and could be as high as 50% (reviewed in Van Buynder and Booy [2]). Studies supportive of an effectiveness for PPV23 against vaccine-type (VT) pneumococcal CAP include: a Japanese prospective cohort study which found 33% VE (95% CI: 5.6–53.1%) against VT pneumococcal CAP in patients that had received at least one dose of PPV23 in the 5 years before [3]; a Spanish cohort study which found 48% (95% CI: 8–71%) VE against non-bacteraemic pneumococcal CAP in subjects vaccinated up to 5 years previously [4]; and a German meta-analytical review which allocated a VE against pneumococcal CAP of 64% (95% CI: 35–80%) out to 2.5 years in randomised clinical trials and of 48% (95% CI: 25–62%) in cohort studies followed out to 5 years [5]. Re-examination of the cost-effectiveness of the PPV23 program applying assumptions regarding effectiveness for PPV23 against VT pneumococcal CAP consistent with the literature described above would greatly enhance the contribution of this publication to public health decision making.

Health care organizations and their staff have a responsibility to prevent occupationally-acquired infections and avoid transmitting disease to patients. As well as being a known source of nosocomial infections, health care workers (HCWs) are at risk themselves of becoming infected in the workplace. Regulatory authorities in many countries advise or mandate screening for key blood-borne pathogens (BBPs) in settings where transmission between patients and staff is possible. Staff infected with a BBP are restricted from performing certain procedures. In addition to screening for BBP, health care organizations require a tuberculosis infection control programme. Routine screening of health care workers for other organisms such as MRSA is usually not indicated. Health care organizations should have robust policies to immunize health care workers against Hepatitis B and respiratory diseases. Many organizations now make immunization against key respiratory diseases a pre-requisite for employment as a key infection control patient safety strategy.

A characterization of pesticides in secondary treated effluent (STE) and a screening health risk assessment were conducted to evaluate potential health impacts of recycled water for potable reuse. Samples of STE were examined pre- and postreverse osmosis (RO) treatment in two plants. Risk quotients (RQ) were estimated by expressing the maximum and median concentration as a function of the health value. Of 128 pesticides analyzed, 11 were detected in STE. Trifluralin was detected in 86.5% of the STE samples followed by metolachlor (67.6%), 2,4-D (50%), and propiconazole (42.5%). Metolachlor was the only pesticide detected post-RO in one sample (0.08 μg/L, limit of reporting = 0.05 μg/L). RQ(max) were all below health values in the STE with the exception of thiophanate methyl (RQ max = 2.4). RO was able to reduce the concentration of all pesticides below LOR. Median removal efficiency for RO ranged from 67.1% (atrazine) to 98.8% (2,4-D). The results indicate that, despite the detection of pesticides in STE, the impact on indirect potable reuse is negligible due to the low concentrations in STE and their subsequent removal during RO treatment. Implementation of risk management strategies to optimize safety and recommendations for a monitoring program are also discussed. Refereed/Peer-reviewed

Please cite this paper as: Van Buynder et al. (2013). Increased reactions to pediatric influenza vaccination following concomitant pneumococcal vaccination Influenza and Other Respiratory Viruses 7(2) 184–190. Background Influenza in children causes significant morbidity and hospitalizations and also some mortality particularly in children

the Western Australian Influenza Vaccine Effectiveness study commenced in 2008 to evaluate a new program to provide free influenza vaccine to all children aged 6 to 59 months. We aimed to assess the protective effect of inactivated influenza vaccination in these children.We conducted a prospective case-control study in general practices and a hospital emergency department, testing all eligible patients for influenza and a range of other common respiratory viruses. Influenza vaccine effectiveness (VE) against laboratory-confirmed influenza was estimated with cases defined as children with an influenza-like illness who tested positive and controls as those with an influenza-like illness who tested negative for influenza virus. We calculated VE using the adjusted odds ratio from multivariate logistic regression. As a surrogate marker for adequate specimen collection, we explored the difference in VE point estimates defining controls as children in whom another respiratory virus was detected.a total of 75 children were enrolled from general practices and 214 through the emergency department, with 12 (27%) and 36 (17%), respectively, having laboratory-confirmed influenza. Using all the influenza-negative controls, the adjusted VE was 58% (95% confidence interval, 9-81). When controls were limited to those with another virus present, the adjusted VE was 68% (95% confidence interval, 26-86).VE estimates were higher when controls included only those children with another respiratory virus detected. Testing for other common respiratory viruses enables the control group to be restricted to those for whom an adequate sample is likely.

