An outbreak of acute rheumatic fever in a remote Aboriginal community.

OBJECTIVES: We describe the public health response to an outbreak of acute rheumatic fever (ARF) in a remote Aboriginal community. METHODS: In August 2021, the Northern Territory Rheumatic Heart Disease Control Program identified an outbreak of acute rheumatic fever in a remote Aboriginal community. A public health response was developed using a modified acute poststreptococcal glomerulonephritis protocol and the National Acute Rheumatic Fever Guideline for Public Health Units. RESULTS: 12 cases were diagnosed during the outbreak; six-times the average number of cases in the same period in the five years prior (n=1.8). Half (n=6) of the outbreak cases were classified as recurrent episodes with overdue secondary prophylaxis. Contact tracing and screening of 11 households identified 86 close contacts. CONCLUSIONS: This outbreak represented an increase in both first episodes and recurrences of acute rheumatic fever and highlights the critical need for strengthened delivery of acute rheumatic fever secondary prophylaxis, and for improvements to the social determinants of health in the region. IMPLICATIONS FOR PUBLIC HEALTH: Outbreaks of acute rheumatic fever are rare despite continuing high rates of acute rheumatic fever experienced by remote Aboriginal communities. Nevertheless, there can be improvements in the current national public health guidance relating to acute rheumatic fever cluster and outbreak management.

Genomic Evidence of In-Flight SARS-CoV-2 Transmission, India to Australia, April 2021.

Epidemiologic and genomic investigation of SARS-CoV-2 infections associated with 2 repatriation flights from India to Australia in April 2021 indicated that 4 passengers transmitted SARS-CoV-2 to >11 other passengers. Results suggest transmission despite mandatory mask use and predeparture testing. For subsequent flights, predeparture quarantine and expanded predeparture testing were implemented.

Effect of an ageing population on services for the elderly in the Northern Territory.

Objective The aim of the present study was to describe the elderly population of the Northern Territory (NT), explore the challenges of delivering aged care services to this population and implications for the acute care sector. Methods Data gathered from a variety of sources were used to describe the demographic and health profile of elderly Territorians, the aged care structure and services in the NT, and admission trends of elderly patients in NT hospitals. Information regarding NT community and residential aged care services was sourced from government reports. NT public hospital admissions from 2001 to 2015 were adjusted by the estimated Aboriginal and non-Aboriginal populations. Results In 2015, elderly people constituted 9.2% of the NT population and this number is predicted to increase. Between 2001 and 2015, the number and rate of elderly admissions to NT public hospitals increased significantly. Compared with other jurisdictions, aged care in the NT is dominated by community services, which are of limited scope. Important geographical and economic factors affect the availability of residential aged care beds. This, in turn, affects the ability of elderly people to transition from hospital settings. Conclusions The NT has a relatively small but growing elderly population with increasing needs. This population is markedly different compared with its counterparts in other Australian states and territories, but receives aged care services based on national policies. Recent changes to community-based services and increases in residential beds should improve services and care, although remaining challenges and gaps need to be addressed. What is known about the topic? Increasing health and care needs of elderly people will place significant stress across the health and aged care system. In Australia, most aged care services are apportioned and funded under a national system. The NT has a markedly different population profile compared with the rest of Australia, which gives rise to unique considerations, but its aged care structure is based on nationally developed policies. What does this paper add? Elderly people in the NT are increasingly using acute care services. Aged care services in the NT have higher ratios of community-based services to residential aged care facilities (RACF) as a consequence of a 'younger' cohort of Aboriginal elderly people who live remotely. In addition, economic factors affect the low number of RACF places. As evidenced in past years, a small pool of beds can adversely affect the numbers and length of stay of elderly people waiting in hospitals. What are the implications for practitioners? The NT has a small but growing population of elderly people, which will place an increasing burden on acute care services that are ill equipped to manage their specific needs. Recent RACF and flexible care bed approvals may alleviate past difficulties to transition hospital patients awaiting RACF placement. Significant changes at the national level to community-based care services that increase flexibility for providers may bring about better outcomes for remote elderly recipients. However, high costs and issues with remote servicing will remain. Psychogeriatrics remains a major underserviced area in the NT with no prospective solution.

