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author:("Hope, kirsten")
1.  Measles transmission in health care waiting rooms: implications for public health response 
Background
Seventeen cases of locally acquired measles occurred in South Western Sydney and Sydney local health districts between July and October 2011. Three of the cases were known to have at least one dose of measles-mumps-rubella (MMR) vaccine. Seven cases were infected within a health care setting waiting room by five index cases. Current national protocols require follow-up of all susceptible contacts in the same waiting room for any length of time for up to two hours after the index case has left.
Methods
Cases were interviewed using a standardized questionnaire. Information included: demographics, illness and activities during the exposure and infectious periods. Health care settings provided arrival and discharge times, maps of floor layouts and location of patients during stay.
Results
All health care setting transmission occurred in cases who were present at the same time as their index cases, with crossover time ranging from 20 to 254 minutes. No index case was isolated. Index cases were between day four and six of illness when transmission occurred. None of the five index cases and one of seven secondary cases had received at least one dose of MMR vaccine. Of the seven secondary cases, two were one year of age, one was 17 years old and four were between 30 and 39 years old.
Conclusion
As Australia moves towards measles elimination, follow-up of cases is important; however, with limited public health resources a targeted response is vital. In this small but well documented series of secondary cases acquired in a health care setting, all were infected following direct, proximate contact of at least 20 minutes. Changes to the national guidelines may be warranted, ensuring that limited resources are focused on following up contacts at greatest risk of disease.
doi:10.5365/WPSAR.2012.3.3.009
PMCID: PMC3729094  PMID: 23908937
2.  Pertussis vaccination in Child Care Workers: room for improvement in coverage, policy and practice 
BMC Pediatrics  2012;12:98.
Background
The “Staying Healthy in Child Care” Australian guidelines provide for illness and disease exclusions and encourage vaccination of staff in child care settings, however these requirements are not subject to accreditation and licensing, and their level of implementation is unknown. This study aimed to describe pertussis vaccination coverage in child care workers in a regional area of northern NSW during 2010; review current staff pertussis vaccination practices; and explore barriers to vaccination.
Methods
A cross sectional survey of all child care centre directors in the Hunter New England (HNE) area of northern NSW was conducted in 2010 using a computer assisted telephone interviewing service.
Results
Ninety-eight percent (319/325) of child care centres identified within the HNE area participated in the survey. Thirty-five percent (113/319) of centres indicated that they had policies concerning respiratory illness in staff members. Sixty-three percent (202/319) of centres indicated that they kept a record of staff vaccination, however, of the 170 centre’s who indicated they updated their records, 74% (125/170) only updated records if a staff member notified them. Of centres with records, 58% indicated that fewer than half of their staff were vaccinated.
Conclusion
Many childcare workers have not had a recent pertussis immunisation. This potentially places young children at risk at an age when they are most vulnerable to severe disease. With increasing use of child care, national accreditation and licensing requirements need to monitor the implementation of policies on child care worker vaccination. Higher levels of vaccination would assist in reducing the risk of pertussis cases and subsequent outbreaks in child care centres.
doi:10.1186/1471-2431-12-98
PMCID: PMC3411446  PMID: 22794120
3.  A large point-source outbreak of Salmonella Typhimurium linked to chicken, pork and salad rolls from a Vietnamese bakery in Sydney 
Introduction
In January 2011, Sydney South West Public Health Unit was notified of a large number of people presenting with gastroenteritis over two days at a local hospital emergency department (ED).
Methods
Case-finding was conducted through hospital EDs and general practitioners, which resulted in the notification of 154 possible cases, from which 83 outbreak cases were identified. Fifty-eight cases were interviewed about demographics, symptom profile and food histories. Stool samples were collected and submitted for analysis. An inspection was conducted at a Vietnamese bakery and food samples were collected and submitted for analysis. Further case ascertainment occurred to ensure control measures were successful.
Results
Of the 58 interviewed cases, the symptom profile included diarrhoea (100%), fever (79.3%) and vomiting (89.7%). Salmonella Typhimurium multiple-locus-variable number tandem repeats analysis (MLVA) type 3–10–8-9–523 was identified in 95.9% (47/49) of stool samples. Cases reported consuming chicken, pork or salad rolls from a single Vietnamese bakery. Environmental swabs detected widespread contamination with Salmonella at the premises.
Discussion
This was a large point-source outbreak associated with the consumption of Vietnamese-style pork, chicken and salad rolls. These foods have been responsible for significant outbreaks in the past. The typical ingredients of raw egg butter or mayonnaise and pate are often implicated, as are the food-handling practices in food outlets. This indicates the need for education in better food-handling practices, including the benefits of using safer products. Ongoing surveillance will monitor the success of new food regulations introduced in New South Wales during 2011 for improving food-handling practices and reducing foodborne illness.
doi:10.5365/WPSAR.2012.3.1.001
PMCID: PMC3729077  PMID: 23908908
4.  Use of a prohibition order after a large outbreak of gastroenteritis caused by norovirus among function attendees 
Introduction
In May 2011, an outbreak of acute gastroenteritis occurred among guests attending two functions (Function A and B) at a local function centre in Sydney, Australia. The Sydney South West Public Health Unit and the New South Wales (NSW) Food Authority sought to determine the cause of the outbreak and implement control measures.
