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Background In 2017, Australia experienced its highest levels of influenza virus activity since the 2009 pandemic. This allowed detailed comparison of the characteristics of patients with community and hospital-acquired influenza, and infection control factors that contributed to influenza spread. Methods A surveillance based study was conducted on hospitalised patients with laboratory-confirmed influenza at the Canberra Hospital during April–October 2017. Differences between the hospital-acquired and community-acquired patient characteristics and outcomes were assessed by univariate analysis. Epidemiologic curves were developed and cluster distribution within the hospital was determined. Results Two hundred and ninety-two patients were included in the study. Twenty-eight (9.6%) acquired influenza in hospital, representing a higher proportion than any of the previous 5 years (range 0.9–5.8%). These patients were more likely to have influenza A (p = 0.021), had higher rates of diabetes (p = 0.015), malignancy (p = 0.046) and chronic liver disease (p = 0.043). Patients acquiring influenza in hospital met clinical criteria for influenza like illness in 25% of cases, compared with 64.4% for community-acquired cases (p

Bacterial skin infections are common presentations to both general practice and the emergency department. The optimal treatment for purulent infections such as boils and carbuncles is incision and drainage. Antibiotic therapy is not usually required. Most uncomplicated bacterial skin infections that require antibiotics need 5–10 days of treatment. There is a high prevalence of purulent skin infections caused by community-acquired (non-multiresistant) methicillin-resistant Staphylococcus aureus. It is therefore important to provide adequate antimicrobial coverage for these infections in empiric antibiotic regimens.

We describe a young man who initially presented with stroke and febrile illness. He was eventually diagnosed with Tropheryma whipplei endocarditis. This is a very rare condition and to the best of our knowledge, this is the first documented case of T. whipplei endocarditis in Australia and New Zealand regions. This report aims to increase awareness of clinicians of this very rare but potentially treatable condition. It is reasonable to exclude T. whipplei endocarditis when dealing with high-risk patients who are suspected for "culture-negative" endocarditis.

We aimed to estimate the effectiveness of H1N1/09 containing influenza vaccines against hospitalization from influenza in Australia. We performed a test-negative case control study in patients hospitalized in 15 sentinel Australian hospitals between March and November 2010, comparing influenza vaccination (H1N1/09 monovalent or 2010 seasonal trivalent) in hospitalized patients with PCR-confirmed influenza compared to PCR-negative controls. Between March and November 2010, 1169 hospitalized patients were tested for suspected influenza, of which influenza vaccine status was ascertained in 165/238 patients with H1N1/09 influenza, 40/64 with seasonal influenza and 558/867 test negative controls; 24% of H1N1/09 cases, 43% of seasonal influenza cases and 54% of controls were vaccinated. VE against hospitalisation with H1N1/09 influenza after adjusting for age, medical comorbidities and pregnancy status was estimated at 49% (95% CI: 13%, 70%). Influenza vaccination was associated with a reduction in hospitalisation caused by H1N1/09 influenza in the 2010 southern hemisphere winter season.

The aim of this study was to determine how often methicillin-resistant Staphylococcus aureus (MRSA) is found in aerosols while healthcare workers were undertaking routine care of patients (e.g. taking blood pressure, making beds). Air sampling was conducted using an air sampler and environmental settle samples in single rooms of patients who were either colonised or infected with MRSA, using a Merck MAS-100 air sampler and MRSA chromogenic agar. The air samples and environmental settle samples were collected between 0700 and 1530 hours over a 10-day period. Atotal of 99 air samples and 26 environmental settle samples were collected: 29/99 (29%) of the air samples and 5/26 (19%) of the environmental settle samples were positive for MRSA. Of the 10 rooms sampled, eight (80%) had MRSApresent in air samples. Concentrations ranged from 1 to 128 colony-forming units m–3. Thus, MRSA can frequently be aerosolised. Although the overall contribution of aerosolisation in the transmission of MRSA is unclear, these findings add further evidence to justify the use of gloves and gowns for staff having contact with MRSA-positive patients or going into the rooms, as environmental contamination is likely to be frequent. Masks should be used more often, especially whenever activities likely to generate aerosols occur, such as bed-making, sputum suction or chest physiotherapy.

ObjectivesTo determine how important governmental, social, and economic factors are in driving antibiotic resistance compared to the factors usually considered the main driving factors-antibiotic usage and levels of economic development.DesignA retrospective multivariate analysis of the variation of antibiotic resistance in Europe in terms of human antibiotic usage, private health care expenditure, tertiary education, the level of economic advancement (per capita GDP), and quality of governance (corruption). The model was estimated using a panel data set involving 7 common human bloodstream isolates and covering 28 European countries for the period 1998-2010.ResultsOnly 28% of the total variation in antibiotic resistance among countries is attributable to variation in antibiotic usage. If time effects are included the explanatory power increases to 33%. However when the control of corruption indicator is included as an additional variable, 63% of the total variation in antibiotic resistance is now explained by the regression. The complete multivariate regression only accomplishes an additional 7% in terms of goodness of fit, indicating that corruption is the main socioeconomic factor that explains antibiotic resistance. The income level of a country appeared to have no effect on resistance rates in the multivariate analysis. The estimated impact of corruption was statistically significant (p< 0.01). The coefficient indicates that an improvement of one unit in the corruption indicator is associated with a reduction in antibiotic resistance by approximately 0.7 units. The estimated coefficient of private health expenditure showed that one unit reduction is associated with a 0.2 unit decrease in antibiotic resistance.ConclusionsThese findings support the hypothesis that poor governance and corruption contributes to levels of antibiotic resistance and correlate better than antibiotic usage volumes with resistance rates. We conclude that addressing corruption and improving governance will lead to a reduction in antibiotic resistance.

