Satisfactory immune response following anaphylaxis to PCECV facilitated by the use of steroids and antihistamines.

INTRODUCTION: Rabies is fatal and can cause almost certain mortality in animals and humans. Effective post-exposure prophylaxis (PEP) using the rabies vaccine remains the cornerstone for preventing disease in humans. We present the first reported case of supporting the live purified-chick-embryo-cell rabies vaccine(PCECV) administration with prophylactic high-dose corticosteroids. CASE: A 39-year-old female was at high-risk of developing rabies-like disease following a bat bite. She was commenced on PEP using PCECV. Our patient developed an anaphylactic reaction with bronchospasm and a rash following her 2nd PCECV dose. Consequently, she received 2 days of loratadine and high-dose prednisolone prior to her final vaccination. During this administration in the emergency department, our patient completed the final PCECV dose. At a two-week follow-up, our patient had no evidence of rabies and had adequate viral neutralizing antibody levels detectable on serology. DISCUSSION: Type 1 hypersensitivity reactions to PCECV are rare. Only 20 anaphylactic cases have been reported from a total of 1.1million administered doses over 8 years. Individuals at higher risk of anaphylaxis include those with a prior history of allergy to either egg white, gelatin, milk, penicillin, bee venom, or beef products. Administering high dose prophylactic corticosteroids prior to vaccination can potentially induce immune tolerance and minimize subsequent risks of hypersensitivity reactions. However, data relating to its use is extremely limited to only animal and limited human case-report data from other vaccines. CONCLUSION: We propose an alternative option which will require further research to manage vaccine-related anaphylaxis where immunization is an essential prophylactic requirement with the support of an immunologist and careful monitoring in an appropriate environment.

Modified measles with an atypical presentation

We report symptomatic confirmed modified measles infection in a person with one documented MMR (measles, mumps, rubella) vaccination and travel to Indonesia. No secondary cases were identified, consistent with other case reports of modified measles infection. The infectivity of modified measles for contact tracing requirements requires further elucidation.

Mass prophylaxis in an outbreak of invasive group A streptococcal disease in a residential aged care facility

In September 2016, an invasive group A streptococcal disease outbreak occurred among residents of a residential aged care facility. An expert advisory group recommended mass prophylaxis for residents and staff in addition to strict infection control practices to prevent further spread. Whole genome sequencing confirmed the cases were related.

An outbreak of Q fever associated with parturient cat exposure at an animal refuge and veterinary clinic in southeast Queensland.

OBJECTIVE: To determine the source of a Q fever outbreak in humans at an animal refuge and veterinary clinic in southeast Queensland from October to December 2016. METHODS: Case interviews and a retrospective cohort study of animal refuge and veterinary clinic staff using a self-administered questionnaire related to clinical history of Q fever, Q fever vaccination status and workplace activities during the exposure period. RESULTS: Seven cases (six confirmed, one probable) were identified. Forty-three questionnaires were completed (92% response rate). Workplace activities associated with the greatest risk of illness were the disposal of deceased cats or dogs (RR, 14.0; 95%CI, 1.9-104.1) and participating in euthanasia of cats or dogs (RR, 4.6; 95%CI, 1.3-16.9). Five feline birthing events occurred at the animal refuge from 25 September to 19 October 2016, each with subsequent euthanasia of the queen cat and litter. All cases had likely exposure to a specific queen cat and her litter that were euthanised the same day as the birthing event. CONCLUSIONS: A parturient cat was the most likely source of the outbreak. Implications for public health: Occupational groups and others with regular exposure to feline or canine parturient products should receive Q fever vaccine.

Mild Illness during Outbreak of Shiga Toxin-Producing Escherichia coli O157 Infections Associated with Agricultural Show, Australia.

During a large outbreak of Shiga toxin-producing Escherichia coli illness associated with an agricultural show in Australia, we used whole-genome sequencing to detect an IS1203v insertion in the Shiga toxin 2c subunit A gene of Shiga toxin-producing E. coli. Our study showed that clinical illness was mild, and hemolytic uremic syndrome was not detected.

Bordetella pertussis PCR positivity, following onset of illness in children under 5 years of age.

