Potential Exposures to Australian Bat Lyssavirus Notified in Queensland, Australia, 2009-2014.

BACKGROUND: Australian bat lyssavirus (ABLV) belongs to the genus Lyssavirus which also includes classic rabies virus and the European lyssaviruses. To date, the only three known human ABLV cases, all fatal, have been reported from Queensland, Australia. ABLV is widely distributed in Australian bats, and any bite or scratch from an Australian bat is considered a potential exposure to ABLV. METHODOLOGY/PRINCIPAL FINDINGS: Potential exposure to ABLV has been a notifiable condition in Queensland since 2005. We analysed notification data for potential exposures occurring between 2009 and 2014. There were 1,515 potential exposures to ABLV notified in Queensland, with an average annual notification rate of 5.6 per 100,000 population per year. The majority of notified individuals (96%) were potentially exposed to ABLV via bats, with a small number of cases potentially exposed via two ABLV infected horses and an ABLV infected human. The most common routes of potential exposure were through bat scratches (47%) or bites (37%), with less common routes being mucous membrane/broken skin exposure to bat saliva/brain tissue (2.2%). Intentional handling of bats by the general public was the major cause of potential exposures (56% of notifications). Examples of these potential exposures included people attempting to rescue bats caught in barbed wire fences/fruit tree netting, or attempting to remove bats from a home. Following potential exposures, 1,399 cases (92%) were recorded as having appropriate post-exposure prophylaxis (PEP) as defined in national guidelines, with the remainder having documentation of refusal or incomplete PEP. Up to a quarter of notifications occurred after two days from the potential exposure, but with some delays being more than three weeks. Of 393 bats available for testing during the reporting period, 20 (5.1%) had ABLV detected, including four species of megabats (all flying foxes) and one species of microbats (yellow-bellied sheathtail bat). CONCLUSIONS/SIGNIFICANCE: Public health strategies should address the strong motivation of some members of the public to help injured bats or bats in distress, by emphasising that their action may harm the bat and put themselves at risk of the fatal ABLV infection. Alternative messaging should include seeking advice from professional animal rescue groups, or in the event of human contact, public health units. Further efforts are required to ensure that when potential exposure occurs, timely reporting and appropriate post-exposure prophylaxis occur.

Australian bat lyssavirus: implications for public health.

Australian bat lyssavirus (ABLV) infection in humans is rare but fatal, with no proven effective therapy. ABLV infection can be prevented by administration of a post-exposure prophylaxis regimen of human rabies immunoglobulin and rabies vaccine. All Australian bats (flying foxes and microbats) should be considered to be carrying ABLV unless proven otherwise. Any bat-related injury (bite, scratch or mucosal exposure to bat saliva or neural tissue) should be notified immediately to the relevant public health unit - no matter how small the injury or how long ago it occurred. Human-to-human transmission of ABLV has not been reported but is theoretically possible. Standard infection control precautions should be employed when managing patients with suspected or confirmed ABLV infection.

Preventing Australian bat lyssavirus: community knowledge and risk perception of bats in South East Queensland.

OBJECTIVES: Ongoing potential exposure of members of the public to Australian bat lyssavirus (ABLV) in South East Queensland, Australia, prompted investigation of community knowledge, risk perception, and intention to handle bats to inform future prevention efforts. METHODS: After pilot testing, a computer-assisted telephone survey of a representative sample of 700 adults without previous potential exposure to ABLV was undertaken in the defined geographic region. RESULTS: Twenty-four percent of eligible contacted individuals participated. Basic knowledge of bats and ABLV was generally high, with 65% of participants answering nine or more of 12 knowledge questions correctly. The perceived risk that bats pose to human health was also high, with 93% indicating some degree of risk. Although 88% of participants indicated they would handle bats in one or more of the scripted situations, overall intention to handle bats was low, with 59% indicating they would handle a bat in four or less of the 12 scenarios. Younger males with lower risk perception of bats most frequently indicated intention to handle bats in varying situations. Knowledge score was not associated with intention to handle bats on multivariate modeling. CONCLUSIONS: Future public health prevention efforts, both in Australia and overseas, should focus further on conveying the risk to humans and to bats when nontrained, nonvaccinated people attempt to handle bats rather than attempting to purely convey knowledge about bats and ABLV or rabies. Suitable alternative measures to handling should be included. Younger adult males are a particular target group for prevention efforts.

Acellular pertussis vaccine effectiveness for children during the 2009-2010 pertussis epidemic in Queensland.