The 2010 Australasian Society for Infectious Diseases Annual Scientific Meeting took place in May in the Northern Territory (Australia) and focussed on infections in the region. The meeting highlights included the changing spectrum of malaria and dengue in endemic regions, the latest on influenza epidemiology, multidrug-resistant organisms and infectious diseases in the Australian indigenous population. This was complemented by subspeciality interest group research encompassing mycobacterial disease, infection control, mycology and virology.

• In 6 weeks, swine influenza A(H1N1) virus has spread from 10 to 74 countries. • Australia has the fifth highest number of cases and the third highest rate of infection among the top five affected nations. • People who are hospitalised with or die from this novel virus are more likely to have predisposing risk factors. • There is a predilection for younger age groups and sparing of older age groups. This may be a property of influenza A viruses in general rather than being specific to swine influenza A. • If unchecked, the sheer number of cases may lead to much higher numbers of deaths and hospitalised patients than would normally be attributed to a standard influenza season. • Paradoxically, the low case-fatality rate of the virus raises the question of how best to approach management of this outbreak. • It is uncertain how an expected vaccine against the novel virus MJA 2009; 191: 138–140 will be used.

With the recent outbreak of swine influenza, the world may be facing this century's first influenza pandemic. In Mexico, around 2000 patients have been hospitalised with respiratory illness and almost 150 people have died. Several other countries have reported smaller numbers of suspected and confirmed cases of swine influenza. This 2009 influenza A virus is a strain of the H1N1 subtype, and appears to be a human-avian reassortment swine virus influenza. It is likely that sustained human-to-human transmission of swine influenza has occurred, at least in Mexico. Despite there being so many hospitalised patients in Mexico, cases outside Mexico have demonstrated a mild influenza-like illness, with only one fatality to date. In contrast to the 1918 influenza pandemic, we now have a more robust public health system, with widespread global networks; vaccines can be developed rapidly; and there are antiviral medications to which the swine influenza A(H1N1) virus is sensitive. Many resources have been invested in pandemic preparedness programs in the health care and public health systems in Australia over the past few years.

In 2012, the first autochthonous Australian case of human babesiosis was reported, after microscopic examinations of blood samples revealed intra-erythrocytic parasites in a hospitalized 56year-old man from NSW, who died in 2011 (Senanayake et al., 2012). Independent molecular analyses carried out in Australia and the USA, identified Babesia microti at the 18S ribosomal RNA (18S rRNA), and the beta-tubulin (β-tubulin) gene loci. Here we present the details of a novel PCR-based assay for the β-tubulin gene that was developed, during the original study, to corroborate the results obtained from the analysis of the 18S rDNA. The complete phylogenetic reconstruction, based on the two loci sequenced from the Australian clinical isolate, is also shown here for the first time.

Immunisation programs are designed to reduce serious morbidity and mortality from influenza, but most evidence supporting the effectiveness of this intervention has focused on disease in the community or in primary care settings. We aimed to examine the effectiveness of influenza vaccination against hospitalisation with confirmed influenza. We compared influenza vaccination status in patients hospitalised with PCR-confirmed influenza with patients hospitalised with influenza-negative respiratory infections in an Australian sentinel surveillance system. Vaccine effectiveness was estimated from the odds ratio of vaccination in cases and controls. We performed both simple multivariate regression and a stratified analysis based on propensity score of vaccination. Vaccination status was ascertained in 333 of 598 patients with confirmed influenza and 785 of 1384 test-negative patients. Overall estimated crude vaccine effectiveness was 57% (41%, 68%). After adjusting for age, chronic comorbidities and pregnancy status, the estimated vaccine effectiveness was 37% (95% CI: 12%, 55%). In an analysis accounting for a propensity score for vaccination, the estimated vaccine effectiveness was 48.3% (95% CI: 30.0, 61.8%). Influenza vaccination was moderately protective against hospitalisation with influenza in the 2010 and 2011 seasons.

