Pneumococcal disease in South Australia: vaccine success but no time for complacency.

BACKGROUND: Trends in age specific and serotype specific incidence rates for invasive pneumococcal disease (IPD) were examined in South Australia 4 years before and 5 years after the commencement of the Australian universal childhood 7 valent pneumococcal conjugate vaccine (7vPCV) program. METHODS: IPD cases were identified by routine enhanced surveillance. IPD serotypes were grouped according to those covered by the 7vPCV, the six serotypes specific to the 13 valent pneumococcal conjugate vaccine (13vPCV), the 11 serotypes specific to the 23 valent pneumococcal polysaccharide vaccine (23vPPV), as well as non-13vPCV and non-23vPPV groups. Poisson regression was used to calculate age-specific and serotype-specific incident rate ratios (IRRs) comparing pre (2002-2004) and post (2007-2009) universal childhood 7vPCV periods. RESULTS: Following the introduction of the 7vPCV program, the rate of IPD in children aged <2 years decreased by 81% for all serotypes (IRR 0.19, 95% CI, 0.13-0.28) and by 98% for 7vPCV serotypes (IRR 0.02, 95% CI, 0.007-0.07). At the same time, there was some evidence for an increase in IPD caused by 13vPCV specific serotypes (IRR 1.58, 95% CI, 0.78-3.21) and non-13vPCV serotypes (IRR 1.80, 95% CI, 0.45-7.21). Among adults aged ≥65 years, overall there was a 27% reduction in IPD caused by all serotypes following introduction of the 7vPCV program (IRR 0.73, 95% CI, 0.58-0.93). However, the rate of IPD increased in the last 2 years of the study period. The initial decrease was a result of a 74% reduction in the rate of IPD due to 7vPCV serotypes (IRR 0.26, 95% CI, 0.17-0.40). At the same time, the rate of IPD increased for 13vPCV specific serotypes (IRR 1.55, 95% CI, 0.94-2.54), 23vPPV specific serotypes (IRR 1.91, 95% CI, 0.99-3.71) and particularly non-23vPPV serotypes (IRR 5.3, 95% CI, 1.83-15.34). CONCLUSION: There has been a large direct and sustained benefit from the universal 7vPCV program in children, particularly those aged <2 years, with some evidence for serotype replacement. There is also good evidence that the childhood program has provided indirect benefits to adults aged ≥65 years, although serotype replacement has reduced the initial benefits.

Outbreak of Salmonella typhimurium phage type 44 infection among attendees of a wedding reception, April 2009.

On 30 April 2009, the Communicable Disease Control Branch (CDCB) South Australia was notified of a Salmonella infection in a person who attended a wedding reception on 25 April 2009. Several other attendees reported becoming unwell with a similar gastrointestinal illness. The CDCB commenced an investigation to: characterise the outbreak in terms of person, place and time; identify probable source or sources; and implement control measures. A retrospective cohort study was undertaken among wedding reception attendees. A questionnaire collecting information on demographics, illness and menu items consumed was given to the majority of attendees. An environmental inspection of the wedding reception premise and food supplier premise, including food sampling was conducted to identify plausible sources of infection. The questionnaire response rate was 77%, from which an attack rate of 20% was calculated. There was a significant association between consumption of garlic aioli and illness (OR 5.4, 95% CI: 1.6, 18.1). Nine wedding reception attendees' stool samples tested positive for Salmonella Typhimurium phage type 44. A sample of garlic aioli also tested positive for Salmonella Typhimurium phage type 44. The ingredients of the garlic aioli included raw egg yolk, roasted garlic, Dijon mustard, vinegar and vegetable oil. The raw egg yolk was identified as a high risk food item; however no eggs tested positive for Salmonella.

The burden of influenza in healthy children in South Australia.

