Public health management of increased incidence of meningococcal disease in the Australian Capital Territory: 2003 to 2004.

This paper describes a sudden increase of meningococcal notifications in the Australian Capital Territory within a 3 month period, and the public health strategies used to manage it. There were 15 cases of meningococcal disease notified to the Communicable Disease Control (CDC) section, Australian Capital Territory Health (ACT Health), between 6 November 2003 and 5 February 2004. This was much higher than the annual average of 6 cases. The cases were notified in 2 clusters. The first cluster of 8 cases, all serogroup C, was notified between 6 November to 8 December 2003. Seven of these cases had an identical phenotype C:2a:P1.4 suggesting a common source. The second cluster of 7 cases was notified between 30 December 2003 and 5 February 2004. Of these, 5 were serogroup B, 1 was serogroup W-135 and 1 was serogroup C, whose phenotype (C:2a:P1.4) was identical to the phenotype of the first cluster of serogroup C cases. Phenotypes were not available for the serogroup B cases. There were 4 main interventions developed to manage the increased incidence based on the epidemiology of the cases; these were implemented concurrently. Factors that supported investigation and management were good surveillance systems, quick turnover of laboratory tests, regular communication with relevant health agencies and maintaining public awareness. As the number of cases notified was much higher than the annual average, the possibility of a community outbreak was considered. The Guidelines for the Early Clinical and Public Health Management of Meningococcal Disease in Australia (national guidelines) were consulted to determine whether there was an outbreak and the influence this had on management is also discussed.

An evaluation of public health interventions during a pertussis outbreak in the ACT, 2003.

OBJECTIVE: To assess whether issuing information alerts increased the proportion of pertussis cases notified within the 21-day infectious period during a pertussis outbreak in the Australian Capital Territory (ACT) in 2003. METHOD: The study included all persons resident in the ACT for whom a notification of pertussis was received with onset of disease between 1 March and 31 December 2003. Cases notified within 21 days of onset were called 'early notifications'. The effectiveness of information alerts was assessed by comparing the proportion of early notifications before and after each alert and over the course of the outbreak. MAIN OUTCOME MEASURE: The proportion of early notifications. RESULTS: The proportion of early notifications ranged from 1/36 (2.7%) prior to the first intervention to 29/52 (55.7%) after the final intervention (p < 0.001). CONCLUSIONS: This study supports the hypothesis that information alerts by ACT Health increase the proportion of cases notified within the infectious period of 21 days. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Early diagnosis of pertussis cases (within the infectious period) has the potential to limit transmission and protect susceptible infants.

The injection of methadone syrup in New South Wales: patterns of use and increased harm after partial banning of injecting equipment.

OBJECTIVE: To describe methadone injectors and the risk practices associated with injecting methadone in New South Wales, Australia. To assess the impact on injecting drug use and risk behaviour of the withdrawal of methadone injecting equipment from government-funded needle and syringe programs. METHOD: Cross-sectional survey, conducted in 1999, of 206 people who had injected methadone at least once in the previous month. Participants were from Central Sydney, West Sydney and rural New South Wales. RESULTS: Of participants who had injected both methadone and other drugs in the previous month (n=162), significantly more reused their methadone injecting equipment compared with those who reused their other drug injecting equipment (60% vs. 28%, p<0.01). There was no significant difference in terms of sharing injecting equipment, with 19% reporting sharing methadone injecting equipment and 14% sharing other drug injecting equipment. However, women were more likely than men to share methadone injecting equipment. Over half of the participants had accessed diverted methadone and a substantial minority reported the use of public spaces for injecting methadone. CONCLUSIONS: Our results suggest that the current policy has led to increased reuse of equipment for injecting methadone. IMPLICATIONS: A range of other possible policy options, such as closer monitoring and dilution of take-home doses, increasing oral doses and implementing trials of injected methadone, may assist to reduce the prevalence of methadone syrup injection and related harms.

AIDS in Papua New Guinea: situation in the Pacific.

There has long been reason to anticipate a major heterosexual epidemic of acquired immunodeficiency syndrome (AIDS) in Papua New Guinea (PNG) and probably in the rest of Melanesia. From the social and behavioural perspectives, Melanesia is strikingly similar to other areas of the world with serious epidemics of AIDS. High levels of other sexually transmitted infections indicate behaviour patterns that would also facilitate transmission of human immunodeficiency virus (HIV) and presence of cofactors for HIV infection. Low levels of male circumcision parallel the situation in other epidemic areas. Near-parity by sex in cases reported so far in PNG is evidence that primary infection is largely heterosexual. The late start of a major epidemic in PNG can probably be attributed to: (a) the relatively small aggregation of people in urban centres (even Port Moresby has only one-quarter of a million people); (b) a highway system that does not network across the whole country; (c) limited size of the organized commercial sex sector; and (d) possibly low level of chancroid to act as a cofactor. The situation is now changing. Over the last seven years, HIV infection, probably the highest in Port Moresby and mostly measured there, has been rising by about 60% per annum. This rise is genuine and, if sustained, would infect 10% of the adult population of PNG in little more than 12 years. Some countries of sub-Saharan Africa have witnessed such exponential rises.