Mumps has re-emerged as an infection in the developed world. Its epidemiology has changed, with the majority of cases now primarily affecting adolescents and adults. While mumps is easily suspected if parotitis is present, parotitis is absent in 10%-30% of symptomatic cases. Mumps is a systemic infection with a variety of extra-parotid complications. In Australia, mumps diagnosis is confirmed by antibody testing and reverse transcriptase-polymerase chain reaction techniques. Suitable specimens for testing are serum, saliva, urine and cerebrospinal fluid. Treatment is generally supportive, although intravenous immunoglobulin therapy may have a future role in mumps management. Interferon alpha-2b treatment may be considered specifically for mumps epididymo-orchitis. Mumps vaccine is included in the measles-mumps-rubella (MMR) vaccine. In Australia, this vaccine is routinely administered at the ages of 1 and 4 years. Serious reactions to the mumps components of the MMR vaccine are rare.

Objective: To determine the proportion of ED staff who are susceptible to pertussis. There was evidence that some winter leave in southern Tasmania might be a reason of pertussis infection among unimmunized staff. This results in loss of individual earning and loss of availability of staff during the peak demand periods in the ED. There is evidence in the literature that underdiagnosis and undertreatment of pertussis occurs worldwide. Methods: All ED staff were approached to participate in this seroprevalence study. A self-completed questionnaire was used to record pervious immunization history for pertussis. Blood samples were collected and analysed to detect and quantify immunoglobulin G and immunoglobulin A titres for pertussis. All confidence intervals (CI) are at 95%. Settings: The Royal Hobart Hospital and the co-located Hobart Private Hospital. Results: Ninety-seven of 106 eligible staff took part in the present study, a participation rate of 92% (CI 84–96). Ninety-one of 97 subjects (94%, CI 87–98) believed that they had been immunized for pertussis in childhood; six subjects had either not been immunized or were unsure (6%, CI 2–13). Twenty-three subjects (24%, CI 16–33) had been immunized as adults. There was serologic evidence of recent infection for 21 participants (22%, CI 14–31). Thirty-one participants (32%, CI 23–42) were susceptible to pertussis on the basis of low immunoglobulin G titres. Conclusion: ED staff should routinely be offered booster immunization for pertussis.

An obscure Portuguese document from 16th century Indonesia describes an illness that destroyed poultry before devastating the human population of the region. The cause of the illness remains unresolved; it may have been infectious or non-infectious. Isolation of the region because of trading practices probably prevented spread of the illness, reinforcing the value of quarantine or isolation as a public health measure.

Non-compliance with treatment of pulmonary tuberculosis (TB) by an individual can put the community at risk of transmission of TB. Public health (detention) orders can be issued to detain non-compliant individuals, but this is a last resort and rarely used. Two recent cases in New South Wales illustrate the process of issuing a public health order in NSW, and some of the issues that may arise. The NSW law can also be applied to patients with severe acute respiratory syndrome (SARS) or HIV/AIDS. The other states and territories have similar laws, which often apply to a broader range of diseases and have fewer limits on issuing and extending orders.

Mycobacterium ulcerans is a slow-growing environmental bacterium that causes Buruli ulcer (also known as Bairnsdale ulcer in Victoria and Daintree ulcer in northern Queensland). We describe two patients with laboratory-confirmed Buruli ulcer who were infected either in New South Wales or overseas. A molecular epidemiological investigation demonstrated that, while one case was probably acquired in Papua New Guinea, the other was most likely to have been acquired in southern NSW. To our knowledge, this is the first case of M. ulcerans infection acquired in NSW.

Escherichia vulneris is a recently identified environmental organism that can colonize humans and animals. To date, very few infections with E. vulneris have been reported. This is the first reported case of peritonitis due to E. vulneris in the setting of peritoneal dialysis.

Zhi-Qiang Chen and colleagues analyse the resurgence of syphilis in China. Although the overall picture is alarming the most staggering figure is that of congenital syphilis with an almost 2000-fold rise in the past 15 years. This figure does not even include the number of stillbirths or miscarriages caused by maternal syphilis. It is therefore disappointing that Chen and colleagues do not discuss the reasons behind such high rates of congenital syphilis specifically in relation to the state of antenatal screening and treatment programmes for syphilis in China. They provide several important reasons for increased rates of maternal syphilis in China such as a rising male migrant population increasing numbers of sex workers and sexual experimentation at a younger age; however in the presence of effective screening and treatment programmes in pregnancy rates of congenital syphilis should be low irrespective of the background rate of maternal syphilis. Syphilis screening in early pregnancy iscost effective even when rates of congenital syphilis are low. Also rapid diagnostic tests for syphilis have been developed. This hopefully will allow health-care workers to diagnose maternal syphilis at the bedside and start an immediate treatment plan instead of losing pregnant women to follow-up. In conclusion although it is unrealistic to expect complete eradication of primary and secondary syphilis in communities there should be a "zero tolerance" policy for congenital syphilis. (excerpt)

SummaryOptic neuritis (ON) is a rare association of Q fever. We report the first case of ON associated with Q fever in Australia and review all previously reported cases in the medical literature. The impact of therapy with antibiotics and steroids on outcome is discussed. Q fever should be considered in the differential diagnosis of patients presenting with apparent acute idiopathic ON.