Bordetella pertussis is a significant cause of respiratory illness and an ongoing public health problem. Pertussis polymerase chain reaction (PCR) testing has been widely utilised since 2001, especially in infants. Uncertainty exists as to how long PCR remains positive following symptom onset. Further information on the time frame for pertussis PCR testing would assist diagnosis, epidemiological research and disease control. The Brisbane Southside Population Health Unit (BSPHU) conducted a retrospective analysis of enhanced surveillance data from pertussis notifications between January 2001 and December 2005, in children less than 5 years of age, in the BSPHU reporting area with the aim to determine the possible range of duration of Bordetella pertussis PCR, from symptom onset for this age group. Of 1,826 pertussis notifications to BSPHU between January 2001 and December 2005, 155 (8.5%) were children under 5 years of age, with 115 pertussis PCR positive results. Analysis indicated a range of PCR positivity from day one to day 31 from the onset of catarrhal symptoms with most (84%) being within 21 days from onset of catarrhal symptoms. The range of PCR positivity following onset of paroxysmal cough was from day one to day 38 with most (89%) being within 14 days from the onset of paroxysmal cough. This review of pertussis PCR data in young children showed that PCR positive results generally mirrored the understood length of infectivity with regard to both catarrhal symptoms and paroxysmal cough; namely that PCR positive results were obtained at least 21 days following onset of catarrhal symptoms and at least 14 days following onset of paroxysmal cough.

"The dust hasn't settled yet": the National Q fever Management Program, missed opportunities for vaccination and community exposures.

AIMS: To determine the proportion of notifiable cases of Q fever attributable to occupational and community exposures and to identify missed opportunities for Q fever vaccination in notifications of occupational exposures. METHODS: A review of Q fever notifications to the BSPHU from January 2000 to September 2006 was undertaken. Notifications were categorised according to probable exposure source. Occupational exposures were further categorised according to reported past exposure to Q fever and Q fever vaccination status. RESULTS: One hundred and ninety-one Q fever notifications were identified, with occupational exposure reported in 106 cases and community exposure reported in 69 cases. In the occupational exposures, 76 cases (71%) were not vaccinated, 15 (14%) reported past exposure to Q fever and eight reported vaccination prior to illness onset, but vaccination status could not be independently verified. Community acquired Q fever was most commonly attributed to living or working near a high-risk industry (26, 38%), incidental exposures such as farm visits, or attending sale yards (27, 39%). CONCLUSIONS: Occupationally acquired cases of Q fever continue to be reported in significant numbers and opportunities for vaccination are being missed. There is an ongoing need to ensure that all employees in high-risk industries are screened and vaccinated. The proportion of community acquired notifications of Q fever has increased since the National Q fever Management Program started, commensurate with the decline in occupationally acquired cases. These proportions may be expected to change with the cessation of the program in Queensland in December 2006.

Observations on managing an outbreak of influenza A infection in an aged care facility.

Influenza outbreaks in aged care facilities (ACFs) can be associated with high morbidity and mortality. National guidance includes the use of antiviral medication for residents and staff and other measures to prevent serious health outcomes. An outbreak of influenza in an ACF was reported to the Brisbane Southside Population Health Unit (BSPHU) on 10 August 2007. The BSPHU assisted the ACF and local general practitioners in the provision of oseltamivir to staff and residents on 11 August 2007. The onset of illness in the last case was 13 August 2007. Antiviral prophylaxis was ceased and the outbreak declared over on 22 August 2007. This paper describes some of the practical issues encountered in the public health response in this setting. Vaccination of ACF residents and staff remains the key preventive strategy for the future.

Early management of meningococcal disease--do attitudes of GPs influence practice?

BACKGROUND: Survival from early meningococcal disease might be improved if general practitioners followed guidelines by immediately administering parenteral antibiotics (before hospital referral). METHODS: Structured telephone interviews with 20 GPs who had previously treated meningococcal cases. RESULTS: General practitioners knew guideline recommendations for early management of meningococcal disease: early parenteral antibiotics would be given by about half the GPs entertaining a diagnosis of meningococcal infection. Barriers to immediate treatment were: diagnostic uncertainty, regarding the case as nonurgent, and practising close to a hospital. DISCUSSION: Diagnosing meningococcal disease is difficult in general practice. Early antibiotic administration for suspected cases is appropriate even in close proximity to referral hospitals.