Community perspectives on the benefits and risks of technologically enhanced communicable disease surveillance systems: A report on four community juries

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective systems. Conclusions Participants across all four events strongly supported the introduction of data linkage and pathogenomics to public health research under current research governance structures. Combining pathogen WGS with event-based data surveillance systems, however, is likely to be controversial because of a lack of public trust, even when the potential public health benefits are clear. Any suggestion of private sector involvement or commercialisation of WGS or surveillance data was unanimously rejected

Shigellosis Linked to Sex Venues, Australia

From January 1 to July 31, 2000, 148 cases of Shigella infection were reported in New South Wales, Australia, compared with an annual average of 95 cases. Of reported cases, 83% were confirmed as Shigella sonnei biotype G infections; 80% were in homosexual men. Visiting a sex venue in the 2 weeks before onset of illness was the only factor significantly associated with shigellosis

Outbreaks of Pandemic (H1N1) 2009 and Seasonal Influenza A (H3N2) on Cruise Ship

Although pandemic virus spread rapidly, especially among children, intensive control measures successfully contained these outbreaks

Probable Psittacosis Outbreak Linked to Wild Birds

Residence in the upper Blue Mountains, age of 50–64 years, direct contact with wild birds, and lawn mowing without a grass catcher were associated with psittacosis

Pelargonidin-3-O-glucoside and its metabolites have modest anti-inflammatory effects in human whole blood cultures

This study hypothesized that the predominant strawberry anthocyanin, pelargonidin-3-O-glucoside (Pg-3-glc), and three of its plasma metabolites (4-hydroxybenzoic acid, protocatechuic acid and phloroglucinaldehyde [PGA]) would affect phagocytosis, oxidative burst and the production of selected pro- and anti-inflammatory cytokines in a whole blood culture model. For the assessment of phagocytosis and oxidative burst activity of monocytes and neutrophils, whole blood was pre-incubated in the presence or absence of the test compounds at concentrations up to 5 μM, followed by analysis of phagocytic and oxidative burst activity using commercially available test kits. For the cytokine analysis, diluted whole blood was stimulated with lipopolysaccharide in the presence or absence of the test compounds at concentrations up to 5 μM. Concentrations of selected cytokines (tumor necrosis factor-α [TNF-α], interleukin [IL]-1β, IL-6, IL-8 and IL-10) were determined using a cytometric bead array kit. There were no effects of any of the test compounds on phagocytosis of opsonized or non-opsonized E. coli or on oxidative burst activity. Pg-3-glc and PGA at 0.08 μM increased the concentration of IL-10 (P<0.01 and P<0.001, respectively), but there was no effect on TNF-α, IL-1β, IL-6 and IL-8 and there were no effects of the other compounds. In conclusion, this study demonstrated a lack of effect of these compounds on the opsonization, engulfment and subsequent destruction of bacteria. Pg-3-glc and PGA, at physiologically relevant concentrations, had anti-inflammatory properties; however, effects were modest, only observed at the lowest dose tested and limited to IL-10

Investigation and response to an outbreak of leptospirosis among raspberry workers in Australia, 2018

Background In 2018, an outbreak of leptospirosis was identified among raspberry workers from a mixed‐berry farm in New South Wales, Australia. Initial testing had not revealed a cause, but eventually leptospirosis was detected via polymerase chain reaction (PCR). Further serological testing detected Leptospira borgpetersenii serovar Arborea, of which rodents are the predominant reservoir. Leptospirosis is rare in Australia, with outbreaks usually related to flooding. We conducted an investigation to identify risk factors for infection, to inform control measures. Methods Cases were detected through laboratory notifications, hospital‐based syndromic surveillance, awareness‐raising among farm employees and clinician alerts. Confirmed cases had a four‐fold rise in antibody titre or single titre ≥400 on microscopic agglutination test, and a positive IgM. Probable cases had a positive Leptospira PCR or IgM, and possible cases had a clinically compatible illness. We conducted a case-control study among raspberry workers on the farm and compared reported exposures between cases and seronegative controls. We assessed environmental risks on‐site and tested rodents for leptospirosis. Results We identified 84 cases over a 5‐month period (50 confirmed, 19 probable and 15 possible). Compared with controls, cases were less likely to wear gloves and more recently employed. Cases also more commonly reported always having scratched hands, likely from the thorns on raspberry plants. We observed evidence of rodent activity around raspberry plants and three of thirteen trapped mice tested positive for Leptospira Arborea. Control measures included enhanced glove use, doxycycline prophylaxis and rodent control. Conclusions This is the largest known outbreak of leptospirosis in Australia. Workers were likely exposed through scratches inflicted during harvesting, which became contaminated with environmental leptospires from mice. Leptospirosis should be considered an occupational risk for raspberry workers, requiring protective measures. Chemoprophylaxis may assist in controlling outbreaks. PCR assists in the early diagnosis and detection of leptospirosis and should be included in surveillance case definitions

Creatine Monohydrate and Conjugated Linoleic Acid Improve Strength and Body Composition Following Resistance Exercise in Older Adults

