That’s entertainment: trends in late-night assaults and acute alcohol illness in Sydney's entertainment precinct

Summary: This report uses various data sources to show the incidence of night-time alcohol-related violence and other alcohol harm in the Sydney CBD in the ten years prior to the 2014 lockout intervention. Between 2004 and 2013 police crime statistics and triple zero (000) calls both show a decrease in alcohol-related assault while emergency department presentations for alcohol illnesses increased.   Aim: To assess the role of administrative police and health databases in monitoring trends in, and epidemiology of, alcohol-related violence and acute alcohol illness associated with the night time economy in the Sydney central business district (CBD) "Entertainment Precinct", prior to the introduction of 2014 government reforms addressing "alcohol-fuelled violence". Method: We examined annual trends in police-recorded incidents of grievous bodily harm, ambulance Triple Zero (000) calls for assault, and acute alcohol illness emergency department presentations that occurred between 10 p.m. and 6 a.m. over a 10-year period (2004–2013). Trends were examined among persons of all ages and young adults (18 to 29 year olds) in the CBD. The rest of metropolitan Sydney provided a comparison area to evaluate whether trends were CBD-specific. Results: Among persons of all ages, there were 913 police-recorded incidents of grievous bodily harm, 10,427 ambulance calls for assault and 14,106 emergency department presentations for acute alcohol illness in the CBD over the 10-year period. Young adults accounted for between 62 per cent and 78 per cent of assault incidents and 58 per cent of alcohol emergency department presentations. Between 2004 and 2008, the annual number of assaults and acute alcohol illness increased two-fold. Alcohol illness emergency department presentation trends subsequently stabilised, while assaults in 2013 were at the lowest levels in 10 years. Similar trends were observed in the rest of metropolitan Sydney. Conclusion: The majority of alcohol-related assaults and emergency department presentations involved young adults. Ambulance and police administrative data sources provided a consistent picture of a recent decline in late-night assault trends. Alcohol-related emergency department presentation trends suggested other alcohol harms may be continuing at relatively high levels both in the CBD and in metropolitan Sydney. While violence appears to be declining in the CBD and across Sydney, continuing alcohol harm remains to be addressed. &nbsp

Can near real-time monitoring of emergency department diagnoses facilitate early response to sporadic meningococcal infection? - prospective and retrospective evaluations

<p>Abstract</p> <p>Background</p> <p>Meningococcal infection causes severe, rapidly progressing illness and reporting of cases is mandatory in New South Wales (NSW), Australia. The NSW Department of Health operates near real-time Emergency Department (ED) surveillance that includes capture and statistical analysis of clinical preliminary diagnoses. The system can provide alerts in response to specific diagnoses entered in the ED computer system. This study assessed whether once daily reporting of clinical diagnoses of meningococcal infection using the ED surveillance system provides an opportunity for timelier public health response for this disease.</p> <p>Methods</p> <p>The study involved a prospective and retrospective component. First, reporting of ED diagnoses of meningococcal infection from the ED surveillance system prospectively operated in parallel with conventional surveillance which requires direct telephone reporting of this scheduled medical condition to local public health authorities by hospitals and laboratories when a meningococcal infection diagnosis is made. Follow-up of the ED diagnoses determined whether meningococcal infection was confirmed, and the time difference between ED surveillance report and notification by conventional means. Second, cases of meningococcal infection reported by conventional surveillance during 2004 were retrospectively matched to ED visits to determine the sensitivity and positive predictive value (PPV) of ED surveillance.</p> <p>Results</p> <p>During the prospective evaluation, 31 patients were diagnosed with meningococcal infection in participating EDs. Of these, 12 had confirmed meningococcal disease, resulting in a PPV of 38.7%. All confirmed cases were notified earlier to public health authorities by conventional reporting.</p> <p>Of 149 cases of notified meningococcal disease identified retrospectively, 130 were linked to an ED visit. The sensitivity and PPV of the ED diagnosis for meningococcal infection was 36.2% and 36.7%, respectively.</p> <p>Conclusions</p> <p>Based on prospective evaluation, it is reassuring that existing mechanisms for reporting meningococcal infection perform well and are timely. The retrospective evaluation found low sensitivity and PPV of ED diagnoses for meningococcal disease. Even if more rapid forwarding of ED meningococcal diagnoses to public health authorities were possible, the low sensitivity and PPV do not justify this. In this study, use of an ED surveillance system to augment conventional surveillance of this scheduled medical condition did not demonstrate a benefit.</p

Monitoring mortality in the setting of COVID-19 pandemic control in Victoria, Australia: a time series analysis of population data.