Methods
A retrospective cohort study was planned. A complete guest list was unavailable, so guests who could be contacted were asked to provide details of other guests. Attendee demographics, symptom profile and food histories were obtained using a standard response questionnaire. Stool samples were requested from symptomatic guests. The NSW Food Authority conducted a site inspection.
Results
Of those interviewed, 73% of Function A guests and 62% of Function B guests were ill, with mean incubation times of 27 and 23 hours respectively. Diarrhoea was the most common symptom. Three stool samples and four environmental swabs were positive for norovirus. One food handler reported feeling ill before and during the functions. A prohibition order was used to stop food handlers implicated in the outbreak from preparing food.
Discussion
This outbreak strongly suggests transmission of norovirus, possibly caused by an infected food handler. Regulatory measures such as prohibition orders can be effective in enforcing infection control standards and minimising ongoing public health risk.
doi:10.5365/WPSAR.2012.3.1.008
PMCID: PMC3729074  PMID: 23908907
5.  Field exercises are useful for improving public health emergency responses 
Problem
Emergencies resulting from disease outbreaks and extreme environmental events present significant challenges for health services.
Context
Preparing to effectively manage emergencies is a core activity in public health units. Field exercises support consolidation of biopreparedness by testing plans, identifying weaknesses, providing training opportunities and developing surge capacity.
Action
An extended field exercise to test response to a novel influenza strain was conducted in New South Wales, Australia in September 2008, eight months before the influenza A(H1N1) 2009 pandemic emerged. Lasting four days and involving over 300 participants, the exercise was set in the early response phase with the staggered presentation of 41 cases to 36 emergency departments in the health area. An additional 150 contacts were written into a complex scenario to test the public health response.
Outcome
The subsequent pandemic emergence in mid-2009 offered a unique opportunity to assess the field exercise format for disaster preparedness. Most roles were adequately tested with recognized benefit during the actual pandemic response. However, the exercise did not adequately challenge the public health planning team that synthesizes surveillance data and forecasts risk, nor did it identify planning issues that became evident during the subsequent pandemic.
Discussion
Field exercises offer the opportunity to rigorously test public health emergency preparedness but can be expensive and labour-intensive. Our exercise provided effective and timely preparation for the influenza A(H1N1) 2009 pandemic but showed that more emphasis needs to be placed on the role and training of the public health planning team.
doi:10.5365/WPSAR.2010.1.1.003
PMCID: PMC3729048  PMID: 23908875
6.  Estimating the Disease Burden of Pandemic (H1N1) 2009 Virus Infection in Hunter New England, Northern New South Wales, Australia, 2009 
PLoS ONE  2010;5(3):e9880.
Introduction
On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) infection in Hunter New England (HNE), New South Wales (NSW), Australia (population 866,000) was identified. We used local surveillance data to estimate pH1N1-associated disease burden during the first wave of pH1N1 circulation in HNE.
Methods
Surveillance was established during June 1-August 30, 2009, for: 1) laboratory detection of pH1N1 at HNE and NSW laboratories, 2) pH1N1 community influenza-like illness (ILI) using an internet survey of HNE residents, and 3) pH1N1-associated hospitalizations and deaths using respiratory illness International Classification of Diseases 10 codes at 35 HNE hospitals and mandatory reporting of confirmed pH1N1-associated hospitalizations and deaths to the public health service. The proportion of pH1N1 positive specimens was applied to estimates of ILI, hospitalizations, and deaths to estimate disease burden.
Results
Of 34,177 specimens tested at NSW laboratories, 4,094 (12%) were pH1N1 positive. Of 1,881 specimens from patients evaluated in emergency departments and/or hospitalized, 524 (26%) were pH1N1 positive. The estimated number of persons with pH1N1-associated ILI in the HNE region was 53,383 (range 37,828–70,597) suggesting a 6.2% attack rate (range 4.4–8.2%). An estimated 509 pH1N1-associated hospitalizations (range 388–630) occurred (reported: 184), and up to 10 pH1N1-associated deaths (range 8–13) occurred (reported: 5). The estimated case hospitalization ratio was 1% and case fatality ratio was 0.02%.
Discussion
The first wave of pH1N1 activity in HNE resulted in symptomatic infection in a small proportion of the population, and the number of HNE pH1N1-associated hospitalizations and deaths is likely higher than officially reported.
doi:10.1371/journal.pone.0009880
PMCID: PMC2848017  PMID: 20360868
7.  Syndromic surveillance: is it a useful tool for local outbreak detection? 
New surveillance systems are required to meet the demands of a changing world.
doi:10.1136/jech.2005.035337
PMCID: PMC2563979  PMID: 16680907
surveillance; bioterrorism; outbreak; syndromic

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