A severe 2017 influenza season dominated by influenza A(H3N2), Victoria, Australia.

Surveillance for influenza-like illness (ILI) and laboratory-confirmed influenza in Victoria, Australia is undertaken jointly by the Victorian Infectious Diseases Reference Laboratory and the Victorian Government Department of Health and Human Services from May to October each year. Surveillance data comprise notifiable laboratory-confirmed influenza and ILI reporting from from two sources - a general practice sentinel surveillance programme and a locum service. The magnitude of the 2017 influenza season was high in Victoria with widespread circulation of influenza type A(H3N2), which peaked in September. A record number of laboratory-confirmed influenza cases were notified, and the proportion of ILI cases to total consultations from both the general practice and locum service were higher than previous years. Notified cases of influenza A were older than influenza B cases with 25% compared to 17% aged more than 65 years, respectively. The proportion of swabs that were positive for influenza peaked at 58%. Antigenic characterization suggested a good match between the circulating and vaccine strains of influenza A(H3N2). Most of the increases observed in notified cases of laboratory-confirmed influenza in recent years in Victoria have been attributed to increases in testing. However, that cases of ILI also increased in Victoria in 2017 is suggestive that 2017 was a relatively severe season. The dominance of influenza type A(H3N2), the extended duration of elevated activity, and a potential phylogenetic mismatch of vaccine to circulating strains are likely to have contributed to the relative severity of the 2017 season. Victoria is Australia's second most populous state and is the mainland's southernmost state. It has a temperate climate with an influenza season usually occurring in the cooler months between May and October. The Victorian Infectious Diseases Reference Laboratory (VIDRL), in partnership with the Victorian Government Department of Health and Human Services (DHHS), coordinates influenza-like illness (ILI) and laboratory-confirmed influenza surveillance in Victoria. There are three data sources included in the influenza surveillance system.

Pooled influenza vaccine effectiveness estimates for Australia, 2012-2014.

Data were pooled from three Australian sentinel general practice influenza surveillance networks to estimate Australia-wide influenza vaccine coverage and effectiveness against community presentations for laboratory-confirmed influenza for the 2012, 2013 and 2014 seasons. Patients presenting with influenza-like illness at participating GP practices were swabbed and tested for influenza. The vaccination odds of patients testing positive were compared with patients testing negative to estimate influenza vaccine effectiveness (VE) by logistic regression, adjusting for age group, week of presentation and network. Pooling of data across Australia increased the sample size for estimation from a minimum of 684 to 3,683 in 2012, from 314 to 2,042 in 2013 and from 497 to 3,074 in 2014. Overall VE was 38% [95% confidence interval (CI) 24-49] in 2012, 60% (95% CI 45-70) in 2013 and 44% (95% CI 31-55) in 2014. For A(H1N1)pdm09 VE was 54% (95% CI-28 to 83) in 2012, 59% (95% CI 33-74) in 2013 and 55% (95% CI 39-67) in 2014. For A(H3N2), VE was 30% (95% CI 14-44) in 2012, 67% (95% CI 39-82) in 2013 and 26% (95% CI 1-45) in 2014. For influenza B, VE was stable across years at 56% (95% CI 37-70) in 2012, 57% (95% CI 30-73) in 2013 and 54% (95% CI 21-73) in 2014. Overall VE against influenza was low in 2012 and 2014 when A(H3N2) was the dominant strain and the vaccine was poorly matched. In contrast, overall VE was higher in 2013 when A(H1N1)pdm09 dominated and the vaccine was a better match. Pooling data can increase the sample available and enable more precise subtype- and age group-specific estimates, but limitations remain.

Moderate influenza vaccine effectiveness in Victoria, Australia, 2011.

We used a sentinel general practitioner (GP) network to conduct surveillance for laboratory-confirmed influenza amongst patients presenting with influenza-like illness (ILI) in Victoria, Australia in 2011. The test negative variation of the case control study design was used to estimate effectiveness for seasonal trivalent influenza vaccine. Cases and controls were ILI patients that tested positive and negative for influenza, respectively. Vaccination status was recorded by GPs and vaccine effectiveness (VE) was calculated as (1-adjusted odds ratio)x100%. There were 529 patients included in the study, of which 29% were influenza positive. Twelve percent of study participants were reported as vaccinated, 6% of cases and 15% of controls. Adjusted VE against all influenza was 56%, but not statistically significant. There was generally little variation in VE estimates when stratified by virus type and subtype, which is consistent with good matches between circulating strains and the vaccine strains. The VE was higher among adults of working age than among children.

An outbreak of Salmonella Typhimurium 9 at a school camp linked to contamination of rainwater tanks.

