Transmission of tuberculosis from a seven-year-old child in a Sydney school.

OBJECTIVES: To determine whether a 7-year-old child with extrapulmonary and pulmonary tuberculosis (TB) and direct smear positive sputum for acid-fast bacilli was infectious to home and school contacts, and to ascertain potential adult sources of infection for these contacts. METHODS: Contact tracing by Mantoux testing was conducted on 220 children at a primary school and after-school care facility, and 59 selected adults considered potential sources of infection. RESULTS: The participation rate for the children was 98% and 92% for the adults. Mantoux positivity (induration >/= 10 mm, or >/= 15 mm with previous BCG) among children was 13% at the school (anticipated rate 2-3%), 26% among school staff, and 7% among children at the after-school care centre where the index case attended. One exposed adult hospital staff member converted from Mantoux negative to positive. No other cases of TB disease were detected among children or adults tested. CONCLUSION: Although spread of TB from children to others is rare, the findings of this investigation indicate that transmission of TB from a young child to other children and an adult may have occurred, and that sputum testing and contact tracing for sputum smear positive children should be considered.

Horizontal transmission of hepatitis B in a children's day-care centre: a preventable event.

Using molecular finger-printing, we provided evidence that, in a children's day-care centre, a known hepatitis B virus (HBV) hepatitis B e antigen (HBeAg) carrier transmitted HBV to another child (the index case). The chronic HBV carrier had an exudative skin lesion and a history of biting. We sought to identify other at-risk children and prevent further transmission. Blood samples were collected and tested serologically for HBV. Of the 90 other children, 78 (87 per cent) were tested and none had serological evidence of HBV infection; 73 (81 per cent) were of Caucasian background; 38 (49 per cent) had a history of HBV immunisation with serological confirmation. Therefore, 1 (2.4 per cent, 95 per cent confidence interval 1.0 to 12.8 per cent) of the 41 known susceptible contacts became infected. The risk of horizontal HBV transmission in a children's day-care centre is low but not negligible. Staff and children should be vaccinated when a child in a day-care centre is a known HBV carrier.

Notification of infectious diseases by general practitioners in New South Wales. Survey before and after the introduction of the Public Health Act 1991 (NSW)

OBJECTIVE: To evaluate attitudes and knowledge about infectious disease notification and the self-reported notifying practices of general practitioners in New South Wales before and after the introduction of the Public Health Act 1991 (NSW). DESIGN: A survey of a random sample of general practitioners in NSW before and after the introduction of the Act. RESULTS: The percentage of doctors who considered notification to be very important increased (57% "before" v. 67% "after"; P = 0.02), as did the percentage who believed that notification usually leads to preventive action (41% v. 54%; P = 0.04). There was no increase in self-reported notification (50% v. 54% who reported notifying cases of notifiable diseases "always, or almost always"; P = 0.42). CONCLUSIONS: Notification of infectious disease by doctors remains suboptimal, but may improve over time as the impact of the new Act is felt. Feedback to doctors showing that preventive action is taken as a result of their notifications may be the most effective way to improve notification practices.

Rabies case in New South Wales, 1990: public health aspects.

OBJECTIVES: To identify the source of rabies in the recent case in New South Wales, and to determine the need for post-exposure rabies prophylaxis among contacts of the patient. DESIGN: Information was obtained by face-to-face interview of the dead girl's family and face-to-face and telephone interviews using a questionnaire of health care workers. Other information was gathered from overseas and local sources through telephone and facsimile contact. RESULTS: The girl had migrated from Vietnam in 1984 to Hong Kong, and from there in 1986 to Australia. No evidence of contact with a rabid animal in Australia or Hong Kong was found. There had also been no organ donations from the girl. Four health care workers were given post-exposure rabies prophylaxis. CONCLUSIONS: Because of the lack of evidence of animal contact in Australia and the fact that extremely long incubation periods for rabies have been documented, it was considered that the most likely source of the rabies virus was North Vietnam. Genetic studies of the virus also supported a South-East Asian source. Nevertheless the presumed incubation period--at least six years and four months--is one of the longest recorded.

Heterosexual gonorrhoea in central Sydney: implications for HIV control.

Gonorrhoea is a sexually transmissible disease (STD) characteristic of a core group of individuals and their contacts. From the experience of a Sydney STD clinic, as well as local and national population-based reports, trends in heterosexually acquired gonorrhoea in Australia over a decade were examined. An overall decline of 90% in case numbers between 1981 and 1989 was found, with an average yearly decline of 30%. The improved compliance with condom use by Sydney prostitutes and their clients could have been a major factor. This occurred in an environment of peer and public education about AIDS and the decriminalisation of prostitution. Improved health professional training and public access to specialist STD services against a background of demographic changes may also have contributed. However a persistent "seeding" of penicillinase-producing strains of gonorrhoea from Southeast Asia through men not using condoms was detected. These data have potential implications for the importation of heterosexually acquired human immunodeficiency virus infection into Australia.