OBJECTIVE: Mortality surveillance was established in the state of Victoria just before the COVID-19 pandemic. Here, we describe the establishment of this surveillance system, justify the modelling approach selected, and provide examples of how the interpretation of changes in mortality rates during the pandemic was influenced by the model chosen. METHODS: Registered deaths occurring in Victoria from 1 January 2015 to 31 December 2020 were sourced from the Victoria Death Index. Observed mortality rates were compared to a raw historical 5-year mean and to predicted means estimated from a seasonal robust regression. Differences between the observed mortality rate and the historical mean (∆MR) and excess mortality rate from the observed and predicted rates were assessed. RESULTS: There were 20&nbsp;375 COVID-19 cases notified in Victoria as of 31 December 2020, of whom 748 (3.7%) died. Victorians aged ≥&nbsp;85 years experienced the highest case fatality ratio (34%). Mean observed mortality rates in 2020 (MR: 11.6; 95% confidence interval [CI]: 11.4, 11.9) were slightly reduced when compared with the annual rate expected using the historical mean method (mean MR: 12.2; 95% CI: 12.1-12.3; ∆MR: -0.57; 95% CI: -0.77, -0.38), but not from the rate expected using the robust regression (estimated MR: 11.7; 95% prediction interval [PI]: 11.5, 11.9; EMR: -0.05; 95% CI: -0.26, 0.16). The two methods yielded opposing interpretations for some causes, including cardiovascular and cancer mortality. DISCUSSION: Interpretation of how pandemic restrictions impacted mortality in Victoria in 2020 is influenced by the method of estimation. Time-series approaches are preferential because they account for population trends in mortality over time

Epidemiology of Influenza-like Illness during Pandemic (H1N1) 2009, New South Wales, Australia

To rapidly describe the epidemiology of influenza-like illness (ILI) during the 2009 winter epidemic of pandemic (H1N1) 2009 virus in New South Wales, Australia, we used results of a continuous population health survey. During July–September 2009, ILI was experienced by 23% of the population. Among these persons, 51% were unable to undertake normal duties for <3 days, 55% sought care at a general practice, and 5% went to a hospital. Factors independently associated with ILI were younger age, daily smoking, and obesity. Effectiveness of prepandemic seasonal vaccine was ≈20%. The high prevalence of risk factors associated with a substantially increased risk for ILI deserves greater recognition

The association between influenza vaccination uptake and influenza and pneumonia-associated deaths in the United States

Background: The influenza mortality burden has remained substantial in the United States (US) despite relatively high levels of influenza vaccine uptake. This has led to questions regarding the effectiveness of the program against this outcome, particularly in the elderly. The aim of this evaluation was to develop and explore a new approach to estimating the population-level effect of influenza vaccination uptake on pneumonia and influenza (P&amp;I) associated deaths. Methods: Using publicly available data we examined the association between state-level influenza vaccination and all-age P&amp;I associated deaths in the US from the 2013–2014 influenza season to the 2018–2019 season. In the main model, we evaluated influenza vaccine uptake in all those age 6 months and older. We used a mixed-effects regression analysis with generalised least squares estimation to account for within state correlation in P&amp;I mortality. Results: From 2013–2014 through 2018–2019, the total number of all-age P&amp;I related deaths during the influenza seasons was 480,111. The mean overall cumulative influenza vaccine uptake (age 6 months and older) across the states and years considered was 46.7%, with higher uptake (64.8%) observed in those aged ≥ 65 years. We found that overall influenza vaccine uptake (6 months and older) had a statistically significant protective association with the P&amp;I death rate. This translated to a 0.33 (95% CI: 0.20, 0.47) per 100,000 population reduction in P&amp;I deaths in the influenza season per 1% increase in overall influenza vaccine uptake. Discussion: These results using a population-level statistical approach provide additional support for the overall effectiveness of the US influenza vaccination program. This reassurance is critical given the importance of ensuring confidence in this life saving program. Future research is needed to expand on our approach using more refined data.</p

