Epidemiology of mumps outbreaks and the impact of an additional dose of MMR vaccine for outbreak control in regional Queensland, Australia, 2017–2018

Background In recent years, there have been ongoing outbreaks of mumps reported in Northern and North-Western Queensland, Western Australia and the Northern Territory, Australia. We aimed to define the epidemiology of mumps outbreaks in Central Queensland, Australia between October 2017 and October 2018 and evaluate the effectiveness of an additional dose of measles, mumps, rubella (MMR) vaccine. Methods A retrospective case control study was conducted, including outbreak investigations with laboratory-confirmed cases of mumps and subsequent comparison with matched controls. We analysed mandatory notifications from the Queensland Health Notifiable Conditions System database and immunisation information from the Queensland Health Vaccination Information and Admin System (VIVAS) and the Australian Immunisation Register. Results Between October 2017 and October 2018, there were 93 cases of mumps reported in Central Queensland with three distinct outbreaks: a discrete Indigenous community; a correctional facility; and a boarding school. Among all cases, 74 (79.6%) were fully vaccinated and 14 (15.1%) were partially vaccinated with MMR vaccine. Eighty-six cases (92.5%) were reported among Aboriginal and Torres Strait Islander people. In all outbreaks, an additional dose of MMR vaccine was offered with 35.4%, 73.6% and 35.8% of the target population being immunised in the discrete Indigenous community, the correctional facility and the boarding school, respectively. Prior to this additional dose of MMR, the mumps attack rate was 31.0 (95% confidence interval [95% CI]: 24.2–39.0) per 1000 population, compared to the post-additional dose MMR attack rate of 10.6 (95% CI: 6.7–15.9) per 1000 population. Conclusion An additional or booster dose of MMR should be included as an effective public health intervention strategy, particularly in communal or high-density living conditions to control mumps outbreaks in highly vaccinated populations.

Salmonella Paratyphi A infection: implications for public health management of extra-intestinal presentations – case study of a neck abscess

This study explores the implications of unusual presentations of Salmonella enterica subsp. enterica ser. Paratyphi (S. Paratyphi) infection for public health management, through a literature review and case study. In 2016, a 36-year-old male presented with a five-day history of right sided painful neck swelling, coryza and a two-day history of fevers after arriving in Australia from India nine weeks earlier. S. Paratyphi A was isolated from a fine needle aspirate sample. A descriptive epidemiological review was performed of confirmed cases of S. Paratyphi notified in New South Wales between 2008 and 2017. S. Paratyphi was isolated in blood and/or faecal samples in 247 cases (98.4%). Only four specimens (1.6%) were from a focal site. A literature review of extraintestinal infections of S. Paratyphi A or B was performed. Of the 41 such cases reported, 16 (39%) had a clear history of a prior gastroenteritis and/or febrile illness, or information suggested this was highly likely. No preceding gastroenteritis or febrile illness occurred in 15 (37%) of the cases. Information was reviewed and presented with a public health lens, valuable for ‘evidence-informed’ public health risk assessment of contacts and exposures related to these types of S. Paratyphi infection. S. Paratyphi infection usually presents as an enteric fever illness. Our case illustrates the variable nature of infectious diseases and the importance of laboratory testing in obtaining a diagnosis. S. Paratyphi can have unusual presentations, which may require adjustment in the public health management of the case. Public health staff should keep an open mind when investigating possible sources and assessing risk. In Western Sydney, this disease is largely associated with residents travelling to high-incidence countries to visit family and friends, and receiving family visits from these countries. The increasing number of cases of S. Paratyphi (prior to COVID-19) in Western Sydney and the importance of awareness of the risk of enteric fever to travellers to endemic regions is highlighted.

COVID-19 Australia: Epidemiology Report 53: Reporting period ending 24 October 2021

This is the fifty-third epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 23:59 Australian Eastern Daylight Time [AEDT] 24 October 2021. It includes data on COVID-19 cases diagnosed in Australia.

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2020

For 27 years, national prospective data on selected rare childhood diseases have been collected monthly by the Australian Paediatric Surveillance Unit (APSU) from paediatricians and other clinical specialists who report cases in children aged up to 16 years. We report here the annual results of APSU surveillance in 2020 for ten rare communicable diseases and complications of communicable diseases, namely: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV) infection; neonatal herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; severe complications of seasonal influenza; juvenile onset recurrent respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. We describe the results for each disease in the context of the total period of study, including demographics, clinical characteristics, treatment and short-term outcomes. Despite challenges presented by the coronavirus disease 2019 (COVID-19) pandemic in 2020, more than 1,400 paediatricians reported regularly to the APSU and an overall monthly reporting rate of > 90% was achieved. The minimum AFP target of 1 case per 100,000 children aged less than 15 years was achieved and there were few cases of vaccine-preventable diseases (JoRRP, rubella, varicella). However, high cases of congenital CMV, neonatal HSV and perinatal exposure to HIV persist. There were no severe complications of seasonal influenza reported for the first time in 13 years. This is consistent with other surveillance data reporting a decline of influenza and other communicable diseases in 2020, and likely reflects the wider effects of public health measures to reduce transmission of SARS-CoV-2 in the Australian community.

