Public health response to a measles outbreak in a large correctional facility, Queensland, 2013

This report documents the prompt, co-ordinated and effective public health response to a measles outbreak in Queensland in 2013. There were 17 cases in a large, high-security, regional correctional facility, a setting with unique challenges. Recommendations are provided to reduce the likelihood and magnitude of measles outbreaks in correctional facilities

Gestational age specific stillbirth risk among Indigenous and non-Indigenous women in Queensland, Australia: a population based study.

BACKGROUND: In Australia, significant disparity persists in stillbirth rates between Aboriginal and Torres Strait Islander (Indigenous Australian) and non-Indigenous women. Diabetes, hypertension, antepartum haemorrhage and small-for-gestational age (SGA) have been identified as important contributors to higher rates among Indigenous women. The objective of this study was to examine gestational age specific risk of stillbirth associated with these conditions among Indigenous and non-Indigenous women. METHODS: Retrospective population-based study of all singleton births of at least 20 weeks gestation or at least 400 grams birthweight in Queensland between July 2005 and December 2011 using data from the Queensland Perinatal Data Collection, which is a routinely-maintained database that collects data on all births in Queensland. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95 % confidence intervals, adjusting for maternal demographic and pregnancy factors. RESULTS: Of 360987 births analysed, 20273 (5.6 %) were to Indigenous women and 340714 (94.4 %) were to non-Indigenous women. Stillbirth rates were 7.9 (95 % CI 6.8-9.2) and 4.1 (95 % CI 3.9-4.3) per 1000 births, respectively. For both Indigenous and non-Indigenous women across most gestational age groups, antepartum haemorrhage, SGA, pre-existing diabetes and pre-existing hypertension were associated with increased risk of stillbirth. There were mixed results for pre-eclampsia and eclampsia and a consistently raised risk of stillbirth was not seen for gestational diabetes. CONCLUSION: This study highlights gestational age specific stillbirth risk for Indigenous and non-Indigenous women; and disparity in risk at term gestations. Improving access to and utilisation of appropriate and responsive healthcare may help to address disparities in stillbirth risk for Indigenous women.Ibinabo Ibiebele is a recipient of the National Health and Medical Research Council Postgraduate Public Health scholarship and the University of Queensland Research Scholarship.This is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s12884-016-0943-

Relating well to people: a mixed-methods evaluation of preventive care implementation for Aboriginal and Torres Strait Islander people in mainstream, urban general practice

IntroductionThere is potential for health gain by Aboriginal and Torres Strait Islander people in Australia through better primary health service in urban areas. Preventive health care delivered with social sensitivity is critical to addressing chronic disease. In the mainstream urban general practice setting, three key linked processes of Indigenous identification, health checks and immunisation for Indigenous people should be improved.BackgroundThe history and current lived experience of Aboriginal and Torres Strait Islander people influence access to mainstream health care services. Known access facilitators in urban areas are low cost, convenience and delivery in a culturally safe setting by practitioners with compatible values and professional culture. In contrast to community controlled health services, mainstream general practices have few practitioners with Indigenous care experience, and low levels of Indigenous identification and Indigenous health check delivery.This thesis presents the development, implementation and evaluation of an intervention in Brisbane designed to address known and suspected barriers to Indigenous people’s access to preventive care in mainstream urban general practice.The following research questions were considered:1.\ua0\ua0\ua0\ua0 Based on the best evidence, what intervention by Division of General Practice and Public Health Unit staff was appropriate and feasible to promote increased coverage of Indigenous health checks and immunisation in mainstream urban general practices?2.\ua0\ua0\ua0\ua0 What were the effects of the intervention targeting mainstream practitioners on Indigenous identification, immunisation and health checks, and what were the other effects?3.\ua0\ua0\ua0\ua0 How could existing barriers to immunisation and health checks in mainstream general practice be overcome?MethodsThe Promoting Indigenous Preventive Care in General Practice (PIPCGP) study used a realist-inspired framework of enquiry and a mixed methods approach. Division of General Practice and Public Health Unit staff used existing resources to provide intensive practice support through an educational workshop, package of activity support materials, progressive audit and feedback, and ongoing contact over twelve months. Seventeen General Practices in two intervention groups were enrolled. Audit data were gathered at the practice, returned to practices, and collated for evaluation purposes. In-depth interviews were conducted with 35 participants, including clinical and non-clinical staff of practices and Indigenous community members.ResultsThe inner suburban group had low attrition, showed a steep rise (78%) in Indigenous patient numbers, and increased health check delivery. Half the Indigenous children aged 2 to 5 years had immunisation data missing from their record prior to intervention, which was rectified. Child immunisation coverage for all vaccines, including Indigenous-specific vaccines, was 46% at the end of the period. The outer suburban group had a high attrition rate of 50%.Preventive care processes for over two thousand Indigenous patients were included in the study. Increased Indigenous identification came from both current and new patient groups. Practices with higher health check activity had staff experienced in Indigenous health, were already delivering checks prior to intervention, and increased their activity. Few low activity practices had previously undertaken checks, and half of these commenced.\ua0 Difficulties reported were a low level of patient willingness to undergo a check, and organisational processes: poorly adapted electronic records, long consultation time, and uncertainty about sharing assessment components between team members.Indigenous identification was welcomed, was associated with acknowledgement of culture, and helped build relationships. Providers experienced in Indigenous health aligned with patients in emphasising the staff-patient relationship as a barrier to preventive care, and provided guidance on relationship building. Other providers focused solely on practical barriers. Most providers and community members expressed the need for links between practices, the Indigenous community, and Indigenous organisations.DiscussionThe PIPCGP study confirms that Indigenous identification can be quickly improved in mainstream General Practices, and highlights an additional range of practical and social issues to be addressed in increasing access to preventive care. These include knowledge of the Indigenous immunisation schedule, improved completeness of immunisation record keeping, and teamwork to plan adequate time and cooperation for health checks. Information system deficits exist in Indigenous identification recording, on-screen activity prompt and recall/ reminder. The success factor of staff experienced in Indigenous health enabled a patient relationship-building focus and influenced system change in the practice.ConclusionMainstream practice efforts to strengthen patient-centred care of chronic disease, should include Indigenous cultural and relationship-focused training for staff, Indigenous patient service planning and quality improvement. A continued dialogue and partnership between Community Controlled Health Services and Primary Health Networks, with the assistance of Public Health Services, is essential to support practices with concentrations of Indigenous patients. Supply of general practice information systems in Australia which support tailored care for Indigenous people could be another lever for change, as could more detailed activity monitoring linked to financial incentives to provide high quality preventive care

