First documented gymnasium cluster of COVID-19 with whole genome sequencing in Australia.

Background: Transmission of coronavirus disease 2019 (COVID-19) has been demonstrated in fitness settings internationally. We report the first documented case of transmission of COVID-19 in a gymnasium in Australia in 2020. Methods: Case finding and case interviews were conducted among attendees in a Western Sydney gymnasium, Australia. Whole genome sequencing using an amplicon-based approach was performed on all SARS CoV-2 polymerase chain reaction positive samples detected through surveillance. Results: We show that five cases of COVID-19 were linked to the gymnasium, with transmission occurring on 7 July 2020, when the index case transmitted the infection to four other gymnasium attendees through the sharing of an enclosed space. Conclusions: There is an ongoing risk of transmission of COVID-19 within gymnasium environments and they are justifiably classified as a 'high-risk' venue. There may be a need to expand ventilation and space requirements to prevent transmission of COVID-19 in such settings in the context of severe COVID-19 variants or to prevent respiratory disease transmission in general.

FluTracking: Weekly online community-based surveillance of influenza-like illness in Australia, 2019 Annual Report.

Abstract: FluTracking provided evidence for an early, long, but moderate influenza season in the Australian community compared to prior years. Influenza-like illness (ILI) activity in 2019 peaked earlier (week ending 16 June) than any season on record in FluTracking data. ILI attack rates were above average early in the 2019 season (peak of 2.2%), and the duration of peak activity was longer than most prior years. However, ILI attack rates were lower than the five-year average in the latter half of the season. FluTracking participants reported higher vaccination coverage in 2019 (73.3%) compared with 2018 (65.7%), with the most notable increase in children aged less than five years (69.3% in 2019, compared to 55.6% in 2018). The total 2019 count of laboratory notifications (312,945) was higher than prior years (2007 onwards), and the peak weekly count of 18,429 notifications in 2019 was also higher than all prior years, except 2017. FluTracking makes a comparison to another surveillance system each year. The peak weekly percentage of calls to HealthDirect that were influenza-related was higher in 2019 (12.8%) than for 2014-2018 (range of 8.2-11.4% for peak week of activity each year). FluTracking participants reported a 2.5 times increase in influenza testing from 2018 to 2019 and a 1.5 times increase from 2017. Although 2019 was of higher activity and severity than 2018, Flutracking data indicates that 2019 was a lower activity and severity season than 2017, and notifications and influenza-related calls were heightened by increased community concern and testing.

Influenza outbreaks in aged care facilities in New South Wales in 2017: impact and lessons for surveillance.

INTRODUCTION: A record number of influenza outbreaks in aged care facilities (ACFs) in New South Wales (NSW) during 2017 provided an opportunity to measure the health impact of those outbreaks and assess the quality of routinely available surveillance data. METHODS: Data for all ACF influenza outbreaks in NSW in 2017 were extracted from the Notifiable Conditions Information Management System. The numbers of outbreaks, residents with influenza-like illness (ILI), hospital admissions and deaths were assessed. For each outbreak the attack rate; duration; timeliness of notification; resident and staff influenza vaccination coverage; and antiviral use for treatment or prophylaxis were analysed. Data were considered for NSW in total and separately for seven of the state's local health districts. Data completeness was assessed for all available variables. RESULTS: A total of 538 ACF outbreaks resulted in 7,613 residents with ILI, 793 hospitalisations and 338 deaths. NSW outbreaks had a median attack rate of 17% and median duration of eight days. Data completeness, which varied considerably between districts, limited the capacity to accurately consider some important epidemiological and policy issues. DISCUSSION: Influenza outbreaks impose a major burden on the residents and staff of ACFs. Accurate assessment of the year-to-year incidence and severity of influenza outbreaks in these facilities is important for monitoring the effectiveness of outbreak prevention and management strategies. Some key data were incomplete and strategies to improve the quality of these data are needed, particularly for: the number of influenza-related deaths among residents; resident and staff vaccination coverage prior to outbreaks; and recorded use of antiviral prophylaxis.

Impact of funding on influenza vaccine uptake in Australian children.

Objectives and importance of study: Young children are at higher risk for serious influenza outcomes but, historically, Australian children aged less than 5 years have had low seasonal influenza vaccine uptake. In 2018, most Australian jurisdictions implemented funded influenza vaccine programs targeted at improving vaccine uptake in this age group. Our aim was to determine how successful these programs were at improving self-reported seasonal influenza vaccine uptake at the community level by comparing vaccination rates in each Australian jurisdiction before and after the introduction of funded vaccines for children aged 6 months to less than 5 years, as well as other age groups. STUDY TYPE: Volunteer observational cohort study. METHODS: Flutracking is an email-based surveillance tool for influenza-like illness that collects information about symptoms and influenza vaccination. We used historical data from 2014 to 2017 to estimate baseline vaccination status before funding of childhood influenza vaccines was introduced. We compared self-reported vaccine uptake in children younger than 5 years, children aged 5-17 years and adults (18-64 years, and 65 years and older) in 2018 and 2019 by state or territory. Mixed effects logistic regressions were used to measure the association between vaccination and a number of predictors, including whether the child was eligible for free vaccines, and whether adults resided with children or not. RESULTS: We found large increases in vaccine uptake for children younger than 5 years in 2018 in all jurisdictions except Western Australia (where vaccines were already funded) and the Northern Territory (where funded vaccines were not introduced until 2019) that coincided with vaccine policy changes. Self-reported vaccination rates for young children in 2018 increased 2.7-4.2-fold in jurisdictions that funded the vaccine (compared with the previous, unfunded period). Being eligible for the funded vaccine was associated with much higher odds (odds ratio [OR] 4.75; 95% confidence interval [CI] 4.57, 4.79) of a young child being vaccinated. Older children and adults younger than 65 years were also more likely to receive the vaccine following policy changes. CONCLUSION: The seasonal influenza vaccine is an important protective measure for those at risk of serious outcomes, including young children. Flutracking data demonstrates that government-funded vaccines can lead to an almost five-fold increase in self-reported vaccine uptake of the targeted age group, as well as previously unreported flow-on effects to older children. This suggests that funded vaccines for young children may encourage caregivers to also vaccinate themselves and their older children.