Australian Gonococcal Surveillance Programme Annual Report, 2020

The Australian Gonococcal Surveillance Programme (AGSP), established in 1981, has continuously monitored antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae for more than 40 years. In 2020, a total of 7,222 clinical isolates of gonococci from patients in the public and private sectors, in all jurisdictions, were tested for in vitro antimicrobial susceptibility by standardised methods. Current treatment recommendations for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. In 2020, decreased susceptibility (DS) to ceftriaxone (minimum inhibitory concentration [MIC] value ≥ 0.06 mg/L) was found nationally in 0.9% of isolates. There was one isolate, reported from Victoria in 2020, that was resistant to ceftriaxone (MIC value ≥ 0.25 mg/L). Resistance to azithromycin (MIC value ≥ 1.0 mg/L) was found nationally in 3.9% of N. gonorrhoeae isolates, continuing a downward trend observed and reported since 2017. Isolates with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) are identified sporadically in Australia; in 2020, there was one such isolate reported in Queensland. In 2020, penicillin resistance was found in 27% of gonococcal isolates nationally, and ciprofloxacin resistance in 36%; however, there is considerable variation by jurisdiction. In some remote settings, penicillin resistance remains low, and this drug continues to be recommended as part of an empiric therapy strategy. In 2020, in remote Northern Territory, no penicillin resistance was reported, and in remote Western Australia 5/116 of gonococcal isolates (4.3%) were penicillin resistant. There was one ciprofloxacin-resistant isolate reported from remote Northern Territory, and ciprofloxacin resistance rates remain comparatively low in remote Western Australia (4/116; 3.4%).

Australian National Enterovirus Reference Laboratory annual report, 2020

Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (WHO). Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2020, no cases of poliomyelitis were reported from clinical surveillance; Australia reported 1.09 non-polio AFP cases per 100,000 children, thereby meeting the WHO’s performance criterion for a sensitive surveillance system. The non-polio enteroviruses coxsackievirus A10 and coxsackievirus A16 were identified from clinical specimens collected from AFP cases. Australia also performs enterovirus surveillance and environmental surveillance to complement the clinical system focussed on children. In 2020, there were 140 cases of wild poliovirus reported from the two remaining endemic countries: Afghanistan and Pakistan. Another 28 countries reported cases of circulating vaccine-derived poliovirus.

COVID-19 in health care workers, Australia 2020

Background Health care workers are at increased risk of SARS-CoV-2 infection due to potential exposure to patients or staff in health care settings. Australian health care services and health care workers experienced intense pressure to prepare for and respond to SARS-CoV-2 infections. We summarise national data on health care worker infections and associated outbreaks during 2020. Methods We collected aggregated data on infected health care workers and outbreaks in health care facilities from all jurisdictions. Health care workers working solely in residential aged care and outbreaks in residential aged care facilities were excluded. Jurisdictions provided data on the number of health care setting outbreaks, confirmed cases, hospitalisation, source of infection, and health care worker role. We analysed data for two periods that aligned with two distinct peaks in the epidemic relative to 1 June 2020, referred to here as the first wave (23 January – 31 May 2020) and the second wave (1 June – 18 September 2020). Results Jurisdictions reported a total of 2,163 health care worker infections with SARS-CoV-2 during the surveillance period. Source of acquisition was known for 81.0% of cases (1,667/2,059). The majority of cases in the first wave were acquired overseas, shifting to locally-acquired cases in the second wave. The odds of infection in the second wave compared to the first wave were higher for nurses/midwives (odds ratio, OR: 1.61; 95% confidence interval (95% CI): 1.32–2.00), lower for medical practitioners (OR: 0.36; 95% CI: 0.28–0.47) and did not differ for ‘other’ health care workers (OR: 1.07; 95% CI: 0. 87–1.32). The odds of infection in the second wave were higher in a health care setting (OR: 1.76; 95% CI: 1.28–2.41) than in the community. There were 120 outbreaks in health care settings with 1,428 cases, of which 56.7% (809/1,428) were health care workers. The majority (88/120; 73.8%) of outbreaks in health care settings occurred in the second wave of the epidemic, with 90.9% of these (80/88) occurring in Victoria. Conclusions In the second wave of the epidemic, when there was heightened community transmission, health care workers were more likely to be infected in the workplace. Throughout the epidemic, nurses were more likely to be infected than staff in other roles.