UNLABELLED: OBJECTIVES To assess the effectiveness of three, four and five doses of acellular pertussis vaccine against pertussis notification for children aged 1 - < 4 years and 5 - < 12 years, and the effectiveness of three doses of acellular pertussis vaccine against pertussis hospitalisation for children aged 1 - < 4 years. DESIGN, SETTING AND PARTICIPANTS: A population-based retrospective study of children aged 1 - < 12 years residing in Queensland, Australia, during 2009 and 2010. Routinely collected notification, hospitalisation, testing and vaccination data were used to describe notification rates and testing patterns and to assess vaccine effectiveness (VE) by the screening method. MAIN OUTCOME MEASURES: VE against pertussis notification for children aged 1 - < 4 years and 5 - < 12 years, by birth year, and VE against pertussis hospitalisation for children aged 1 - < 4 years. RESULTS: 1961 notifications and 29 hospitalisations were included in the VE calculations. VE point estimates against pertussis notification and hospitalisation in children aged 1 - < 4 years were similar in 2009 and 2010, and ranged between 83.5% and 89.4%. VE point estimates against notification among children aged 5 - < 12 years were between 71.2% and 87.7% in 2009, and between 34.7% and 70.3% in 2010. The numbers of pertussis tests performed for children, particularly polymerase chain reaction (PCR) tests, increased between 2009 and 2010. CONCLUSIONS: Acellular pertussis vaccine provided good protection within the first years of priming, but this waned as age increased. Changes in pertussis testing behaviour, because of increases in PCR use and awareness, may have contributed to increased pertussis notification rates and lower estimates of VE against notification owing to identification of milder disease.

Enhanced surveillance for gonorrhoea in two diverse settings in Queensland in the 2000s: comparative epidemiology and selected management outcomes.

Gonorrhoea is an important sexually transmitted notifiable condition. This paper describes findings from two gonorrhoea enhanced surveillance programs operating during the 2000s in Queensland: one in the remote Torres and Northern Peninsula Area (T&NPA); the other in an urban region. The overall response rate in the T&NPA (2006-2011) was 82% (723 of 879), and in Brisbane Southside and West Moreton (BSWM) (2003-2011), it was 62% (1,494 of 2,401 notifications). In the T&NPA, cases were young (80% <25 years), Indigenous (97%) and 44% were male. In the BSWM, cases were predominantly male (76%), non-Indigenous (92%) and 42% were aged less than 25 years. Co-infection with chlamydia was found in 54% of males and 60% of females in the Torres, and in 18% of males and 35% of females in the BSWM. In the BSWM 35% of the men without a syphilis test recorded had reported sexual contact with men; similarly 34% of the men without an HIV test recorded had reported sexual contact with men. Compliance with recommended treatment (ceftriaxone) was greater than 90% in all years except 2008 (84%) in the T&NPA. Treatment compliance increased significantly, from 40% in 2003 to 84.4% in 2011 (P<0.0001) in the BSWM cohort. The proportion of contacts with a documented treatment date increased significantly in the T&NPA from 56% in 2009 to 76% in 2011 (P=0.019), after a system for follow-up with the clinician became routine. Gonorrhoea epidemiology and management challenges vary across Queensland populations. Enhanced surveillance allows public health authorities to monitor epidemiology and reminds clinicians to prioritise effective sexually transmitted infection treatment for their clients.

Hendra virus: an emerging paramyxovirus in Australia.

Hendra virus, first identified in 1994 in Queensland, is an emerging zoonotic pathogen gaining importance in Australia because a growing number of infections are reported in horses and people. The virus, a member of the family Paramyxoviridae (genus Henipavirus), is transmitted to horses by pteropid bats (fruit bats or flying foxes), with human infection a result of direct contact with infected horses. Case-fatality rate is high in both horses and people, and so far, more than 60 horses and four people have died from Hendra virus infection in Australia. Human infection is characterised by an acute encephalitic syndrome or relapsing encephalitis, for which no effective treatment is currently available. Recent identification of Hendra virus infection in a domestic animal outside the laboratory setting, and the large range of pteropid bats in Australia, underpins the potential of this virus to cause greater morbidity and mortality in both rural and urban populations and its importance to both veterinary and human health. Attempts at treatment with ribavirin and chloroquine have been unsuccessful. Education, hygiene, and infection control measures have hitherto been the mainstay of prevention, while access to monoclonal antibody treatment and development of an animal vaccine offer further opportunities for disease prevention and control.

Potential exposure to Australian bat lyssavirus in south east Queensland: what has changed in 12 years?

Public health measures have been targeting potential exposure to Australian bat lyssavirus (ABLV) since the first recognised human cases, more than a decade ago. The effect of these measures on the epidemiology of notifications of potential exposure has not been investigated since 2003. Trends in notifications of potential exposure to ABLV reported to the Brisbane Southside Public Health Unit between November 1996 and October 2008 were examined. During the study period notification rates declined among all population groups and potential exposures were notified more promptly. The proportion of female notifications and the proportion of notifications from volunteer bat carers and their families and professional groups decreased over time. These changes over 12 years may indicate success of public health measures, under-reporting of potential exposure or both. Intentional handling of bats by untrained members of the public continues to be an important source of potential exposure to ABLV and requires a sustained public health response.

