The integrity of the vaccine cold chain in the Hunter area of New South Wales

Abstract: Two surveys investigated the integrity of the cold chain from the State Vaccine Centre in Sydney to immunisation centres in the Hunter Area. The first examined the extent to which temperatures of vaccines in transit during November 1991 exceeded 10°C. Temperatures had exceeded 10°C for unknown periods. The cumulative effect of such cold-chain impairment and reported inadequacies in vaccine maintenance and handling by the State Vaccine Centre cannot be estimated. The second survey examined the effectiveness of refrigerators used to store vaccines by Hunter area councils and community health centres and a random sample of general practices in the Hunter. Only 29 per cent of council and community health refrigerators and 22 per cent of general practice refrigerators were effective. While the second survey described the storage environment of particular vaccines for a very short period on one day only, maintenance of such conditions could compromise the integrity of stored vaccines.     

An outbreak of epidemic keratoconjunctivitis in a regional ophthalmology clinic in New South Wales

The objective of the study was to identify the extent and cause of an outbreak of epidemic keratoconjunctivitis (EKC). The study design was active case finding and a case-control study of clinic patients who developed symptoms of EKC between 31 December 2005 and 31 March 2006. The main outcome measures were clinical procedures carried out and clinicians seen during clinic visit. Significantly more cases than controls had tonometry with instillation of anaesthetic drops (OR 16.5, 95% CI 3.9-145.1, P<0.01), optical coherence tomography (OR 4.7, 95% CI 1.2-21.9, P=0.01), or instillation of dilating drops by an orthoptist (OR 2.3, 95% CI 1.1-4.7, P=0.01). Significantly more cases than controls were seen by one orthoptist (OR 21.8, 95% CI 8.2-60.0, P<0.01). Transmission of EKC within the clinic was probably due to contamination of either or both the anaesthetic drops and the tonometer head in the room used by an orthoptist. A comprehensive suite of strategies is required to prevent healthcare-associated EKC.     

Lessons Learned from the Hunter Region Health Promoting Schools Project in New South Wales, Australia

This paper describes development, over a five-year period, of the Hunter Region Health Promoting Schools Project in New South Wales (NSW), Australia. The project implemented the principles and philosophy of the Health Promoting Schools concept and evaluated its effectiveness using a randomized controlled trial involving 22 public secondary schools. An overview of the preliminary intervention model based on the health promoting schools philosophy and trialed in a pilot study is provided. The authors also outline barriers to, and difficulties in, implementing the philosophically based intervention model in the secondary school setting. The current intervention approach, which evolved over five years, is described in relation to the roles played by project team members and school communities. In addition, the authors outline guiding principles arising from the new approach which facilitated adoption of health promotion strategies in secondary school settings.     

Ischemic heart disease in the Hunter Region of New South Wales, Australia, 1979-1985

In Australia, mortality rates from ischemic heart disease have declined by more than 40 per cent in the last 20 years. To investigate the reasons for this trend, detailed studies are being conducted in the Hunter Region of New South Wales, an area with high heart disease rates. Data on death rates and attack rates from 1979 to 1984-1985 were obtained from three sources: national mortality records, local hospital statistics, and heart disease registers conducted in 1979 and 1984-1985 using World Health Organization protocols. Age-standardized death rates from ischemic heart disease, hospitalization rates for acute myocardial infarction, and attack rates from myocardial infarction determined from the disease registers all showed declines of approximately 3-4 per cent per year from 1979 to 1985. The results differ from findings in New Zealand, where the decrease in ischemic heart disease mortality has been attributed to fewer sudden deaths. These discrepancies demonstrate the need for carefully standardized studies to gain insight into evolving patterns of heart disease in different populations.     

从化市农村一起麻疹暴发流行的调查分析

目的 查明从化市某镇农村麻疹暴发流行的原因,为麻疹防治提供科学依据。方法 回顾性调查麻疹流行过程、临床特征,并进行抗体水平检测。结果 2002年12月7日至2003年1月8日共发现麻疹病例72例,罹患率为1．61％;流行高峰在12月17～25日,共46例,占63．9％;患者以5～9岁为多,共57例,占79．2％。72例患者中有麻疹基础免疫史、免疫史不详、免疫史空白的病例分别占总病例数的41．7％、5．5％、51．4％。结论 计划外生育儿童的免疫空白和加强免疫不及时落实是本次麻疹暴发流行的主要原因。今后应切实做好儿童的基础免疫和加强免疫接种工作,努力消除免疫空白人群。     