OBJECTIVE: To describe the influenza-related morbidity and mortality in healthy children aged under 5 years in South Australia, in order to further understand the potential role of influenza vaccination. DESIGN AND SETTING: We undertook a descriptive analysis of SA hospital separations data and Australian Bureau of Statistics death data for children aged under 5 years admitted to hospital for influenza. All diagnoses related to an influenza admission were examined to determine whether children were at risk of complications from influenza, according to the criteria of the National Health and Medical Research Council. MAIN OUTCOME MEASURES: Mean influenza admission rates per 100 000 population per year in children aged under 5 years between 1996 and 2006, and the proportion of children admitted to hospital who did not have a secondary diagnosis putting them at higher risk of influenza-related complications. RESULTS: From 1996 to 2006, 649 children aged under 5 years were admitted to hospital for influenza. Mean annual admission rates per 100 000 were highest in children aged under 1 year (151.0), and decreased with age. Aboriginal and Torres Strait Islander children aged under 5 years had a mean admission rate of 161.8 per 100 000. Most children under 5 years (81%) admitted to hospital did not have an underlying illness that would put them at risk of influenza-related morbidity. CONCLUSION: Healthy children aged under 2 years and Aboriginal and Torres Strait Islander children under 5 years old have high rates of hospital admission, which may have implications for the target group recommendations for influenza immunisation. Currently, vaccination is recommended only for children with specified chronic diseases.

Surveillance of Shiga toxigenic Escherichia coli in Australia.

All Australian States and Territories have low rates (< or = 0.32 cases per 100,000 population) of notification for Shiga toxin-producing Escherichia coli (STEC), except for South Australia where the rates are ten-fold higher at 2.58 cases per 100,000 population. To explore possible reasons for the variation in rates we surveyed public health reference laboratories to determine the methods used and number of specimens tested for these organisms. Only five of eight jurisdictions routinely conducted testing for STEC, and polymerase chain based tests were most common. Culture was also common and in one jurisdiction that tests specimens with culture, approximately 1.2 per cent of specimens were positive. The notification rates for different jurisdictions reflected the number of specimens tested, with jurisdiction testing < or = 500 specimens having rates < or = 0.32 cases per 100,000 population. The use of culture as a test method may also influence notification rates. Public health agencies must consider the number of specimens tested in interpreting surveillance data.

An outbreak of Campylobacter jejuni infection among conference delegates.

Campylobacter infection is one of the most commonly reported foodborne diseases in Australia however, reported Campylobacter outbreaks are rare. This report describes such an outbreak among delegates attending a 10 day international academic meeting in South Australia during May 2001. A retrospective cohort study of the 29 delegates who attended the conference was conducted. A questionnaire was sent by email with a response rate of 93 per cent. Ten cases (onset of diarrhoea while attending the conference) were identified. Two were culture positive for Campylobacter jejuni. There was a significant association between the illness and eating a number of food items from two restaurants however, environmental investigation of the two venues did not identify a definitive source for the outbreak. This investigation demonstrates the usefulness of email in the distribution of questionnaires among specific cohorts.

Information and support for women following the primary treatment of breast cancer.

OBJECTIVE: To examine the need for, use of and satisfaction with information and support following primary treatment of breast cancer. DESIGN: Cross-sectional survey. PARTICIPANTS: Cohort of 266 surviving women diagnosed with breast cancer over a 25-month period at a tertiary hospital, Adelaide, Australia. Time since diagnosis ranged from 6 to 30 months. MAIN OUTCOME MEASURES: Need for, use of and satisfaction with information and support. RESULTS: Women reported high levels of need for information about a variety of issues following breast cancer treatment. Ninety-four percentage reported a high level of need for information about one or more issues, particularly recognizing a recurrence, chances of cure and risk to family members of breast cancer. However, few women (2-32%) reported receiving such information. The most frequently used source of information was the surgeon followed by television, newspapers and books. The most frequently used source of support was family followed by friends and the surgeon. Few women (<7%) used formal support services or the Internet. Women were very satisfied with the information and support that they received from the surgeon and other health professionals but reported receiving decreasing amounts of information and support from them over time. CONCLUSIONS: Women experience a high need for information about breast cancer related issues following primary treatment of breast cancer. These needs remain largely unmet as few women receive information about issues that concern them. The role of the surgeon and other health professionals is critical in narrowing the gap between needing and receiving information.