The impact of pre-departure screening and treatment on notifications of malaria in refugees in south-east Queensland.

This study aimed to investigate changes in the notification rate of malaria in refugees over a period of national policy change on pre-departure screening. Notifying clinicians were interviewed to complete a standardised enhanced surveillance form. A decline in refugee malaria notifications occurred after implementation of a national policy to offer pre-departure malaria screening and treatment as necessary to refugees. Surveillance data support the benefit of offering pre-departure screening and treatment as necessary to refugees.

An outbreak of shiga toxin-producing Escherichia coli infection associated with a school camp.

In November 2008, a case of Shiga toxin-producing Escherichia coli (STEC) infection was reported to the Brisbane Southside Public Health Unit. The case had participated in a school camp. Subsequent investigations confirmed 5 other asymptomatic cases among camp attendees or visitors. Examination of the camp water supply identified that most water sources had high levels of E. coli and did not meet the Australian Drinking Water Guidelines with STEC isolated from 2 water sources. This outbreak highlights the emerging issue of asymptomatic carriage of STEC and the importance of thorough maintenance and attention to drinking water supplies in the rural and school camp setting.

Outbreaks of Salmonella Typhimurium phage type 197 of multiple genotypes linked to an egg producer.

This paper describes outbreaks of Salmonella Typhimurium phage type 197 (STm197) linked to eggs from the farm of a single egg producer. Epidemiological and microbiological investigations (genotyping by multiple locus variable number tandem repeats analysis [MLVA]) identified outbreaks of STm197 with the same or closely-related MLVA profiles in a series of restaurants across Brisbane over 2 months. Environmental health investigations revealed that these restaurants were supplied with eggs from the same egg producer and that cross-contamination may have contributed to the outbreak. Environmental swabs taken from restaurant kitchens and the farm of the egg producer identified a number of salmonellas including STm197, many with MLVA profiles matching or closely related to the human strains from outbreak cases. A case-to-case comparison study showed a significant association between illness with 1 MLVA type and attending a restaurant during the 5 days before onset of illness (odds ratio [OR] 8.1, 95% confidence interval [CI] 1.8, 35.4). MLVA has become a valuable tool for S. Typhimurium surveillance and outbreak investigation. This outbreak further justifies the Commonwealth Government's decision to develop a draft national primary production and processing standard for eggs and egg products to address food safety risks posed by cracked and dirty eggs.

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.

Two years of enhanced surveillance of sexually-transmitted chlamydia in South East Queensland.

The National Sexually Transmissible Infections Strategy 2005-2008, released in 2005, lists exploring and addressing barriers to enhanced data collection for chlamydia surveillance among the actions required for chlamydia control and prevention. This study describes a method of enhanced surveillance of sexually transmitted chlamydia notifications undertaken in South East Queensland, and the epidemiology and management of chlamydia over the study period. The service providers of a random sample of chlamydia notifications meeting preset inclusion criteria were faxed an information package and questionnaire. Telephone follow-up was initiated for non-responders. The first year of data were compared to the second year of data. The overall response rate was 93.2 per cent. Males were more likely than females to be tested because of symptoms in the first year of the study, but not the second. Females were 5.2 times (95% CI 2.43, 10.91) more likely to be screened on the suggestion of the service provider than males. The positivity rate among those tested for sexually transmitted chlamydia increased across the study period. An information package and questionnaire faxed to notifying clinicians is a simple and effective means of conducting enhanced surveillance of sexually transmitted chlamydia. An increase in the screening of males may be contributing to the increasing rate of notifications. An increasing positivity rate among all those tested for chlamydia may be due to more prevalent disease, or more focused testing of high risk groups.

The public health implications of a sporadic case of culture-proven Legionnaires' disease.

Legionella pneumophila is an important cause of community-acquired pneumonia. Domestic sources of infection have been increasingly recognised among community-acquired cases. This report summarises the public health investigations and management of a single community-acquired case of Legionnaires' disease in Queensland, commenced in the context of a suspected outbreak. Legionellae from the case's domestic water supply were indistinguishable from the clinical isolate. The implications for future investigation of sporadic cases are discussed.

Trends in potential exposure to Australian bat lyssavirus in South East Queensland, 1996 to 2003.

This study examined trends in notifications of potential exposure to Australian bat lyssavirus reported to the Brisbane Southside Public Health Unit, Australia between 1 November 1996 and 31 January 2003. Notification rates declined among all population groups and potential exposures were notified more promptly. Concern exists regarding possible under-reporting of potential exposure to Australian bat lyssavirus especially among volunteer bat carers.