Tuberculosis in elderly Australians: a 10-year retrospective review.

Objective: This report describes the epidemiology of active tuberculosis (TB) in elderly Australians (≥ 65 years) with analysis of the factors associated with TB disease and successful treatment outcomes. Methods: A retrospective study of TB cases reported to the National Notifiable Diseases Surveillance System over a 10-year period from 2011 to 2020 was conducted. Cases were stratified by sex, age, risk factors, drug resistance, treatment type and outcome. Notification rates and incidence rate ratios with 95% confidence intervals were calculated and factors associated with treatment success analysed using multivariable logistic regression. Results: A total of 2231 TB cases among elderly people were reported over the study period, with a 10-year mean incidence rate of 6.2 per 100 000 population. The median age of cases was 75 years (range 65-100 years); most were male (65%) and born overseas (85%). Multivariable analysis found that successful treatment outcome was strongly associated with younger age, while unsuccessful treatment outcome was associated with being diagnosed within the first 2 years of arrival in Australia, ever having resided in an aged-care facility and resistance to fluoroquinolones. Discussion: Compared to other low-incidence settings in the Western Pacific Region, TB incidence in elderly people is low and stable in Australia, with most cases occurring among recent migrants from TB-endemic settings. Continued efforts to reduce TB importation and address migrant health, especially among elderly people, are important.

Cohorting children in a childcare setting: a strategy to reduce SARS-CoV-2 Delta transmission, August-September 2021.

Background: Childcare centres can be high-risk settings for SARS-CoV-2 transmission due to age, vaccination status, and infection control challenges. We describe the epidemiology and clinical characteristics of a childcare SARS-CoV-2 Delta outbreak. When the outbreak occurred, little was known about the transmission dynamics of SARS-CoV-2 ancestral and Delta strains among children. Vaccinations for coronavirus disease 2019 (COVID-19) were not mandatory for childcare staff, and children (< 12 years) were ineligible. Methods: A retrospective cohort design of childcare attendees was used to investigate age-cohorts exposure and transmission of SARS-CoV-2. We defined a case as a person who tested positive to SARS-CoV-2; we defined a close contact as a person who attended the childcare during 16-20 August 2021. Childcare centre exposures were defined by three cohorts: younger children (0-< 2.5 years) with designated staff; older children (2.5-5 years) with designated staff; and a staff-only group that moved between both age cohorts. We calculated the number and proportion of SARS-CoV-2 Delta infections, symptom profile and severity in children and adults, secondary attack rates, and relative risks (RR) with 95% confidence intervals (CIs) to compare age-cohort exposures and SARS-CoV-2 infection. Results: There were 38 outbreak cases that tested positive to SARS-CoV-2 Delta infection, comprising one primary case, 11 childcare attendees and 26 household members. Child attendees were in two non-interacting groups, 0-< 2.5 years and 2.5-5 years, with designated staff, separate rooms, and independent ventilation. The greatest risk of infection to childcare attendees was in the < 2.5 years age cohort which had a secondary attack rate of 41% and were five times more likely to be infected with SARS-CoV-2 (RR = 5.73; 95% CI: 1.37-23.86; p ≤ 0.01). No identified transmission (n = 0/21) occurred in the ≥ 2.5 years age cohort. Conclusion: Young children play an important role in SARS-CoV-2 Delta transmission to their peers and staff in childcare settings and to household members. Cohorting may be effective at limiting the propagation of SARS-CoV-2 in childcare settings. These findings highlight a need for multi-layered mitigation strategies and implementation support to manage respiratory infection control challenges at childcares. If prevention measures are not in place, this may facilitate ongoing transmission in these settings and into the broader community.