The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review.

BACKGROUND: Rheumatic heart disease (RHD) poses a major disease burden among disadvantaged populations globally. It results from acute rheumatic fever (ARF), a complication of Group A Streptococcal (GAS) infection. These conditions are acknowledged as diseases of poverty, however the role of specific social and environmental factors in GAS infection and progression to ARF/RHD is not well understood. The aim of this systematic review was to determine the association between social determinants of health and GAS infection, ARF and RHD, and the effect of interventions targeting these. METHODOLOGY: We conducted a systematic literature review using PubMed, the Cochrane Library and Embase. Observational and experimental studies that measured: crowding, dwelling characteristics, education, employment, income, nutrition, or socioeconomic status and the relationship with GAS infection, ARF or RHD were included. Findings for each factor were assessed against the Bradford Hill criteria for evidence of causation. Study quality was assessed using a standardised tool. PRINCIPLE FINDINGS: 1,164 publications were identified. 90 met inclusion criteria, comprising 91 individual studies. 49 (50.5%) were poor quality in relation to the specific study question. The proportion of studies reporting significant associations between socioeconomic determinants and risk of GAS infection was 57.1%, and with ARF/RHD was 50%. Crowding was the most assessed factor (14 studies with GAS infection, 36 studies with ARF/RHD) followed by socioeconomic status (6 and 36 respectively). The majority of studies assessing crowding, dwelling characteristics, education and employment status of parents or cases, and nutrition, reported a positive association with risk of GAS infection, ARF or RHD. Crowding and socioeconomic status satisfactorily met the criteria of a causal association. There was substantial heterogeneity across all key study aspects. CONCLUSION: The extensive literature examining the role of social determinants in GAS infection, ARF and RHD risk lacks quality. Most were observational, not interventional. Crowding as a cause of GAS infection and ARF/RHD presents a practical target for prevention actions.

A retrospective population-based study of induction of labour trends and associated factors among aboriginal and non-aboriginal mothers in the northern territory between 2001 and 2012.

BACKGROUND: Induction of labour (IOL) has become more common among many populations, but the trends and drivers of IOL in the Northern Territory (NT) of Australia are not known. This study investigated trends in IOL and associated factors among NT Aboriginal and non-Aboriginal mothers between 2001 and 2012. METHODS: A retrospective analysis of all NT resident women who birthed in the NT between 2001 and 2012 at ≥32 weeks gestation. Demographic, medical and obstetric data were obtained from the NT Midwives' Collection. The prevalence of IOL was calculated by Aboriginal status and parity of the mother and year of birth. The prevalence of each main indication for induction among women was compared for 2001-2003 and 2010-2012. Linear and logistic regression was used to test for association between predictive factors and IOL in bivariate and multivariate analysis, separately for Aboriginal and non-Aboriginal mothers. RESULTS: A total of 42,765 eligible births between 2001 and 2012 were included. IOL was less common for Aboriginal than non-Aboriginal mothers in 2001 (18.0 % and 25.1 %, respectively), but increased to be similar to non-Aboriginal mothers in 2012 (22.6 % and 24.8 %, respectively). Aboriginal primiparous mothers demonstrated the greatest increase in IOL. The most common indication for IOL for both groups was post-dates, which changed little over time. Medical and obstetric complications were more common for Aboriginal mothers except late-term pregnancy. Prevalence of diabetes in pregnancy increased considerably among both Aboriginal and non-Aboriginal mothers, but was responsible for only a small proportion of IOLs. Increasing prevalence of risk factors did not explain the increased IOL prevalence for Aboriginal mothers. CONCLUSIONS: IOL is now as common for Aboriginal as non-Aboriginal mothers, though their demographic, medical and obstetric profiles are markedly different. Medical indications did not explain the recent increase in IOL among Aboriginal mothers; changes in maternal or clinical decision-making may have been involved.