Adults over the age of 60-65 years suffer disproportionally from seasonal influenza, experiencing high rates of complications, exacerbation of underlying medical comorbidities, and excess mortality. Thus, older adults are an important priority for influenza immunisation campaigns. Unfortunately, older adults generally display lower immune responses to standard influenza vaccines because of immunosenescence, with resulting suboptimal vaccine effectiveness. Thus, the development of improved vaccines that heighten immune responses and improve effectiveness is an important medical need. To this end, enhanced influenza vaccines specifically targeting this age group have been developed, which seek to overcome the inherent limitations in the immune responses of older adults. Both the licensed high-dose trivalent influenza vaccine (hdTIV) containing fourfold higher antigen contents than standard vaccine, and the MF59® -adjuvanted trivalent influenza vaccine (aTIV) have been proven to be safe and well-tolerated while enhancing the immune response. Healthcare providers for populations of older adults should be advised to routinely use these enhanced influenza vaccines in seasonal immunisation campaigns to provide improved immunity against influenza and its consequences in this particularly susceptible age group.

Please cite this paper as: Van Buynder et al. (2010) Marketing paediatric influenza vaccination: results of a major metropolitan trial. Influenza and Other Respiratory Viruses 5(1), 33–38. Objectives After a cluster of rapidly fulminant influenza related toddler deaths in a Western Australian metropolis, children aged six to 59 months were offered influenza vaccination in subsequent winters. Some parental resistance was expected and previous poor uptake of paediatric influenza vaccination overseas was noted. A marketing campaign addressing barriers to immunization was developed to maximise uptake. Design Advertising occurred in major statewide newspapers, via public poster displays and static ‘eye-lite’ displays, via press releases, via a series of rolling radio advertisements, via direct marketing to child care centres, and via a linked series of web-sites. Parents were subsequently surveyed to assess reasons for vaccination. Main Outcome Results The campaign produced influenza vaccination coverage above that previously described elsewhere and led to a proportionate reduction in influenza notifications in this age group compared to previous seasons. Conclusions Influenza in children comes with significant morbidity and some mortality. Paediatric influenza vaccination is safe, well tolerated and effective if two doses are given. A targeted media campaign can increase vaccine uptake if it reinforces the seriousness of influenza and addresses community ‘myths’ about influenza and influenza vaccine. The lessons learned enabling enhancements of similar programs elsewhere.

Please cite this paper as: Dixon et al. (2010) Lessons from the first year of the WAIVE study investigating the protective effect of influenza vaccine against laboratory-confirmed influenza in hospitalised children aged 6–59 months. Influenza and Other Respiratory Viruses 4(4), 231–234. Background Influenza is major cause of paediatric hospitalisation. Influenza vaccine was offered to all children aged 6–59 months resident in Western Australia in 2008, and we wished to evaluate the effectiveness of this immunisation programme. Objectives To assess the practicalities of a nested matched case–control design to estimate the protective effect of inactivated influenza vaccination in hospitalised children aged 6–59 months. Methods Cases were hospitalised children with laboratory-confirmed influenza, while matched controls were recruited from children admitted for an acute non-respiratory illness. We estimated influenza vaccine effectiveness (VE) against influenza as 1 – the adjusted odds ratio from multivariate logistic regression. Results The 2008 influenza season was characterised by a late peak and a predominance of influenza virus B. We recruited 26 hospitalised patients with laboratory-confirmed influenza and 50 matched controls. The proportion of cases who were fully vaccinated was 7% versus 30% of controls giving an adjusted VE of 83% (95% CI −54 to 98). Conclusions Recruiting sufficient controls was problematic and in the future, we will select controls hospitalised for an influenza-like-illness but influenza negative by laboratory PCR testing. The VE estimate was high but non-significant, reflecting the low number of cases.

