Protocol for mapping the heterogeneous dendritic cell network across the murine tissue landscape via high-dimensional flow cytometry.

Dendritic cells (DCs) populate nearly all tissues and represent the central orchestrators of immunity. Here, we present a protocol for the mild but efficient preparation of single-cell suspensions from multiple murine tissues and the downstream analysis of the DC network via high-parameter flow cytometry. Additionally, we provide evaluation strategies that facilitate the stringent separation of the DC family from other myeloid cells, particularly macrophages and monocytes, and include an in-depth assessment of DC-intrinsic heterogeneity. For complete details on the use and execution of this protocol, please refer to Amon et al.1.

Engaging with culturally and linguistically diverse communities during a COVID-19 outbreak: a NSW Health interagency public health campaign.

OBJECTIVES: To report on efforts to engage culturally and linguistically diverse (CALD) communities to provide an effective and appropriate public health response to coronavirus disease 2019 (COVID-19), and to report how a tailored, interagency response addressing specific community needs was rapidly rolled out in a pandemic setting. Type of program or service: A novel, rapid, interagency public health campaign led by NSW Health and Sydney Local Health District (SLHD) was established in response to a local outbreak of COVID-19 in the multicultural suburb of Lakemba, in Sydney's south west, in October 2020. The public education and testing campaign was run over 2 weeks and involved in-language development of COVID-19 resources, establishment of a local pop-up testing clinic, 'COVID Safe' inspections of local businesses, engagement with local community leaders and distribution of written and verbal in-language education by cultural support workers. METHODS: We describe the campaign impact in engaging CALD communities in a pandemic setting, including the impact on COVID-19 testing rates, identification of close contacts and engagement with local businesses, as well as learnings from a multi-agency debrief at the conclusion of the campaign. RESULTS: There was an 87% increase in COVID-19 testing in the local area during the campaign. Despite 890 close contacts being identified during the outbreak, only 17 cases of COVID-19 were identified. Regulators visited 127 local businesses to provide 'COVID Safe' education and advice. SLHD cultural support personnel worked with the community to provide verbal and written in-language resources and education. Community and religious leaders were engaged to act as 'COVID Safe' champions. LESSONS LEARNT: A key to the success of the Lakemba campaign was the rapid, multi-agency collaboration between NSW Health, SLHD and regulators. An important lesson from the COVID-19 pandemic has been the importance of providing a flexible, tailored public health response that reacts to the target community's needs. This is even more important in our CALD communities, where mainstream health messages are insufficient. The Lakemba campaign is an example of how such a response can be undertaken rapidly while maintaining the key principles of community partnership, engagement and equity.

Understanding barriers to effective management of influenza outbreaks by residential aged care facilities.

OBJECTIVE: To identify the perceived barriers to the implementation of the Australian national guidelines on influenza outbreak management with Sydney Local Health District (SLHD) residential aged care facility (RACF) staff. METHODS: All SLHD RACFs were invited to participate in a telephone interview. The questionnaire collected information about demographic characteristics and participants' level of agreement with statements regarding perceived barriers to implementing the national guidelines for influenza outbreak management. RESULTS: Twenty-eight of 61 RACFs (46%) participated in the study. The three most common barriers identified were as follows: scepticism towards staff influenza vaccination (n = 13, 46%); the effort required to read the national guidelines (n = 11, 39%); and lack of infrastructure to physically separate residents during an outbreak (n = 10, 36%). CONCLUSIONS: We recommend implementing and evaluating programmes which address misconceptions about influenza vaccination amongst RACF staff. Further, all RACF staff, including care staff, should receive targeted education on the role of infection control in influenza outbreak management.

Communicating with the public about the risks of naturally occurring asbestos.

OBJECTIVES: To explore the application of evidence based risk communication to community messaging about naturally occurring asbestos (NOA). Type of program or service: Risk communication education about NOA. METHODS: We apply principles and determinants of risk communication to the topic of NOA. RESULTS: We emphasise the importance of erring on the side of transparency and trust, even when officials may be concerned about inadvertently heightening needless public concern. We offer a range of practical suggestions for how to lower public concern and outrage relating to the issue of NOA when it arises in local contexts. LESSONS LEARNT: Public concern and outrage can be reduced by favouring early and frequent communication, awareness and use of the 'rule of threes' in media communication, open acknowledgement of uncertainty, prioritising response to community concern above narrow myth-busting strategies, and supporting community action.

A review of recommendations on the safe and effective use of topical mosquito repellents.

