Household transmission of COVID-19 in 2020 in New South Wales, Australia.

Households are high-risk settings for the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examines factors associated with transmission among cases diagnosed with coronavirus disease 2019 (COVID-19) and their household contacts, in New South Wales (NSW), Australia, during July-October 2020. A register of all laboratory-confirmed COVID-19 cases was used to extract demographic and clinical information for cases and household contacts. Secondary attack rates (SARs) among household members were calculated and generalised estimating equations were used to estimate risks of transmission in relation to various characteristics of the primary case and the household contacts. In total, 229 households were included; they consisted of 229 primary cases and 659 close contacts. The overall household SAR was 22.5% (148/659). After adjusting for symptoms, age and sex of primary case, spouse status of household contacts and household size, the odds of secondary transmission were lower in primary cases who were asymptomatic at diagnosis than in symptomatic cases (odds ratio, OR: 0.13; 95% confidence interval (95% CI): 0.04-0.48); and higher in primary cases aged 60 years and over than in those aged 19-39 years (OR: 3.45; 95% CI: 1.53- 7.75). Being a spouse of the primary case was also associated with increased transmission compared to non-spouses (OR: 1.93; 95% CI: 1.24-3.02). After adjustments, there was no significant effect on transmission of the primary case's sex, or of the number of people in the household. This study documents demographic and clinical characteristics that increase transmission rates in households in the period prior to the introduction of SARS-CoV-2 variants. These data can be used as a baseline from which to compare household transmission in outbreaks dominated by new variants.

Effectiveness of Acellular Pertussis Vaccine in Older Adults: Nested Matched Case-control Study.

BACKGROUND: Despite recommendations that older adults receive acellular pertussis vaccines, data on direct effectiveness in adults aged over 50 years are sparse. METHODS: A case-control study nested within an adult cohort. Cases were identified from linked pertussis notifications and each matched to 3 controls on age, sex, and cohort recruitment date. Cases and controls were invited to complete a questionnaire, with verification of vaccination status by their primary care provider. Vaccine effectiveness (VE) was estimated by conditional logistic regression, with adjustment for reported contact with children and area of residence. RESULTS: Of 1112 notified cases in the cohort, we had complete data for 333 cases and 506 controls. Among 172 PCR-diagnosed cases (mean age, 61 years), 11.2% versus 19.5% of controls had provider-verified pertussis vaccination, on average, 3.2 years earlier. Adjusted VE against PCR-diagnosed pertussis was 52% (95% CI, 15-73%), nonsignificantly higher if vaccinated within 2 years (63%; -5-87%). Adjusted VE was similar in adults born before 1950, presumed primed by natural infection (51%; -8-77%) versus those born 1950 or later who may have received whole-cell pertussis vaccine (53%; -11-80%) (P-heterogeneity = 0.9). Among 156 cases identified by single-point serology, adjusted VE was -55% (-177-13%). CONCLUSIONS: We found modest protection against PCR-confirmed pertussis among older adults (mean age, 61 years; range, 46-81 years) within 5 years after acellular vaccine. The most likely explanation for the markedly divergent VE estimate from cases identified by single-titer serology is misclassification arising from limited diagnostic specificity in our setting.

Predictors of treatment response to liraglutide in type 2 diabetes in a real-world setting.