In March 2007, an outbreak of gastroenteritis was identified at a school camp in rural Victoria, Australia, affecting about half of a group of 55 students. A comprehensive investigation was initiated to identify the source. Twenty-seven attendees were found to have abdominal pain, diarrhoea and nausea (attack rate 49%). Of 11 faecal specimens tested all were positive for Salmonella Typhimurium definitive phage type 9 (DT9). Of four samples taken from the untreated private water supply, two were positive for DT9. Drinking water from containers filled from rainwater tanks [relative risk (RR) 3.2, P=0.039] and participation in two recreational activities - flying fox (RR 5.3, P=0.011), and beam-balance (RR 3.9, P=0.050) - were indicative of a link with illness. Environmental and epidemiological investigations suggested rainwater collection tanks contaminated with DT9 as being the cause of the outbreak. Increased use of rainwater tanks may heighten the risk of waterborne disease outbreaks unless appropriate preventative measures are undertaken.

Long term compliance with California's Smoke-Free Workplace Law among bars and restaurants in Los Angeles County.

OBJECTIVE: To assess long term compliance with the California Smoke-Free Workplace Law in Los Angeles County freestanding bars and bar/restaurants. DESIGN: Population based annual site inspection survey of a random sample of Los Angeles County freestanding bars and bar/restaurants was conducted from 1998 to 2002. MAIN OUTCOME MEASURES: The primary outcomes of interest were patron and employee smoking. The secondary outcomes of interest were the presence of ashtrays and designated outdoor smoking areas. RESULTS: Significant increases in patron non-smoking compliance were found for freestanding bars (45.7% to 75.8%, p < 0.0001) and bar/restaurants (92.2% to 98.5%, p < 0.0001) between 1998 and 2002. Increases in employee non-smoking compliance were found for freestanding bars (86.2% to 94.7%, p < 0.0003) and bar/restaurants (96.5% to 99.2%, p < 0.005). CONCLUSIONS: This study provides clear evidence that the California Smoke-Free Workplace Law has been effective at reducing patron and employee smoking in Los Angeles County bars and restaurants. Recommendations include educational campaigns targeted to freestanding bar owners and staff to counter perceptions of lost revenue, more rigorous enforcement, and more severe penalties for repeat violators such as alcohol licence revocation. Policymakers can enact smoke-free restaurant and bar policies to protect employees and patrons from secondhand smoke, confident that these laws can be successfully implemented.

Meeting the data needs of a local health department: the Los Angeles County Health Survey.

Monitoring the health status of populations is a core function of all public health agencies but is particularly important at the municipal and community levels, where population health data increasingly are used to drive public health decision making and community health improvement efforts. Unfortunately, most local health jurisdictions lack important data for developing population health profiles, such as data on chronic disease prevalence, quality-of-life measures, functional status, and self-perceptions of health status. In addition, data on important determinants of health, including health behaviors and access to health care services, are rarely available locally. These data frequently are collected in national and state surveys (e.g., the National Health Interview Survey and the Behavioral Risk Factor Surveillance System) and provide critical information to assess progress toward achieving state and national health objectives. The surveys rarely serve local data needs, however, because of insufficient sample size and lack of flexibility to address local health issues. To address gaps in local health data, in 1997 the Los Angeles County Department of Health Services inaugurated the Los Angeles County Health Survey.

Halting the illegal sale of prescription medications in Los Angeles County.

The illegal sale of prescription medications by unlicensed vendors is a widespread practice in Los Angeles County. Many members of ethnic and particularly Latino communities turn to unlicensed vendors because of financial and cultural reasons and/or a lack of access to the U.S. health care system. In response, Los Angeles County Department of Health Services developed a two-part effort to curb the illegal sale of pharmaceuticals. Dramatically increased law enforcement resulted in 280 investigations, 121 arrests, and the confiscation of $4-$4.5 million worth of illegal pharmaceuticals during the first 20 months. The department also has begun outreach efforts to educate those communities most affected by these practices.

Are older hazardous and harmful drinkers less likely to participate in health-related behaviors and practices as compared with nonhazardous drinkers?

