An evaluation of the Australian Rotavirus Surveillance Program.

The Australian Rotavirus Serotyping Program (ARSP) serotypes rotavirus isolates obtained from stool samples sent from Australian laboratories. In collaboration with ARSP the Australian Government Department of Health and Ageing evaluated the program for its utility and capacity to monitor effectiveness of the rotavirus vaccines recently introduced into the Australian National Immunisation Program. The system was described using ARSP annual reports and staff interviews. The attributes of the system were assessed by adapting standard guidelines for evaluating a surveillance system. Email surveys or face to face interviews were conducted with staff of ARSP, participating laboratories, rotavirus vaccine manufacturing companies and representatives of the Communicable Diseases Network Australia. The ability of the ARSP to monitor changes in rotavirus serotype epidemiology was assessed. ARSP serotypes rotavirus isolates received from participating laboratories at least bi-annually, with results being reported at least as often. Serotype analyses have informed formulation of rotavirus vaccines and contributed to forecasting the extent of outbreaks caused by novel serotypes. The ARSP will be able to monitor changes in rotavirus serotype epidemiology and identify probable vaccination failures. Enhancement of the representativeness and sensitivity of the system are needed for the data to remain useful in the public health context. Methods for transferring data between the program and state and territory health departments need to be developed.

Tuberculosis notifications in Australia, 2006.

The National Notifiable Disease Surveillance System received 1,201 tuberculosis (TB) notifications in 2006, of which 1,142 were new cases and 59 were relapses. The incidence of TB in Australia was 5.8 cases per 100,000 population in 2006 up from 5.3 per 100,000 in 2005, but still below 6 per 100,000 as it has been since 1985. Eighty-five per cent of TB notifications in 2006 were in people born outside Australia. The incidence in people born overseas and Indigenous Australians were 20.7 and 6.6 cases per 100,000 population, respectively. By contrast, the incidence of TB in the non-Indigenous Australian-born population was 0.9 cases per 100,000 population. Household or other close contact was reported as the most common risk factor for TB infection. The number of cases of TB reported in health care workers increased in 2006; these were mostly in health care workers born in TB-endemic countries and there were no reports of TB transmission in Australian health care settings. Outcome data of the 2005 TB cohort indicates that treatment success was attained in more than 95% of cases. Progress towards TB elimination in Australia will rely on continued TB awareness, maintenance of high standards of TB diagnostic and control practices, and promoting regional and global TB control activities.

Invasive pneumococcal disease in Australia, 2006.

Enhanced surveillance for invasive pneumococcal disease (IPD) was carried out in all Australian states and territories in 2006 with comprehensive comparative data available since 2002. There were 1,445 cases of IPD notified to the National Notifiable Diseases Surveillance System in Australia in 2006; a notification rate of 7 cases per 100,000 population. The rates varied between states and territories and by geographical region with the highest rates in the Northern Territory, the jurisdiction with the largest proportion of Indigenous people. Invasive pneumococcal disease was reported most frequently in those aged 85 years or over (30.8 cases per 100,000 population) and in children aged one year (26.5 cases per 100,000 population). There were 130 deaths attributed to IPD resulting in an overall case fatality rate of 9%. The overall rate of IPD in Indigenous Australians was 4.3 times the rate in non-indigenous Australians. The rate of IPD in the under two years population continued to fall in 2006, but the rate in Indigenous children (73 cases per 100,000 population) was significantly greater than in non-Indigenous children (21 cases per 100,000 population). The rates of disease caused by serotypes in the 7-valent pneumococcal conjugate vaccine (7vPCV) decreased between 2002 and 2006 by 78% in children aged under two years as a result of the introduction of a universal childhood 7vPCV immunisation program. Significant decreases in IPD caused by 7vPCV serotypes also occurred in the 2-14 years and 65 years or over age groups. Rates of disease caused by non-7vPCV in the same periods were little changed. Serotypes were identified in 94% of all notified cases, with 43% of disease caused by serotypes in the 7vPCV and 85% caused by serotypes in the 23-valent polysaccharide pneumococcal vaccine (23vPPV). The number of invasive pneumococcal isolates with reduced penicillin susceptibility remains low and reduced susceptibility to third generation cephalosporins is rare.