AIMS: There is an unmet need among healthcare providers to identify subgroups of patients with type 2 diabetes who are most likely to respond to treatment. METHODS: Data were taken from electronic medical records of participants of an observational, retrospective study in Italy. We used logistic regression models to assess the odds of achieving glycated haemoglobin (HbA1c) reduction ≥ 1.0% point after 12-month treatment with liraglutide (primary endpoint), according to various patient-related factors. RECursive Partitioning and AMalgamation (RECPAM) analysis was used to identify distinct homogeneous patient subgroups with different odds of achieving the primary endpoint. RESULTS: Data from 1325 patients were included, of which 577 (43.5%) achieved HbA1c reduction ≥ 1.0% point (10.9 mmol/mol) after 12 months. Logistic regression showed that for each additional 1% HbA1c at baseline, the odds of reaching this endpoint were increased 3.5 times (95% CI: 2.90-4.32). By use of RECPAM analysis, five distinct responder subgroups were identified, with baseline HbA1c and diabetes duration as the two splitting variables. Patients in the most poorly controlled subgroup (RECPAM Class 1, mean baseline HbA1c > 9.1% [76 mmol/mol]) had a 28-fold higher odds of reaching the endpoint versus patients in the best-controlled group (mean baseline HbA1c ≤ 7.5% [58 mmol/mol]). Mean HbA1c reduction from baseline was as large as - 2.2% (24 mol/mol) in the former versus - 0.1% (1.1 mmol/mol) in the latter. Mean weight reduction ranged from 2.5 to 4.3 kg across RECPAM subgroups. CONCLUSIONS: Glycaemic response to liraglutide is largely driven by baseline HbA1c levels and, to a lesser extent, by diabetes duration.

Australian trachoma surveillance annual report, 2013.

Australia remains the only developed country to have endemic levels of trachoma (a prevalence of 5% or greater among children) in some regions. Endemic trachoma in Australia is found predominantly in remote and very remote Aboriginal communities. The Australian Government funds the National Trachoma Surveillance and Reporting Unit to collate, analyse and report trachoma prevalence data and document trachoma control strategies in Australia through an annual surveillance report. This report presents data collected in 2013. Data are collected from Aboriginal and Torres Strait Island communities designated at-risk for endemic trachoma within New South Wales, the Northern Territory, South Australia and Western Australia. The World Health Organization grading criteria were used to diagnose cases of trachoma in Aboriginal children, with jurisdictions focusing screening activities on the 5-9 years age group; but some children in the 1-4 and 10-14 years age groups were also screened. The prevalence of trachoma within a community was used to guide treatment strategies as a public health response. Aboriginal adults aged 40 years or over were screened for trichiasis. Screening coverage for the estimated population of children aged 5-9 years and adults aged 40 years or over in at-risk communities required to be screened in 2013 was 84% and 30%, respectively. There was a 4% prevalence of trachoma among children aged 5-9 years who were screened. Of communities screened, 50% were found to have no cases of active trachoma and 33% were found to have endemic levels of trachoma. Treatment was required in 75 at-risk communities screened. Treatment coverage for active cases and their contacts varied between jurisdictions from 79% to 100%. Trichiasis prevalence was 1% within the screened communities.

Risk factors and burden of acute Q fever in older adults in New South Wales: a prospective cohort study.

OBJECTIVES: To measure the acute burden of and to identify risk factors associated with notified Q fever in older adults in New South Wales. DESIGN, SETTINGS AND PARTICIPANTS: A prospective cohort of adults aged 45 years and over (the 45 and Up Study) recruited during 2006-2009 and followed using linked Q fever notifications, hospital records and death records during 2006-2012. MAIN OUTCOME MEASURES: Incident cases of Q fever, based on a linked Q fever notification; proportion of cases with a Q fever-coded hospitalisation. RESULTS: A total of 266 906 participants were followed up for 1 254 650 person-years (mean, 4.7 ± 1.0 years per person). In our study population, the incidence of notified Q fever during follow-up was 3.6 (95% CI, 2.7-4.8) per 100 000 person-years. After adjustments, age (≥ 65 years v 45-54 years: hazard ratio [HR], 0.39; 95% CI, 0.16-0.96), sex (women v men: HR, 0.48; 95% CI, 0.26-0.88), and area and type of residence (P < 0.001 for trend) remained significantly associated with Q fever. Compared with those living in an inner regional area but not on a farm, the risk of notified Q fever was highest for those living on a farm in outer regional or remote areas (HR, 11.98; 95% CI, 5.47-26.21), followed by those living on a farm in inner regional areas (HR, 4.95; 95% CI, 1.79-13.65). Of notified Q fever cases, 15 of 39 (38%) had been hospitalised with a diagnosis consistent with Q fever. CONCLUSIONS: Adults living on a farm in outer regional and remote areas are at a substantially greater risk of contracting Q fever. This suggests that, as well as targeting specific occupational groups for vaccination, there would be benefits in increasing public awareness of Q fever and vaccination among those living on and near farms in outer regional and remote areas of Australia.