OBJECTIVES: To describe the (1) prevalence of at-risk drinking and participation in health-related behaviors and practices and (2) associations of at-risk drinking with other health-related behaviors and practices among older persons completing a health-risk appraisal for the elderly (HRA-E). DESIGN: Cross-sectional study using data from a self-administered, mailed survey sample. SETTINGS: Persons from three organizations were surveyed: (1) the American Association of Retired Persons; and (2) a large medical group and (3) a community-based senior health center in southern California. PARTICIPANTS: 1,889 persons age 55 years and older. MEASUREMENTS: The HRA-E included items on health characteristics, drinking behaviors (including amount of alcohol use and two alcoholism screening measures: the CAGE (Cut down, Annoyed, Guilty, Eye opener) and Short Michigan Alcoholism Screening Test-Geriatric version (SMAST-G), and participation in selected health-related behaviors and practices. Social drinkers were defined as those who drank fewer than 14 drinks weekly and screened negative on the CAGE (defined as two or more "no" responses) and SMAST-G. Hazardous drinkers drank fewer than 14 drinks weekly and screened negative. Harmful drinkers drank fewer than 14 drinks weekly and screened positive. Possible at-risk drinkers drank 14 or more drinks weekly and screened positive. Least squares regression models were used to assess the effects of hazardous, harmful, and possible at-risk drinking on each of the health-related practices and behaviors. We also conducted these analyses using three other definitions of social, possible at-risk, hazardous, and harmful drinking. RESULTS: Of all respondents, 40% were social drinkers, 3% were harmful drinkers, 2% were hazardous drinkers, and 11% were possible at-risk drinkers. Hazardous, harmful, and possible at-risk drinkers commonly reported driving after drinking or being driven by someone who had been drinking (67%, 76%, and 64% respectively). Harmful and possible at-risk drinkers were more likely than social drinkers to smoke and were less likely to use seatbelts regularly. These findings were observed regardless of how the drinking groups were defined. CONCLUSION: All groups of at-risk drinkers more commonly engaged in selected adverse health-related behaviors and practices than did social drinkers.

Effectiveness of altered incentives in a food safety inspection program.

BACKGROUND: The Los Angeles County Department of Health Services revamped its retail food establishment inspection program in 1998 to include, among other novel provisions, the prominent posting of grades. The purpose of the present study is to examine results from the second year of the revamped program to determine the longer-term impact of the program. METHODS: An analysis of program results for Year 1 led to several program refinements: stratification of risk categories, certification of food handlers, and an external fraud hotline. Outcome measures used included routine inspection scores; closure rates; scores from owner-initiated inspections and departmentally initiated inspections; inspection frequencies; compliance with food handler certification requirements; and frequency of use of the external fraud hotline. RESULTS: Inspection scores continued to increase in 1999, while the rate of closures decreased. The owner-initiated inspections also resulted in improved scores, generally maintained on subsequent inspections. Higher risk establishments were inspected more frequently than were lower risk establishments. Over 30,000 food handlers were certified. The external fraud hotline received 16 fraud complaints. CONCLUSIONS: Results indicate that retail food establishments are taking stronger action to assure compliance with food safety practices.

Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke.

This report presents the results of systematic reviews of effectiveness, applicability, other effects, economic evaluations, and barriers to use of selected population-based interventions intended to reduce tobacco use and exposure to environmental tobacco smoke. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (TFCPS) regarding the use of these selected interventions. The TFCPS recommendations are presented on page 67 of this supplement.

Promoting adolescent health: worksite-based interventions with parents of adolescents.

A promising public health approach for reducing adolescent risk behavior is to recognize and support the role of parents in promoting healthful behaviors. Although there are various settings where parents can be reached, this article focuses on one particular setting--the parent's place of employment. The article discusses the development and implementation of parenting programs for parents of adolescents. Such programs are new and should be evaluated to determine whether they are effective.

Motor-vehicle occupant injury: strategies for increasing use of child safety seats, increasing use of safety belts, and reducing alcohol-impaired driving.

The Task Force on Community Preventive Services has conducted systematic reviews of interventions designed to increase use of child safety seats, increase use of safety belts, and reduce alcohol-impaired driving. The Task Force strongly recommends the following interventions: laws requiring use of child safety seats, distribution and education programs for child safety seats, laws requiring use of safety belts, both primary and enhanced enforcement of safety belt use laws, laws that lower the legal blood alcohol concentration (BAC) limit for adult drivers to 0.08%, laws that maintain the minimum legal drinking age at 21 years, and use of sobriety checkpoints. The Task Force recommends communitywide information and enforcement campaigns for use of child safety seats, incentive and education programs for use of child safety seats, and a lower legal BAC for young drivers (in the United States, those under the minimum legal drinking age). This report provides additional information regarding these recommendations, briefly describes how the reviews were conducted, and provides information to help apply the interventions locally.

Changing the paradigm: planning for ambulatory care expansion in Los Angeles County using a community-based and evidence-based model.

In 1998, Los Angeles County's Department of Health Services (DHS) embarked on a planning process to expand ambulatory care services for the county's 2.7 million uninsured and otherwise medically indigent residents. This planning process was novel in two ways. First, it used a quantitative, needs-based approach for resource allocation to ensure an equitable distribution of safety-net ambulatory care services across the county. Second, it used a new community-based planning paradigm that took into consideration the specific needs of each of the county's eight geographic service planning areas. Together, the evidence-based approach to planning and the community-based decision-making will ensure that DHS can more equitably provide for the needs of Los Angeles County's medically indigent residents.