Australia's notifiable diseases status, 2005: annual report of the National Notifiable Diseases Surveillance System.

In 2005, 60 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 125,461 cases of communicable diseases to the National Notifiable Diseases Surveillance System: an increase of 10% on the number of notifications in 2004. In 2005, the most frequently notified diseases were sexually transmissible infections (51,557 notifications, 41% of total notifications), gastrointestinal diseases (29,422 notifications, 23%) and bloodborne diseases (19,278 notifications, 15%). There were 17,753 notifications of vaccine preventable diseases; 4,935 notifications of vectorborne diseases; 1,826 notification of other bacterial infections (legionellosis, leprosy, meningococcal infections and tuberculosis) and 687 notifications of zoonotic diseases.

Annual report of the National Influenza Surveillance Scheme, 2005.

Surveillance of influenza in Australia is based on laboratory isolation of influenza viruses, sentinel general-practitioner reports of influenza-like illness, and absenteeism data from a major national employer. In 2005, 4,575 cases of laboratory-confirmed influenza-like illness were reported, which was 115 per cent higher than in 2004. The influenza season started in the first week of June, with peak activity in early August, a month earlier than in 2004. Influenza A was the predominant type notified (73%), while influenza B activity continued to increase compared to previous years. During 2005, the influenza notification rate amongst persons aged over 65 years (22 cases per 100,000 population) was 70 per cent higher than the mean rate of the last four years. One thousand one hundred and seventy-four influenza isolates from Australia were antigenically analysed: 689 were A(H3N2), 210 were A(H1N1) strains and 275 were influenza B viruses. Continued antigenic drift was seen with the A(H3N2) viruses from the previous reference strains with approximately one quarter of isolates being distinguishable from A/Wellington/1/2004-like viruses and more closely matched to A/California/7/2004-like viruses.

Australia's notifiable diseases status, 2004, annual report of the National Notifiable Diseases Surveillance System.

In 2004, 60 diseases and conditions were nationally notifiable in Australia. States and Territories reported a total of 110,929 cases of communicable diseases to the National Notifiable Diseases Surveillance System (NNDSS): an increase of 4 per cent on the number of notifications in 2003. In 2004, the most frequently notified diseases were sexually transmissible infections (46,762 cases; 42% of total notifications), gastrointestinal diseases (25,247 cases; 23% of total notifications) and bloodborne diseases (19,191 cases; 17% of total notifications). There were 13,206 notifications of vaccine preventable diseases, 6,000 notifications of vectorborne diseases, 1,799 notifications of other bacterial infections (includes, legionellosis, leprosy, meningococcal infections and tuberculosis) and 877 notifications of zoonotic diseases.

Invasive pneumococcal disease in Australia, 2004.

There were 2,375 cases of invasive pneumococcal disease (IPD) notified to the National Notifiable Diseases Surveillance System in Australia in 2004; a notification rate of 11.8 cases per 100,000 population. The rate varied between states and territories and by geographical region with the highest rates in the Northern Territory. Invasive pneumococcal disease was reported most frequently in children aged less than 5 years (55.4 cases per 100,000 population). Enhanced surveillance for IPD was carried out in all states and territories, in 2004, providing additional data on 2,023 (85%) cases. The overall rate of IPD in Indigenous Australians was 3.2 times the rate in non-Indigenous Australians. There were 154 deaths attributed to IPD resulting in an overall case fatality rate of 7.6 per cent. Rates of IPD in the Indigenous and non-Indigenous under 2-year-old population were similar in 2004 (91.5 and 93.6 cases per 100,000 population, respectively) following a targeted introduction of the 7-valent pneumococcal conjugate vaccine (7vPCV) in mid-2001 for Indigenous infants and children. Serotypes of isolates were identified from 80 per cent of all notified cases, with 72 per cent of isolates belonging to serotypes represented in the 7vPCV and 91 per cent in the 23-valent polysaccharide pneumococcal vaccine (23vPPV). Comparison of serotypes in the 7vPCV target population showed that the rate of IPD due to 7vPCV serotypes decreased by 74 per cent between 2001-02 and 2003-04. Of 216 isolates with reduced penicillin susceptibility, 83 per cent belonged to pneumococcal serotypes in the 7vPCV and 95 per cent in the 23vPPV.