Towards public health surveillance of intensive care services in NSW, Australia

Outbreaks of known and novel pathogens causing very severe illness increase the risk to public health in a globalised community and alarm the public&nbsp;Intensive care units (ICUs) may be an underused setting for public health surveillance. This study investigates the electronic Record for Intensive Care (eRIC), an electronic clinical information and management system being developed for New South Wales ICUs, and its surveillance opportunity offerings. The surveillance benefits being introduced by the eRIC were evaluated through consultation with stakeholders and the eRIC program team. The consultation process involved providing stakeholders with background information about the eRIC system. Based on the consultation, a draft data and information model for surveillance was developed. The model was evaluated using guidelines from the US Centers for Disease Control and Prevention. Population health stakeholders confirmed that the eRIC offers an appealing surveillance data source for pathogens and other hazards causing severe illness, the study found. Suggested application of the surveillance included, for known hazards, seasonal and pandemic influenza, enterovirus&nbsp;71, Murray Valley encephalitis virus, enterohaemorrhagic&nbsp;Escherichia coli&nbsp;0104:H4 and parechovirus. The proposed surveillance model uses syndromic rather than specific-cause surveillance. It may offer greater timeliness and sensitivity than relying on reporting of diagnoses of specific pathogens. Five syndromes derived from clinical pathways in the eRIC are proposed: severe acute respiratory disease, severe acute neurological disease, sepsis or septicaemia, jaundice or hepatitis, and acute renal failure. This paper concludes that the new intensive care clinical information systems offer a largely untapped resource for continuous, mainstream, rapid ICU surveillance of severe illness. A continuous, mainstream, rapid ICU surveillance facility that will readily adapt to emergency situations would be a valuable resource for protecting population health. The&nbsp;study establishes a firm basis on which ICU surveillance can be developed

Should cities hosting mass gatherings invest in public health surveillance and planning? Reflections from a decade of mass gatherings in Sydney, Australia

<p>Abstract</p> <p>Background</p> <p>Mass gatherings have been defined by the World Health Organisation as "events attended by a sufficient number of people to strain the planning and response resources of a community, state or nation". This paper explores the public health response to mass gatherings in Sydney, the factors that influenced the extent of deployment of resources and the utility of planning for mass gatherings as a preparedness exercise for other health emergencies.</p> <p>Discussion</p> <p>Not all mass gatherings of people require enhanced surveillance and additional response. The main drivers of extensive public health planning for mass gatherings reflect geographical spread, number of international visitors, event duration and political and religious considerations. In these instances, the implementation of a formal risk assessment prior to the event with ongoing daily review is important in identifying public health hazards.</p> <p>Developing and utilising event-specific surveillance to provide early-warning systems that address the specific risks identified through the risk assessment process are essential. The extent to which additional resources are required will vary and depend on the current level of surveillance infrastructure.</p> <p>Planning the public health response is the third step in preparing for mass gatherings. If the existing public health workforce has been regularly trained in emergency response procedures then far less effort and resources will be needed to prepare for each mass gathering event. The use of formal emergency management structures and co-location of surveillance and planning operational teams during events facilitates timely communication and action.</p> <p>Summary</p> <p>One-off mass gathering events can provide a catalyst for innovation and engagement and result in opportunities for ongoing public health planning, training and surveillance enhancements that outlasted each event.</p

Metabarcoding Reveals a Potentially Undescribed Columnaris‐Causing Bacterium in Peracute Skin Disease of Rainbow Trout (Oncorhynchus mykiss, Walbaum)

Columnaris-causing bacteria (CCB) represent a group of four Flavobacterium species, previously classified under Flavobacterium columnaris, causing a threatening condition in salmonid farming characterised by cutaneous and gill lesions, commonly referred to as ‘saddleback disease’. A peracute skin disease outbreak with high mortality in rainbow trout (Oncorhynchus mykiss) farms in Northern Italy was investigated. The disease presented with skin discoloration and scale lifting without internal organ abnormalities, leading to a weekly cumulative mortality of up to 80%. The disease was successfully managed with Oxytetracycline treatment, with no relapses observed. Conventional investigation methods produced inconsistent results, prompting additional analyses. Metagenomic sequencing of the 16S rRNA identified Flavobacterium species differing from the classical CCB based on the alignment of the V3 and V4 regions, with best matches to&nbsp;Flavobacterium bernardetii, Flavobacterium aquicola, and Flavobacterium hiemivividum. Histopathology and SEM confirmed epidermal necrosis and bacterial infiltration in the dermis, with filamentous bacteria resembling Flavobacterium morphology yet differing from classical CCB lesions. These findings point to a previously undescribed Flavobacterium-related skin disease with significant economic implications, supporting the value of metagenomic in investigating microbial dynamics in aquaculture diseases, especially in sites exposed to external environments. Further research is required to clarify the pathogenic mechanisms and guide effective management strategies for future outbreaks

Progress and Remaining Gaps in Estimating the Global Disease Burden of Influenza

Influenza has long been a global public health priority because of the threat of another global pandemic. Although data are available for the annual burden of seasonal influenza in many developed countries, fewer disease burden data are available for low-income and tropical countries. In recent years, however, the surveillance systems created as part of national pandemic preparedness efforts have produced substantial data on the epidemiology and impact of influenza in countries where data were sparse. These data are leading to greater interest in seasonal influenza, including implementation of vaccination programs. However, a lack of quality data on severe influenza, nonrespiratory outcomes, and high-risk groups, as well as a need for better mathematical models and economic evaluations, are some of the major gaps that remain. These gaps are the focus of multilateral research and surveillance efforts that will strengthen global efforts in influenza control in the future