Mosquito-borne disease is an annual problem in Australia, with endemic pathogens such as Ross River virus infecting thousands of people each year. The recent emergence of Zika virus in South America and the Pacific, together with ongoing outbreaks of dengue viruses in Southeast Asia, generated great community interest in the most effective strategies to avoid mosquito bites. Large-scale mosquito control programs are not common in Australia and are limited in New South Wales (NSW). The use of topical insect repellents is a key recommendation by health authorities to prevent mosquito-borne disease. All products sold in Australia purporting to repel mosquitoes must be registered with the Australian Pesticides and Veterinary Medicines Authority. Despite around 100 commercial products registered as repelling mosquitoes, there are relatively few active ingredients used across these formulations. The most common are diethyltoluamide (DEET), picaridin, p-menthane-3,8-diol (PMD) and a range of plant-derived products (e.g. melaleuca, eucalyptus, citronella oils). Research has shown that each of these active ingredients varies in the duration of protection provided against biting mosquitoes. Recommendations by health authorities are informed by this research, but inconsistencies between recommendations and available repellent formulations and their concentration of active ingredients can cause confusion in the community. There are conflicts between the data resulting from scholarly research, marketing promotion by manufacturers and recommendations provided by overseas health authorities. A review was undertaken of NSW Health's current recommendations on choosing and using insect repellents, taking into consideration recent research and currently registered topical repellents.

A systematic review of the health risks from passive exposure to electronic cigarette vapour.

OBJECTIVES: Electronic cigarettes (ECs) have recently become popular around the world, and their safety is being widely discussed in the scientific literature. Previous studies have examined the chemicals in e-liquids and vapour, and demonstrated that the aerosol from ECs can contain toxic chemicals that are harmful to health. However, little is known about the potential adverse health effects of passive exposure to EC vapour. The aim of this paper is to summarise and review all studies that have examined potential adverse health effects of passive exposure from inhaling EC vapour. Specifically, our research objectives were to describe 1) the absolute impact of passive exposure from inhaling vapour when compared with background, and 2) the relative impact of passive exposure from inhaling vapour when compared with passive exposure from inhaling conventional cigarette smoke. METHODS: A systematic review was conducted to identify articles published from 1996 to 10 September 2015 from Embase, Ovid MEDLINE and PreMEDLINE. Papers eligible for inclusion had to be written in English, study health effects from passive exposure to EC vapour in animals or humans, test or analyse the EC vapour directly or in the ambient air (with an inference made about passive or second-hand vapour exposure). The review was conducted using the PRISMA guidelines for reporting on systematic reviews. We identified 312 studies, and 16 were relevant for inclusion in our review. RESULTS: A variety of study designs were used to investigate potential health risks from passive exposure to EC vapour. These included direct exposure studies involving humans and animals, and indirect exposure studies using volunteer EC users or smoking machines. The majority of studies determined that passive exposure to EC vapour may pose a health risk to bystanders. All papers encountered a number of limitations. CONCLUSION: Our review found that the absolute impact from passive exposure to EC vapour has the potential to lead to adverse health effects. The risk from being passively exposed to EC vapour is likely to be less than the risk from passive exposure to conventional cigarette smoke.

Workplace nutrition and physical activity promotion at Liverpool Hospital.

ISSUE ADDRESSED: The workplace is an effective way of reaching large numbers of adults during working hours, and increasing physical activity, promoting healthy eating or both.This paper evaluates the effectiveness of a workplace intervention in a hospital setting in Australia. METHODS: A 12-week program was conducted with 399 employees of Liverpool Hospital, NSW, to increase physical activity and healthy eating. Participants received a pedometer, healthy cookbook, water bottle, sandwich container and Measure Up campaign resources. A web-based survey was completed at baseline and follow up. RESULTS: Sixty-six per cent of participants completed the follow-up survey. Those that did not complete the follow-up evaluation were not significantly different to completers. Respondents reported a significant increase in median minutes walked to 200 minutes and in vigorous physical activity to 85 minutes over the previous week. Participants consuming adequate fruit and vegetable per day increased by 24.7% and 22.7%, respectively. More participants also consumed breakfast on seven days of the week and consumed one or more litres of water per day. CONCLUSIONS: The intervention was successful for the participants. With some improvements to processes, we encourage further similar programs with the health sector workforce.

Hendra virus: what do we know?

Hendra virus infection is an emerging infectious disease that is not well understood. Most cases of Hendra virus infection have occurred in Queensland, with one case in a horse in NSW. Hendra virus infection has a high mortality rate in horses and humans and as cases could occur anywhere in Australia it is important to be ready for prompt action should an outbreak occur in NSW. This paper: reviews the current knowledge on Hendra virus infection including methods for preventing the disease; explains the animal health and human health response for an outbreak within NSW; and discusses possible future avenues for post-exposure prophylaxis and prevention by vaccination.