Tuberculosis notifications in Australia, 2004.

The National Notifiable Disease Surveillance System received 1,076 tuberculosis (TB) notifications in 2004, of which 1,043 were new cases and 33 were relapses. The incidence of TB in Australia has remained at a stable rate since 1985 and was 5.4 cases per 100,000 population in 2004. The high-incidence groups remain people born overseas and Indigenous Australians at 21.7 and 8.1 cases per 100,000 population, respectively. By contrast, the incidence of TB in the non-Indigenous Australian-born population was 1.0 cases per 100,000 population. Comparison of the 2004 TB notification data against the performance indicators set by National Tuberculosis Advisory Committee highlights that enhanced TB control measures should be considered among these high-risk groups.

Annual report of the National Influenza Surveillance Scheme, 2004.

The National Influenza Surveillance Scheme includes data on influenza-like illness from sentinel general practitioner practices, laboratory reports of influenza from National Notifiable Diseases Surveillance Scheme and absenteeism data from a national employer. In 2004, 2,116 cases of laboratory-confirmed influenza-like illness were reported, which was 41 per cent lower than the previous year. Peak activity was recorded in September, a month later than in 2003. Influenza A was again predominant while influenza B had an increased activity compared to the previous season. Four hundred and fifty-four isolates were antigenically analysed: 342 were A (H3N2 strain), 4 were A(H1N1 strain) strains and 108 were influenza B viruses. Further antigenic drift was seen in the A(H3N2) subtype with approximately one third of all isolates antigenically distinguishable from the A/Fujian/411/2002 reference strain. Vaccination coverage indicated that 79 per cent of Australians aged over 65 years received the 2004 influenza vaccine.

Evaluation of the Australian Gonococcal Surveillance Programme.

The Australian Gonococcal Surveillance Programme (AGSP) is a laboratory network that monitors the susceptibility of gonococcal isolates to antibiotics used in the treatment of infection. This report evaluates and reports on the simplicity, flexibility, sensitivity, representativeness, timeliness and acceptability of the AGSP. The World Health Organization's (WHO) Questionnaire for Assessment of Antimicrobial Resistance (AMR) National Networks was used in undertaking this evaluation and we report on the questionnaire's usefulness. The evaluation revealed that the AGSP was structurally simple, acceptable, timely and that the data were actively used by the stakeholders. However, the flexibility, representativeness and sensitivity of the AGSP are challenged by the increasing use of molecular based methods to diagnose gonococcal infections, as this is reducing the number of isolates available for testing. Despite this challenge, the AGSP has been able to identify differences in the antimicrobial susceptibility of gonococcal strains circulating in metropolitan and regional communities and the data generated are used to devise or modify standard treatment regimens for gonorrhoea. The functioning of the system can be improved by better availability of data through a dedicated website. Ideally, linkage of AGSP data to notification data would ensure that the AGSP is sensitive to and representative of the changes in gonococcal resistance amongst various sub-populations, although it will increase system complexity. The WHO questionnaire was found to be useful in undertaking the evaluation of the AGSP as it was simple and well-structured. However, the questionnaire needs to be expanded to include benchmarks that guide the assessment process.

The paper grip test for screening on intrinsic muscle paralysis in the foot of leprosy patients.