National trachoma surveillance annual report, 2012.

Australia remains the only developed country to have endemic levels of trachoma (a prevalence of 5% or greater among children) in some regions. Endemic trachoma in Australia is found predominantly in remote and very remote Aboriginal communities. The Australian Government funds a National Trachoma Surveillance and Reporting Unit to collate, analyse and report trachoma prevalence data and document trachoma control strategies in Australia through an annual surveillance report. This report presents data collected in 2012. Data are collected from Aboriginal and Torres Strait communities designated as at-risk for endemic trachoma in the Northern Territory, Queensland, South Australia and Western Australia. The World Health Organization grading criteria were used to diagnose cases of trachoma in Aboriginal children with jurisdictions focusing screening activities on the 5-9 years age group; however, some children in the 1-4 and 10-14 years age groups were also screened. The prevalence of trachoma within a community was used to guide treatment strategies as a public health response. Aboriginal adults aged 40 years or older were screened for trichiasis. Community screening coverage of the designated at-risk communities was 96%. Screening coverage of the estimated population of children aged 5-9 years and adults aged 40 years or older in at-risk communities was 71% and 31%, respectively. Trachoma prevalence among children aged 5-9 years who were screened was 4%. Of communities screened, 63% were found to have no cases of active trachoma and 25% were found to have endemic levels of trachoma. Treatment was required in 87 at-risk communities screened. Treatment coverage of active cases and their contacts varied from 79%-97% between jurisdictions. Trichiasis prevalence was 2% within the screened communities.

High incidence of hospitalisation due to infectious gastroenteritis in older people associated with poor self-rated health.

OBJECTIVES: To estimate the incidence and risk factors for gastroenteritis-related hospitalisations in older adults. DESIGN: Longitudinal cohort study. PARTICIPANTS: The 45 and Up Study is a large-scale Australian prospective study of adults aged ≥ 45 years (mean 62.7 years) at recruitment in 2006-2009. Self-reported demographic, health and dietary information at recruitment from 265,440 participants were linked to infectious gastroenteritis hospitalisation data. OUTCOME MEASURES: We estimated the incidence of hospitalisation for infectious gastroenteritis, and calculated HRs using Cox regression, adjusting for sociodemographic, health and behavioural variables, with age as the underlying time variable. RESULTS: There were 6077 incident infectious gastroenteritis admissions over 1,111,000 person-years. Incidence increased exponentially with increasing age; from 2.4 per 1000 (95% CI 2.2 to 2.5) in individuals aged 45-54 years to 9.5 per 1000 (95% CI 9.2 to 9.8) in those aged 65+ years. After adjustment, hospitalisation due to infectious gastroenteritis was significantly more common in those reporting use of proton pump inhibitors (HR 1.6, 95% CI 1.5 to 1.7), and those with poorer self-rated health (HR 4.2, 95% CI 3.6 to 4.9). CONCLUSIONS: Infectious gastroenteritis results in hospitalisation of approximately 1% of people ≥ 65 years old each year. Early recognition and supportive treatment of diarrhoea in older patients with poorer self-rated health may prevent subsequent hospitalisation.

Australian trachoma surveillance annual report, 2011.