There is marked variation in the rate of surgical site infections (SSIs) following total hip and knee replacements reported by hospitals submitting data to the Healthcare Infection Surveillance Western Australia. Ablinded retrospective case review was performed in order to determine if the differences were due to varying surveillance and reporting effectiveness. To further assess the quality of surveillance methodology the infection control professional at each site completed a paper-based, structured interview. A total of 444 patient charts were reviewed. Overall, the sensitivity of routine surveillance was 83%, the specificity 99%, the positive predictive value 94% and the negative predictive value 97%. The sensitivity varied between hospitals, ranging from 20 to 100%. The results of the methodology survey revealed fairly comparable surveillance practices at nine of the 10 hospitals. The hospitals with the lowest SSI rates were also those with the highest sensitivity to detect an SSI, suggesting that the difference in the quality of surveillance and reporting by each hospital is not responsible for the variation in SSI rates. The results of this study support the notion that those hospitals reporting the lowest SSI rates demonstrate high performance in both detection and prevention of SSI following hip and knee replacement surgery.

An outbreak of 26 cases of Salmonella Litchfield infection occurred in the states of Western Australia and Queensland between October 2006 and January 2007. A case-control study was conducted with 12 cases and 24 controls, and a significant association was found between illness and consumption of papaya (odds ratio, 32.8; 95% confidence interval, 2.71 to 883.5). Papaya samples were collected from 26 stores in Western Australia, and 9 of 38 samples were contaminated with Salmonella Litchfield. These samples had pulsed-field gel electrophoresis patterns and multilocus variable-number tandem-repeat analysis profiles indistinguishable from the outbreak strain. Three farms in Western Australia supplied the contaminated papaya, and two of these farms were inspected. Salmonella Litchfield was not detected in papaya samples, fungal sprays, or water samples from the farms; however, at one farm other serotypes of Salmonella were detected in untreated river water that was used for washing papaya. Only treated potable water should be used for washing fresh produce that is to be eaten raw.

An assessment of potential health impacts of radioactive compounds in recycled water to augment drinking water supplies was conducted. Gross alpha and gross beta particle activity was selected for the screening of radioactive species. Samples both pre- and post-reverse osmosis treatment of secondary effluent in Perth, Australia were examined in both a full-scale and in a pilot water reclamation plant. Risk quotients (RQs) were estimated by expressing the mean (RQ mean) and the maximum concentration (RQ max) at each sampling point as a function of the recommended Australian screening levels of 0.5 Bq/L. The results indicate that reverse osmosis (RO) is able to reduce the concentration of gross alpha particle activity (average removal of almost 80%) and gross beta particle activity (average removal of 95%) and produce water of high quality. Maximum gross alpha particle activity in the recycled water was 0.023 Bq/L and maximum gross beta (excluding 40K) particle activity was 0.03 Bq/L, which correspond to an RQ max of 0.07 for gross alpha and 0.06 for gross beta particle activity, respectively. No increased human radiological risk is anticipated if recycled water is used to augment drinking water supplies in Perth. Refereed/Peer-reviewed

Objective: Exposure to birds has long been associated with disease in humans. Three respiratory diseases (psittacosis, allergic alveolitis and asthma) were reviewed in association with pet bird ownership with the aim to clarify the spectrum of avian‐related respiratory illnesses. Approach: Nineteen studies were selected for review based on recreational bird exposure in relation to psittacosis, allergic alveolitis and asthma. Conclusion: Literature reveals little consensus on the relationship between pet bird ownership and respiratory illness. Implications: Future studies should aim to clarify the spectrum of avian‐related illnesses, and to direct the dissemination of public health information to clinicians and members of the public who keep birds as pets. Refereed/Peer-reviewed

The growing scarcity of potable water supplies is among the most important issues facing many cities, in particular those using single sources of water that are climate dependent. Consequently, urban centers are looking to alternative sources of water supply that can supplement variable rainfall and meet the demands of population growth. A diversified portfolio of water sources is required to ensure public health, as well as social, economical and environmental sustainability. One of the options considered is the augmentation of drinking water supplies with advanced treated recycled water. This paper aims to provide a state of the art review of water recycling for drinking purposes with emphasis on membrane treatment processes. An overview of significant indirect potable reuse projects is presented followed by a description of the epidemiological and toxicological studies evaluating any potential human health impacts. Finally, a summary of key operational measures to protect human health and the areas that require further research are discussed. Refereed/Peer-reviewed