Aging is associated with lower muscle mass and an increase in body fat. We examined whether creatine monohydrate (CrM) and conjugated linoleic acid (CLA) could enhance strength gains and improve body composition (i.e., increase fat-free mass (FFM); decrease body fat) following resistance exercise training in older adults (>65 y). Men (N = 19) and women (N = 20) completed six months of resistance exercise training with CrM (5g/d)+CLA (6g/d) or placebo with randomized, double blind, allocation. Outcomes included: strength and muscular endurance, functional tasks, body composition (DEXA scan), blood tests (lipids, liver function, CK, glucose, systemic inflammation markers (IL-6, C-reactive protein)), urinary markers of compliance (creatine/creatinine), oxidative stress (8-OH-2dG, 8-isoP) and bone resorption (Ν-telopeptides). Exercise training improved all measurements of functional capacity (P<0.05) and strength (P<0.001), with greater improvement for the CrM+CLA group in most measurements of muscular endurance, isokinetic knee extension strength, FFM, and lower fat mass (P<0.05). Plasma creatinine (P<0.05), but not creatinine clearance, increased for CrM+CLA, with no changes in serum CK activity or liver function tests. Together, this data confirms that supervised resistance exercise training is safe and effective for increasing strength in older adults and that a combination of CrM and CLA can enhance some of the beneficial effects of training over a six-month period. Trial Registration. ClinicalTrials.gov NCT0047390

Pandemic influenza

&nbsp; In 2009, New South Wales (NSW) Health launched its most intensive public health surveillance, investigation and containment effort in living memory. This unprecedented effort was in response to something that had been planned for and feared for many years: an outbreak of a new strain of influenza to which the world’s population had no immunity, with the potential to cause disease, death and disruption on a massive scale. NSW Health, along with other Australian health authorities and government agencies, had been preparing, with renewed earnest, for such a pandemic since the SARS outbreak of 2002–03. That outbreak had highlighted the potential immense health, social and economic consequences that an emerging infectious disease can cause within a country. This edition of the New South Wales Public Health Bulletin contains articles relating the the outbreak of H1N1 in Australia in 2009 and the lessons learnt by the health system in managing the disease. &nbsp; Descriptive Table of Contents PDF (100 KB) &nbsp; Guest Editorial: Pandemic (H1N1) 2009 influenza in NSW Sarah V. Thackway and Jeremy M. McAnulty Full Text | PDF (212.7 KB) &nbsp; Pandemic (H1N1) 2009 influenza in NSW: an overview of the public health response Paula J. Spokes, Michelle A. Cretikos and John G. Ward Abstract | Full Text | PDF (135.9 KB) &nbsp; Isolation and quarantine during pandemic (H1N1) 2009 influenza in NSW: the operational experience of public health units Philippa L. Binns, Vicky Sheppeard and Michael P. Staff Abstract | Full Text | PDF (267.5 KB) &nbsp; An influenza prophylaxis clinic in a primary school: 24 hours from notification to protection Kathryn M. Weston and George Truman Abstract | Full Text | PDF (115.2 KB) &nbsp; Reflections on public health surveillance of pandemic (H1N1) 2009 influenza in NSW Tim Churches, Stephen J. Conaty, Robin E. Gilmour and David J. Muscatello Abstract | Full Text | PDF (130 KB) &nbsp; Responding to pandemic (H1N1) 2009 influenza in Aboriginal communities in NSW through collaboration between NSW Health and the Aboriginal community-controlled health sector Sian Rudge and Peter D. Massey Abstract | Full Text | PDF (120.7 KB) &nbsp; Truth, double truth and statistics Robert Booy and Dominic E. Dwyer Full Text | PDF (91.2 KB) &nbsp; Pandemic (H1N1) 2009 influenza vaccine roll-out in NSW Jan Fizzell, Sue Campbell-Lloyd, Andrew J. Hallett, Chris P. Lowbridge, Dennis Meijer and Sophie E. Tyner Abstract | Full Text | PDF (121.6 KB) &nbsp; Lessons from the NSW laboratory response to pandemic (H1N1) 2009 influenza Sheena Adamson, Jan Fizzell, Dominic E. Dwyer, William Rawlinson and Paul K. Armstrong Abstract | Full Text | PDF (132.2 KB) &nbsp; Pig in a china shop: a personal perspective of how pandemic (H1N1) 2009 affected the work of intensive care units in NSW Richard J. Totaro Abstract | Full Text | PDF (92.2 KB) &nbsp; Bug Breakfast in the Bulletin: Pandemic (H1N1) 2009 influenza Ben Polkinghorne, Kate Ward and Richard Totaro Full Text | PDF (292 KB) &nbsp; Communicable Diseases Report, NSW, November and December 2009 Communicable Diseases Branch Abstract | Full Text | PDF (148.1 KB

Controlling Tuberculosis in New South Wales

This document has three parts. The first part provides an overview of the epidemiology of TB in NSW. The second part defines the goals, targets and implementation indicators for the NSW TB Control Strategy. The third part contains policies and guidelines for TB Services, which were endorsed by a consensus meeting of Chest Clinic Staff, Respiratory, Public Health and Infectious Disease Physicians in October, 1992