Plantar intrinsic foot muscles provide structure to the foot during walking and thus regulate mechanical foot sole stresses. When paralyzed, for instance in leprosy patients with neuropathy of the distal part of the tibial nerve, there is a high prevalence of plantar ulceration and deformities, especially when muscle weakness goes together with loss of foot sole sensibility. These patients should get immediate care involving education, special footwear and reconstructive surgery before further foot impairment and deformity becomes manifest. Thus far, in leprosy patients little attention is paid to screening of plantar intrinsic muscles activity. This can be done with a new simple and non-invasive method, the Paper Grip Test (PGT). There are two variants for detecting intrinsic muscle weakness of the foot, PGT1 for the great toe and PGT2 for the combined lesser toes. In this study, 517 leprosy patients and 170 healthy volunteers were investigated with the PGT. Sensibility of the foot sole was tested by means of a 10 gram monofilament. Specificity to the PGT1 is found to be about 95.3% which is considered good for physical diagnostic tests. PGT2 is less specific than PGT1. Individual muscle power and understanding of the patient seems to influence the outcome of the test to a certain extent. Sensitivity can only be calculated when the diagnosis is confirmed by electromyography. Especially patients with anesthetic feet, females, older patients and patients with PN-, BB- or LL-types of leprosy appeared to have a higher prevalence of intrinsic foot muscle weakness. All results were analyzed by means of the bivariate Pearson correlation-analysis and proved to be statistically significant (p = < 0.05). It is concluded that the PGT1, more than the PGT2, is a useful screening test on the function of plantar intrinsic foot muscles in leprosy patients in hospitals and during fieldwork in developing countries.

The paper grip test for screening on intrinsic muscle paralysis in the foot of leprosy patients

Plantar intrinsic foot muscles provide structure to the foot during walking and thus regulate mechanical foot sole stresses. When paralyzed, for instance in leprosy patients with neuropathy of the distal part of the tibial nerve, there is a high prevalence of plantar ulceration and deformities, especially when muscle weakness goes together with loss of foot sole sensibility. These patients should get immediate care involving education, special footwear and reconstructive surgery before further foot impairment and deformity becomes manifest. Thus far, in leprosy patients little attention is paid to screening of plantar intrinsic muscles activity. This can be done with a new simple and non-invasive method, the Paper Grip Test (PGT). There are two variants for detecting intrinsic muscle weakness of the foot, PGT1 for the great toe and PGT2 for the combined lesser toes. In this study, 517 leprosy patients and 170 healthy volunteers were investigated with the PGT. Sensibility of the foot sole was tested by means of a 10 gram monofilament. Specificity to the PGT1 is found to be about 95.3% which is considered good for physical diagnostic tests. PGT2 is less specific than PGT1. Individual muscle power and understanding of the patient seems to influence the outcome of the test to a certain extent. Sensitivity can only be calculated when the diagnosis is confirmed by electromyography. Especially patients with anesthetic feet, females, older patients and patients with PN-, BB- or LL-types of leprosy appeared to have a higher prevalence of intrinsic foot muscle weakness. All results were analyzed by means of the bivariate Pearson correlation-analysis and proved to be statistically significant (p = < 0.05). It is concluded that the PGT1, more than the PGT2, is a useful screening test on the function of plantar intrinsic foot muscles in leprosy patients in hospitals and during fieldwork in developing countries.

Predicción casos muy positivos entre pacientes de lepra MB con parámetros clínicos

Aunque se sabe que los casos frotis muy bacilíferos presentan un riesgo elevado de recidivas después de ser dadas de alta de la MDT, los programas de control en el campo sin facilidades para efectuar frotis no disponen de un método alternativo para poder detectarlos. Este estudio presentó una prevalencia significativa de este tipo de casos entre 2.374 casos multibacilares nuevos recientemente detectados por frotis cutáneos en Nepal y análisis retrospectivos de 555 casos nuevos recien detectados, BL y LL sin tratar, para identificar parámetros clínicos y de laboratorio asociados con un frotis cutáneo muy bacilíferos. Mientras que alguno de estos parámetros presentan gran sensibilidad en precedir "casos muy bacilíferos", ninguno presenta simultáneamente elevada sensibilidad y especificidad.