Immunisation coverage of Queensland Indigenous two-year-old children by cluster sampling and by register

Objectives: To obtain, through a survey, estimates of immunisation coverage in a birth cohort of Indigenous children, and to compare survey estimates with those obtained from the Australian Childhood Immunisation Register (ACIR) for the same birth cohort of Indigenous children. Methods: Cluster sampling of a birth cohort of two‐year‐old Indigenous children across Queensland, stratified according to accessibility/remoteness from services, was undertaken in 2003. An innovative method of identifying participants was used. Survey results of 10 vaccine doses were compared with ACIR data. Results: The survey obtained a 4% sample of the birth cohort (137 children). Universally recommended vaccines showed high levels of coverage at 12 and 24 months, and survey estimates were slightly higher than ACIR estimates. Diphtheria‐tetanus‐acellular pertussis vaccine dose 3 (DTPa3) coverage was 93.8% (95% CI 88.0–99.6) by 12 months on survey and 87.5% on ACIR. Coverage was not timely and a lag phase of 4–6 months occurred for each vaccine dose. Haemophilus influenzae type b vaccine dose 2 (Hib2), scheduled for the age of four months, reached 90% coverage by nine months of age in the survey children. Conclusion: Both methods reported here provided similar results. Implications: These data indicate that ACIR Indigenous reporting rates have increased and coverage estimates are comparable to those provided by a survey. Immunisation coverage appears to be high, and the main remaining challenge in further reducing vaccine‐preventable disease in Indigenous children is to improve immunisation timeliness. </p

Immunisation coverage of Queensland Indigenous two-year-old children by cluster sampling and by register

Objectives: To obtain, through a survey, estimates of immunisation coverage in a birth cohort of Indigenous children, and to compare survey estimates with those obtained from the Australian Childhood Immunisation Register (ACIR) for the same birth cohort of Indigenous children

Immunisation coverage of Queensland Indigenous two-year-old children by cluster sampling and by register

Objectives: To obtain, through a survey, estimates of immunisation coverage in a birth cohort of Indigenous children, and to compare survey estimates with those obtained from the Australian Childhood Immunisation Register (ACIR) for the same birth cohor

Timing of treatment and serological testing following exposure to rabies virus or Australian Bat Lyssavirus.

*<p>Treatment abbreviations.</p><p>v = single dose of rabies vaccine; vaccine given intramuscularly unless otherwise indicated.</p><p>vv = double dose of rabies vaccine.</p><p>HRIG = human rabies immunoglobulin.</p>†<p>Anti-rabies antibody titre EU/mL.</p>‡<p>Relative volume of vaccine given intradermally and subcutaneously not available in patient's notes.</p

Carriage of Methicillin-Resistant Staphylococcus Aureus in a Queensland Indigenous Community

Abstract: Objectives: To determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage and infection among children living in an Indigenous community in Queensland. Design, Setting and Participants: Swabs for culture of S. aureus were collected from the nose, the throat and skin wounds of primary school children. Main Outcome Measures: MRSA carriage, antibiotic sensitivity, genetic relatedness, presence of the virulence factor Panton-Valentine leukocidin (pvl) and epidemiologic risk factors for MRSA carriage. Results: Ninety two of 157 (59%) eligible children were included in the study. Twenty seven (29%) carried S. aureus, 14 (15%) of whom carried MRSA. MRSA was isolated from 29% of wound swabs, 8% of nose swabs, and 1% of throat swabs. Fourteen of 15 MRSA isolates were sensitive to all non--lactam antibiotics tested. Eight children (9%) carried CA-MRSA clonal types; 6 children carried the Queensland clone (ST93), while 2 carried the South West Pacific clone (ST30). All these isolates carried the virulence factor pvl. The remaining 6 children carried a hospital-associated MRSA strain (ST5), all of which were negative for pvl. Conclusions: We have identified a high prevalence of CA-MRSA carriage in school children from a Queensland Indigenous community. In this setting, antibiotics with activity against CA-MRSA should be considered for empiric therapy of suspected staphylococcal infection. Larger community-based studies are needed to improve our understanding of the epidemiology of CA-MRSA, and to assist in the development of therapeutic guidelines for this important infection