Core protein phosphorylation modulates pregenomic RNA encapsidation to different extents in human and duck hepatitis B viruses.

To clarify the role of core protein phosphorylation in pregenomic-RNA encapsidation of human and duck hepatitis B viruses (HBV and DHBV, respectively), we have examined the phosphorylation states of different forms of intracellular HBV core protein and the phenotypic effects of mutations in the phosphorylation sites of HBV and DHBV core proteins. We show that HBV core protein is phosphorylated to similar extents in the form of protein dimers and after further assembly in pregenomic RNA-containing capsids. Individual and multiple substitutions of alanine and aspartic acid for serine in the phosphorylation sites of HBV core protein resulted in site-specific and synergistic effects on RNA encapsidation, ranging from 2-fold enhancement to more than 10-fold inhibition. Core protein variants with mutations in all phosphorylation sites exhibited dominant-negative effects on RNA encapsidation by wild-type protein. The results suggest that the presence of phosphoserine at position 162 of HBV core protein is required for pregenomic-RNA encapsidation, whereas phosphoserine at position 170 optimizes the process and serine might be preferable in position 155. Examination of the pregenomic-RNA-encapsidating capacities of DHBV core protein variants, in which four phosphorylation sites were jointly mutated to alanine or aspartic acid, suggests that phosphorylation of DHBV core protein at these sites may optimize pregenomic-RNA encapsidation but that its impact is much less profound than in the case of HBV. The possible mechanisms by which RNA encapsidation may be modulated by core protein phosphorylation are discussed in the context of the observed differences between the two viruses.

Community health report cards. Results of a national survey.

INTRODUCTION: The purpose of this research is to examine the state-of-the-art in community health report card development and use in order to increase their effective integration into community health improvement efforts. METHODS: A mailed survey was sent to 115 "report card" communities nationwide. This list was generated through multiple key informants at the national, regional, and state levels. Seventy-four percent (85/115) were eligible for the study. The report cards returned were inventoried for: quality of their data, comprehensiveness, presentation, appropriateness to target audiences, purpose and sponsorship, relevance to policy development, community involvement, comparability, replicability, and other factors. RESULTS: Of the 85 eligible projects, 65 responded. The report cards varied significantly in all areas. Only one half of communities used pre-existing formats or the experience of others to guide this resource-intensive development process. Data collection was the greatest challenge encountered in development. Local health departments, hospitals, and non-profit civic groups were the community groups most likely to be involved in development. CONCLUSION: There is need for infrastructure, technical assistance, and improved, easy-to-use tools to facilitate the report card development process and the sharing of expertise and experience among involved communities. Greater systematization of the process would enhance the reasonableness and sustainability of the effort. Broad community involvement, including support of the local health department, other community agencies, as well as the local business community, may be key to their success.

Public health in the twentieth century: advances and challenges.

Substantial advances in public health methods, practice, and the health of the public have occurred in the twentieth century. Some of the contributions most notable for their impact on mortality and longevity are vaccine development and widespread use, smallpox eradication, large reductions in communicable disease epidemics, and the rise and decline of several serious chronic diseases. Many methodological advances have facilitated better understanding of disease processes and opportunities for control. Epidemiological methods have advanced, but studies often ignore the determinants of health at the community level and above, leading to simplistic formulations of multiple risk factors contributing to chronic and other diseases and injuries. Occupational and environmental health developed as disciplines in this century, making significant contributions to current and future population health. The health care system became more organized, technologically sophisticated, and costly. New tools to assess health and the burden of ill health, to improve the effectiveness of interventions, and to measure economic effects of alternative investments promise greater efficiency and effectiveness for public health. An increasingly fragmented public health infrastructure must confront unprecedented challenges including dramatic global population growth, increased aging of the population associated with enhanced longevity, and possible irreversible changes in key environmental health determinants.

Development of a health risk appraisal for the elderly (HRA-E).

The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire cover a comprehensive range of content domains relevant to health promotion in the elderly. The goal of the HRA-E system is to prevent functional decline. Samples of eligible subjects from the American Association of Retired Persons (AARP), a group practice, and a senior center were extended invitations to participate. Those responding affirmatively to the invitation were given a questionnaire and evaluation form. Each person who returned the questionnaire received his or her personal report and a second evaluation form. Four months after receiving their reports, respondents were questioned about behavior changes during the interim. Preliminary findings, based on 1895 respondents, indicate that nearly all participants found the questionnaire easy to complete and were pleased with its overall length. In addition, most participants read their reports, and many planned to take action, based on report recommendations. In the next phase of this project, the intent is to refine the questionnaire, extend the intervention protocols for longitudinal application, and evaluate its impact on health-related behaviors, medical care utilization, and functional decline.