Vaccination with DNA of the Mycobacterium tuberculosis 85B antigen protects mouse foot pad against infection with M. leprae

A DNA vaccine composed of the gene for the common mycobacterial secreted protein antigen 85B was demonstrated to protect the mouse foot pad against infection with Mycobacterium leprae. The protective effect was demonstrated by a 61%-88% reduction in the bacterial number, a protective effect less than that of BCG. The same DNA vaccine has been shown to protect mice against M. tuberculosis infection, and the importance of testing other candidate tuberculosis vaccines for their potential to protect against leprosy is discussed.

Interferon-Gamma responses to candidate leprosy skin-test reagents detect exposure to leprosy in an endemic population

New tools for the detection of leprosy exposure in a community will be necessary for the eradication of leprosy. Candidate leprosy skin-test antigens derived from the fractionation of the leprosy bacillus into cytoplasmic and cell-wall proteins free of immuno-inhibitory mycobacterial lipoglycans and carbohydrates were used in an overnight blood test to determine whether exposure to leprosy can be detected by the production of the cytokine interferon gamma (IFN-gamma). Strong IFN-gamma responses were detected in leprosy contacts to both skin-test antigens compared with control subjects from the same endemic communities. There was little response in patients with tuberculosis. Responses were greatest in contacts with recent leprosy exposure. The implications of these findings for the application of these reagents in a field trial as skin tests to detect exposure to leprosy are discussed in light of the strong association between overnight IFN-gamma to PPD and the tuberculin skin-test responses previously reported.

Risk Factor for erythema nodosum leprosum

A retrospective study of new borderline lepromatous and lepromatous patients reporting for multidrug therapy (MDT) for leprosy at the Anandaban Leprosy Hospital, Kathmandu, Nepal, over an 8-year period was conducted to determine the prevalence of erythema nodosum leprosum (ENL), the time and frequency of reactions, and clinical and laboratory parameters associated with ENL. An overall prevalence of ENL in this cohort of 19% was found. One third of these reactions occurred in patients before MDT was given, one third in the first 6 months and one third after 6 months of treatment. Nearly 1 in 10 of the ENL reactions occurred in patients who had completed 2 years of MDT; 45% of patients with ENL had more than one episode. Data collected at the patients' first presentation was used to identify four major risk factors. Patients with lepromatous disease, skin infiltration or a bacterial index (BI) of > 4+ were at significantly increased risk. Patients older than 40 were at significantly decreased risk of ENL. There was a linear relationship in the risk of ENL with an increasing BI and an inverse relationship to increasing age. These observations should enable clinicians to recognize patients at first presentation who will be likely to develop ENL.

Rapid method for diagnosis of leprosy by measurements of antibodies to the M. leprae 35-kDa protein: comparison with PGL-1 antibodies detected by ELISA and Dipstick methods

A new rapid immuno-chromatographic test card for the detection of antibodies to the Mycobacterium leprae 35-kD protein is described. The new assay is compared in the same group of subjects with a direct enzyme ELISA method for 35-kD antibodies and with assays for anti-phenolic glycolipid-I (PGL-I) antibodies using a standard ELISA as well as the recently described [quot ]dipstick[quot ] method. Good concordance was found between the rapid methods and the corresponding ELISA methods. The detection of untreated paucibacillary leprosy by the 35-kD test card was 59% compared with 27% for the PGL-I dipstick; however, the specificity for the 35-kD test card was 90% compared with 100% for the PGL-I dipstick in an endemic population. The potential application of these new, rapid serologic methods for the diagnosis of leprosy under field conditions is discussed.

Contribution of type 1 reactions to sensory and motor function loss in borderline leprosy patients and the efficacy of treatment with prednisone

The changes in nerve function tests in 297 new leprosy patients over an average period of 30 months were measured. The impact of type 1 reactions (T1R) on sensory and voluntary muscle function was measured by standard tests. Sensory function was improved in patients with single episodes of cutaneous T1R, but not improved in patients with neural T1R or with multiple episodes of either kind of T1R. Patients over 40 years of age improved less than younger patients, and patients admitted for treatment of T1R improved more than those treated as outpatients. These data point to a need to find better regimens for the treatment of nerve damage in T1R.