An assessment of potential health impacts of dioxin and dioxin-like compounds in recycled water for indirect potable reuse was conducted. Toxic equivalency factors (TEFs) for 2,3,7,8-substituted polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (PCBs) congeners have been developed by the World Health Organization to simplify the risk assessment of complex mixtures. Samples of secondary treated wastewater in Perth, Australia were examined pre-and post-tertiary treatment in one full-scale and one pilot water reclamation plant. Risk quotients (RQs) were estimated by expressing the middle-bound toxic equivalent (TEQ) and the upper-bound TEQ concentration in each sampling point as a function of the estimated health target value. The results indicate that reverse osmosis (RO) is able to reduce the concentration of PCDD, PCDF and dioxin-like PCBs and produce water of high quality (RQ after RO=0.15). No increased human health risk from dioxin and dioxin-like compounds is anticipated if highly treated recycled water is used to augment drinking water supplies in Perth. Recommendations for a verification monitoring program are offered.

In early 2003, after a prolonged drought period, extensive bushfires occurred in the east of Victoria affecting 1.5 million hectares of land. At the time, smoke and ash from bushfires, settling on roofs, contained pollutants that could potentially contaminate rainwater collected and stored in tanks for domestic use. The major concerns include polycyclic aromatic hydrocarbons (PAHs) from incomplete combustion of organic matter and arsenic from burnt copper chrome arsenate (CCA) treated wood. An increase in microbial contamination through altered nutrient levels was also hypothesised. A pilot study of 49 rainwater tank owners was undertaken in north-east Victoria. A rainwater tank sample was taken and analysed for a variety of parameters including organic compounds, microbiological indicators, metals, nutrients and physico-chemical parameters. A survey was administered concurrently. A number of results were outside the Australian Drinking Water Guideline (ADWG) values for metals and microbiological indicator organisms, but not for any tested organic compounds. PAHs and arsenic are unlikely to be elevated in rainwater tanks as a result of bushfires, but cadmium may be of concern.

Infants under 6 months of age are at greatest risk of mortality and severe morbidity from pertussis disease. Interventions that increase pertussis protection in newborns are therefore a clear public health imperative. The objective of this study was to assess maternal pertussis toxin antibody (anti-PT) level as a potential source of mother-to-child transfer of pertussis-associated antibodies that may reduce neonatal risk of pertussis disease. Anti-PT level was assessed in a 2013 cohort of pregnant women from two regions in two Canadian provinces, British Columbia and Nova Scotia. Basic demographics, health, and pertussis immunization history were collected, along with blood specimens. Anti-PT levels were compared for self-reported vaccination status and prior pertussis disease. To assess secular trend, a parallel analysis was also undertaken, using anonymized residual sera from a 1996-1997 cohort of pregnant women in British Columbia. A total of 169 pregnant women participated in the study - 50 from Nova Scotia and 119 from British Columbia. The mean and median age of participants from both sites was 31 years of age (range 16-42 years). The lower limit of quantification of the anti-PT assay was 10 ELISA units per milliliter (EU/ml). Overall, 59% of women had anti-PT levels less than 10 EU/ml and anti-PT level did not differ with time since last self-reported pertussis vaccination (χ(2)(2)=3.166, p=0.205). Among a 1996-1997 cohort of pregnant women in British Columbia, 101 of 200 (51%) had anti-PT levels less than 10 EU/ml. Our study found that most pregnant women in two geographically disparate health regions in Canada have low residual anti-PT levels, may be vulnerable to pertussis infection themselves, and would unlikely be a source of passive ante- or postnatal transfer of anti-PT to their newborn.