Australia remains the only developed country to have endemic trachoma in some regions. Endemic levels of trachoma in Australia are found predominantly in remote and very remote Aboriginal communities. Data are collected from Aboriginal communities designated at risk for endemic trachoma (defined as a prevalence of 5% or greater among children) in the Northern Territory, South Australia and Western Australia. This report presents data collected in 2011. The World Health Organization (WHO) grading criteria were used to diagnose cases of trachoma in Aboriginal children with jurisdictions focusing screening activities on the 5-9 year age group. The prevalence of trachoma within a community was used to guide appropriate treatment strategies as a public health response. Aboriginal adults aged 40 years or older were screened for trichiasis. Population screening coverage for trichiasis in 2011 was 9% with a prevalence of 2% in those adults screened. Trachoma screening coverage of the estimated populationof children aged 5-9 years in at-risk communities was 65%. Trachoma prevalence among children aged 5-9 years who were screened was 7%. Of the communities screened, 47% were found to have no cases of active trachoma and 40% were found to have endemic levels. Treatment was required in 80 at-risk communities screened. Treatment coverage of active cases and their contacts varied between jurisdictions, ranging from 53% to 98%. This report provides evidence of increasing coverage of trachoma screening and control activities. In the Northern Territory and Western Australia, there is also evidence of a decline in the prevalence of infection that may be attributable to an improvement in control activities. Despite these apparent advances, trachoma prevalence remains at endemic levels in many communities in remote Australia. Continued efforts are required to ensure that Australia remains on track to reach the goal of elimination by 2020 or sooner.

Australian trachoma surveillance annual report, 2010.

Endemic trachoma continues to exist in remote Aboriginal communities in Australia. The National Trachoma Surveillance and Reporting Unit, established in 2006, is responsible for the collation, analysis and reporting of trachoma prevalence data and the documentation of trachoma control strategies in Australia. Data were collected from Aboriginal communities designated at-risk for endemic trachoma (defined as prevalence of 5% or greater among children) within the Northern Territory, South Australia and Western Australia. This report presents data collected in 2010. Aboriginal children aged 1-14 years were screened using the World Health Organization grading criteria to diagnose and classify individual cases of trachoma. Aboriginal adults aged 40 years or older were screened for trichiasis. Community screening coverage of the designated at-risk communities was 60% in 2010. Screening coverage of the estimated population of children aged 1-14 years and of adults aged 40 years or older in at-risk communities was 11.5% and 5%, respectively. Trachoma prevalence among children aged 1-14 years who were screened was 11%. Of the communities screened, 36% were found to have no cases of active trachoma and 55% were found to have endemic levels of trachoma. Treatment coverage of active cases and their contacts varied between jurisdictions from 64% to 90%. Trichiasis prevalence was 4% within the screened communities.

Pertussis in older adults: prospective study of risk factors and morbidity.

BACKGROUND: There is limited information on the incidence, morbidity and risk factors for pertussis in adults, particularly those aged over 65 years. METHODS: Population-based prospective cohort study of 263094 adults aged over 45 years (mean 62.8 years) recruited in the Australian state of New South Wales (the 45 and Up Study) between 2006 and 2008, and followed by record-linkage to laboratory-confirmed pertussis notifications, hospitalizations, and death records. The incidence of pertussis notifications and hospitalizations and relative risk (RR) of pertussis according to various participant characteristics was estimated using proportional hazards models. RESULTS: Over a total follow-up of 217524 person-years, 205 adults had a pertussis notification and 12 were hospitalized; the incidence rate was 94 (95% confidence interval [CI], 82-108) and 5.5 (95% CI, 3.1-9.7) per 100000 person-years, respectively. The incidence of a pertussis notification did not differ by age but hospitalization rates progressively increased (2.2, 8.5, and 13.5 per 100000 person-years in age groups 45-64, 65-74, and 75+ years, respectively; P(trend) = .01). After adjusting for age, sex, and other factors, adults with a high body mass index (BMI; RR=1.52; 95% CI, 1.06-2.19 for BMI 30+kg/m(2) vs BMI <25 kg/m(2)) and with preexisting asthma (RR=1.64; 95% CI, 1.06-2.55 compared to those without asthma) were more likely to be notified. CONCLUSIONS: Adults older than 65 years are more likely to be hospitalized for pertussis than those aged 45-64 years. Obesity and preexisting asthma were associated with a higher likelihood of pertussis notification. These findings suggest that pertussis vaccination would be particularly important for adults with these characteristics.