Case study: breakthrough mpox infection in Aotearoa New Zealand and Australia after completed two-dose course of subcutaneous modified vaccinia Ankara (MVA-BN) vaccines.

BACKGROUND: In August 2022, in response to a global mpox outbreak, the World Health Organization recommended the Vaccinia vaccination for at-risk people. METHODS: Case study. RESULTS: We describe a case of a HIV-negative bisexual man who developed a symptomatic mpox infection 13weeks after completing a two-dose course of subcutaneous third-generation modified vaccinia Ankara vaccines. The case likely acquired his mpox infection in the USA; was diagnosed in Aotearoa, New Zealand; and was followed-up in Australia, as he was actively travelling during his infection. CONCLUSIONS: This case highlights the importance of maintaining clinical suspicion for mpox in people who present with consistent symptoms, even if they are fully vaccinated. Also, as he travelled around Aotearoa, New Zealand, and Australia during his infection, this case highlights how public health authorities and clinicians can cooperate across jurisdictional boundaries to support cases and minimise the risk of onward transmission.

Isolate independent molecular typing improves the yield of O typing of infections due to Shiga toxin producing Escherichia coli.

Molecular screening has increased detection of Shiga-toxin producing Escherichia coli (STEC). However, it is difficult to isolate the organism for epidemiological typing. We applied a molecular method for direct detection of nine O types from 110 stx positive faeces samples and compared the results with conventional isolate based methods. Using conventional methods 55/110 (50%) samples were O typed. Using the molecular method, 72/110 (65%) were O typed, including 23/38 (61%) culture negative samples. Combining both techniques typed 88/110 (80%) of samples. Molecular typing increased detection of O128 (2-25%, p<0.001), O26 (11-16%) O45 (0-6%) and O103 (1-6%) infections. Molecular typing of STEC direct from faecal samples improved O type yield; risk of bias in epidemiological and surveillance activities may be reduced by inclusion of culture independent typing methods.

Raising the bar: using program evaluation for quality improvement.

The Cancer Quality Council of Ontario has undertaken 3 programmatic reviews, in partnership with Cancer Care Ontario, to evaluate an emerging or existing program and to provide future directions. The reviews are a quality improvement tool consisting of an assessment of the program's current state, a critical appraisal, and an environmental scan in advance of an event where attendees hear best practices from jurisdictions and participate in a discussion leading to a set of recommendations for the program.

Community blood lead survey with emphasis on preschool children following lead dust pollution in Esperance, Western Australia.

OBJECTIVE: To assess the impact of airborne lead dust on blood lead levels in residents of Esperance, a regional Western Australian town, with particular reference to preschool children. METHODS: Following identification of significant airborne lead contamination, residents were notified that a blood lead clinic was available to all, with testing of preschool children encouraged. About 40% (333 children) of the preschool group and about 20% of the remaining population were tested. The main measures were blood lead levels, prevalence of elevated results and comparisons to other Western Australian surveys. RESULTS: In preschoolers, 2.1% (seven children) had blood lead levels exceeding the current 10 µg/dL level of concern. This was not significantly different to two previous community-based surveys elsewhere in Western Australia. However, at a lower cut-off of 5 µg/dL, the prevalence of elevated lead levels was 24.6%, significantly higher than children tested in a previous Western Australian survey. The prevalence of blood lead levels of 10 µg/dL or greater in adults was 1.3% (26 adults), not significantly different from a previous Western Australian survey. CONCLUSIONS: The prevalence of preschool children with blood lead levels exceeding the current level of concern was not significantly increased. However, the increased prevalence of children with lead levels at or above 5 µg/dL demonstrates exposure to lead dust pollution. IMPLICATIONS: This episode of lead dust contamination highlights the need for strict adherence to environmental controls and effective monitoring processes to ensure the prevention of future events.

Windblown lead carbonate as the main source of lead in blood of children from a seaside community: an example of local birds as "canaries in the mine".

BACKGROUND: In late 2006, the seaside community in Esperance, Western Australia, was alerted to thousands of native bird species dying. The source of the lead was thought to derive from the handling of Pb carbonate concentrate from the Magellan mine through the port of Esperance, begun in July 2005. Concern was expressed for the impact of this process on the community. OBJECTIVE: This study was designed to evaluate the source of Pb in blood of a random sample of the community using Pb isotope ratios. METHODS: The cohort comprised 49 children (48 < 5 years of age) along with 18 adults (> 20 years of age) with a bias toward higher blood lead (PbB) values to facilitate source identification. RESULTS: Mean PbB level of the children was 7.5 microg/dL (range, 1.5-25.7 microg/dL; n = 49; geometric mean, 6.6 microg/dL), with four children whose PbB was > 12 microg/dL. The isotopic data for blood samples lay around two distinct arrays. The blood of all children analyzed for Pb isotopes contained a contribution of Pb from the Magellan mine, which for young children ranged from 27% up to 93% (mean, 64%; median, 71%). Subtraction of the ore component gave a mean background PbB of 2.3 mug/dL. Several children whose PbB was > 9 microg/dL and most of the older subjects have complex sources of Pb. CONCLUSIONS: The death of the birds acted as a sentinel event; otherwise, the exposure of the community, arising from such a toxic form of Pb, could have been tragic. Isotopic data and mineralogic and particle size analyses indicate that, apart from the recognized pathway of Pb exposure by hand-to-mouth activity in children, the inhalation pathway could have been a significant contributor to PbB for some of the very young children and in some parents.