Factors contributing to the variation in plasma lipoprotein (a) (Lp(a)) concentration were surveyed in an Aboriginal population (175 men and 219 women), aged 24-86 years, from Western Australia. The plasma Lp(a) levels were highly skewed towards low levels in this population, with a median of 84 mg/L and a mean of 166 mg/L. Approximately 20% had plasma Lp(a) above the threshold value of 300 mg/L, while 52% had Lp(a) levels below 100 mg/L. The most commonly occurring phenotype was apolipoprotien(a) S4. In this phenotype, Lp(a) concentrations ranged from not detectable to 468 mg/L. There was a positive relationship between cigarette smoking and plasma Lp(a) concentration in men. Apolipoprotein A1 and bilirubin were positively associated with Lp(a) in the 40-60 age group and a positive relationship between weight and Lp(a) concentrations was observed in those aged 60 years or over. Thus, although Lp(a) is mainly genetically determined, there are clearly other factors which contribute to variations in Lp(a) concentrations.

Characterisation of the concentrations and potential health risks of chemicals in recycled water is important if this source of water is to be safely used to supplement drinking water sources. This research was conducted to: (i) determine the concentration of volatile organic compounds (VOCs) in secondary treated effluent (STE) and, post-reverse osmosis (RO) treatment and to; (ii) assess the health risk associated with VOCs for indirect potable reuse (IPR). Samples were examined pre and post-RO in one full-scale and one pilot plant in Perth, Western Australia. Risk quotients (RQ) were estimated by expressing the maximum and median concentration as a function of the health value. Of 61 VOCs analysed over a period of three years, twenty one (21) were detected in STE, with 1,4-dichlorobenzene (94%); tetrachloroethene (88%); carbon disulfide (81%) and; chloromethane (58%) most commonly detected. Median concentrations for these compounds in STE ranged from 0.81 μg/L for 1,4-dichlorobenzene to 0.02 μg/L for carbon disulphide. After RO, twenty six (26) VOCs were detected, of which 1,4-dichlorobenzene (89%); acrylonitrile (83%) chloromethane (63%) and carbon disulfide (40%) were the more frequently detected. RQ(max) were all below health values in the STE and after RO. Median removal efficiency for RO was variable, ranging from −77% (dichlorodifluoromethane) to 91.2% (tetrachloroethene). The results indicate that despite the detection of VOCs in STE and after RO, their human health impact in IPR is negligible due to the low concentrations detected. The results indicate that 1,4-dichlorobenzene is a potential treatment chemical indicator for assessment of VOCs in IPR using RO treatment. Refereed/Peer-reviewed

The city of Perth in Western Australia is facing a future of compromised water supplies. In recent years, this urban region has been experiencing rapid population growth, coupled with drying climate, which has exacerbated water shortages. As part of the government strategy to secure water sustainability and to address an agenda focused on all elements of the water cycle, a target of 20% reuse of treated wastewater by 2012 was established. This includes a feasibility review of managed aquifer recharge for indirect potable reuse. A characterization of contaminants in wastewater after treatment and an assessment of the health implications are necessary to reassure both regulators and the public. To date, the commonly used approach involves a comparison of measured contaminant concentrations with the established drinking-water standards or other toxicological guidelines for the protection of human health. However, guidelines and standards have not been established for many contaminants in recycled water (unregulated chemicals). This article presents a three-tiered approach for the preliminary health risk assessment of chemicals in order to determine key contaminants that need to be monitored and managed. The proposed benchmark values for the calculation of risk quotients are health based, systematically defined, scientifically defensible, easy to apply, and clear to interpret. The proposed methodology is based on the derivation of health-based levels for unregulated contaminants with toxicity information and a "threshold of toxicological concern" for unregulated contaminants without toxicity data. The application of this approach will help policymakers set guidelines regarding unregulated chemicals in recycled water.

Long-term health impacts in communities that have experienced natural disasters are often overlooked. Recovery from natural disasters is often a long, drawn-out process. Recovery plans need to address these interruptions in the return to pre-disaster functioning and make provisions for addressing ongoing health problems. The following review will examine illness patterns that may arise, directly or indirectly, in the months and years following a disaster event. The objectives of the review are: (i) to identify the burden of long-term community ill-health following natural disaster events; (ii) to evaluate current gaps in the ongoing process of health monitoring for populations affected by disaster; (iii) to review approaches that would provide ongoing surveillance of physical and psychosocial ill-health.