Flutracking weekly online community survey of influenza-like illness annual report, 2016

Flutracking is a national online community influenza-like illness (ILI) surveillance system that monitors weekly ILI attack rates and seriousness of disease in the Australian community. This article reports on the 2016 findings. From 2015 to 2016 there was an 11.4% increase in participants to 30,998 completing at least one survey with a peak weekly response of 27,094 participants and a minimum weekly response of 26,123. The 2016 Flutracking national weekly percentage of participants with fever and cough peaked in late August at 2.7%, one week earlier than the national counts of laboratory confirmed influenza peaked. A lower percentage of participants took 2 or more days off from work or normal duties and sought medical advice in 2016 (peak level 1.6% and 1.0% respectively) compared with 2015 (peak level 2.0% and 1.3% respectively). Flutracking fever and cough peaked in the same week as death rates for influenza and pneumonia recorded by the NSW Registry of Births, Deaths and Marriages. The percentage of participants aged 0 to 14 years with cough and fever was higher than all other age groups in 2016. Overall, Flutracking surveillance demonstrated that the attack rates and seriousness of disease for the 2016 season at the community level were lower than 2015 and 2014.

Enablers of innovation in digital public health surveillance: lessons from Flutracking.

Opportunities for digital innovation in public health surveillance have never been greater. Social media data streams, Open Data initiatives, mHealth geotagged data, and the 'internet of things' are ripe for development. To embrace these opportunities we need to provide public health professionals with environments that support experimentation with new technology. Innovative practitioners will lead discovery, adaption, trialling and deployment of new technological solutions mostly developed outside their organisation. To enhance innovation agencies will need to learn from 'startup culture' and the practices of large organisations that ring fence innovative teams to protect them and allow them to 'break rules', 'fail fast', and innovate.

Flutracking weekly online community survey of influenza-like illness annual report, 2015.

Flutracking is a national online community influenza-like illness (ILI) surveillance system that monitors weekly ILI activity and impact in the Australian community. This article reports on the 2015 findings from Flutracking. From 2014 to 2015 there was a 38.5% increase in participants to 27,824 completing at least 1 survey with a peak weekly response of 25,071 participants. The 2015 Flutracking national ILI weekly fever and cough percentages peaked in late August at 5.0% in the unvaccinated group, in the same week as the national counts of laboratory confirmed influenza peaked. A similar percentage of Flutracking participants took two or more days off from work or normal duties in 2015 (peak level 2.3%) compared with 2014 (peak level 2.5%) and the peak weekly percentage of participants seeking health advice was 1.6% in both 2014 and 2015. Flutracking fever and cough peaked in the same week as Influenza Complications Alert Network surveillance system influenza hospital admissions. The percentage of Flutracking participants aged 5 to 19 years with cough and fever in 2015 was the highest since 2011. The 2015 season was marked by a transition to predominantly influenza B strain circulation, which particularly affected younger age groups. However, for those aged 20 years and over, the 2015 national Flutracking influenza season was similar to 2014 in community ILI levels and impact.

Flutracking weekly online community survey of influenza-like illness: 2013 and 2014.

Flutracking is a national online community influenza-like illness (ILI) surveillance system that monitors weekly ILI activity and field vaccine effectiveness. This article reports on the 2013 and 2014 findings from Flutracking. From 2013 to 2014 there was a 14.0% increase in participants who completed at least 1 survey to 21,021 participants. By the end of the 2013 and 2014 seasons, respectively 59.7% and 59.1% of all participants had received the seasonal influenza vaccine. The 2013 Flutracking national ILI weekly incidence peaked in late August at 4.3% in the unvaccinated group, 1 week earlier than national counts of laboratory confirmed influenza. The 2014 Flutracking national ILI weekly incidence also peaked in late August at 4.7% in the unvaccinated group, in the same week as national counts of laboratory confirmed influenza. A lower percentage of Flutracking participants took two or more days off from work or normal duties in 2013 (peak level 1.6%) compared with 2014 (peak level 2.5%) and sought health advice in 2013 (peak level of 1.1%) compared with 2014 (peak of 1.6%). Flutracking ILI surveillance suggests that 2014 was a moderately more intense season than 2013 and similar to 2012.

Building influenza surveillance pyramids in near real time, Australia.

A timely measure of circulating influenza virus severity has been elusive. Flutracking, the Australian online influenza-like illness surveillance system, was used to construct a surveillance pyramid in near real time for 2011/2012 participants and demonstrated a striking difference between years. Such pyramids will facilitate rapid estimation of attack rates and disease severity.