A statewide outbreak of cryptosporidiosis in New South Wales associated with swimming at public pools

From December 1997 to April 1998, 1060 laboratory-confirmed cryptosporidiosis cases were reported in New South Wales, Australia. In a case-control study, compared with 200 controls, the 100 cases were younger (mean age 42 versus 71 years; P < 0.0001), more likely to report swimming at a public pool (59% versus 38%; adjusted OR and 95% CI = 27; 1.4-5.1) and swimming in a dam, river or lake (OR = 48; 1.1-20.3) but less likely to report drinking bottled water (OR = 0.4; 0.2-0.9). In subgroup analyses, in rural areas illness was associated mainly with contact with another person with diarrhoea, and in urban areas illness was associated with swimming in a public pool. Cryptosporidium oocysts were more commonly detected in pools to which at least two notified cases had swum (P = 004). Outbreaks of cryptosporidiosis can be prolonged, involve multiple pools and be difficult to control.     

Laboratory surveillance of Shiga toxin producing Escherichia coli in South Australia and the Hunter Health Area, New South Wales, Australia.

To estimate the prevalence of Shiga toxin producing Escherichia coli in Australia, bloody stool samples from two Australian locations were screened for the presence of Shiga toxin genes, stx1 and stx2. Four of 126 (3.2%) and 139 of 5,829 (2.4%) patients from the two locations had a positive polymerase chain reaction for Shiga toxin genes.     

Hepatitis A in New South Wales, Australia from consumption of oysters: the first reported outbreak

Between 22 January and 4 April 1997, 467 hepatitis A cases were reported to the New South Wales Health Department, Australia. To identify the cause of the outbreak, we conducted a matched case-control study, and an environmental investigation. Among 66 cases and 66 postcode-matched controls, there was a strong association between illness and consumption of oysters (adjusted odds ratio 42; 95 % confidence interval 5-379). More than two-thirds of cases reported eating oysters, including one third of cases and no controls who reported eating oysters in the Wallis Lake area. A public warning was issued on 14 February, and Wallis Lake oysters were withdrawn from sale. Hepatitis A virus was subsequently identified in oyster samples taken from the lake. Hepatitis A virus poses a special risk to consumers who eat raw oysters because it can survive for long periods in estuaries and cause severe disease.     

Enteric disease outbreak reporting, New South Wales, Australia, 2000 to 2005

OBJECTIVE: To review enteric disease outbreaks reported to the NSW Department of Health. METHODS: Data from existing electronic enteric disease outbreak summary databases were used to describe the number and type of outbreaks reported, burden of illness and cause of the outbreaks. RESULTS: Between 2000 and 2005, 998 enteric disease outbreaks were reported (148 foodborne and 850 non-foodborne), affecting 24 260 people and associated with 771 hospitalisations and 21 deaths. Salmonella was confirmed in 28 per cent of foodborne outbreaks, and norovirus in 18 per cent of non-foodborne outbreaks. CONCLUSIONS: Enteric disease outbreaks cause a substantial burden of disease in NSW.     

An outbreak of measles at an emergency room

A small outbreak of measles occurred after a 33-year-old female aircrew (cabin) member presented at an emergency room with fever. Three members of the hospital staff were infected: a 42-year-old man, a 33-year-old woman, and a 26-year-old woman. The first 2 patients had not been immunised, and the third had received 2 immunisations according to the Dutch National Immunisation Programme. Vaccination of the 2 sero-negative patients within 48 h after exposure with the measles-mumps-rubella vaccine (MMR) did not prevent the development of measles. Vaccination was deemed unnecessary in the third patient. No tertiary cases occurred. The same measles virus (genotype D5) was detected by PCR and sequencing in all 4 patients. Measles remains a risk for hospital staff members who have not acquired natural immunity. The current policy of immunising patients within 72 h after exposure to measles may not be sufficient. It also appears that immunisation through the Dutch National Immunisation Programme does not always protect against nosocomial infection. Providing MMR vaccination or boosters to hospital staff in certain departments might be beneficial.     

Higher prevalence of childhood overweight and obesity in association with gender and socioeconomic status in the Hunter region of New South Wales

Objective:  To determine the prevalence of overweight and obesity in primary school-aged children in the Hunter region and examine associations with gender, age, socioeconomic status (SES) and geographical location.
Design:  Cross-sectional survey of a stratified sample of randomly selected government primary schools in the Hunter region with SES defined by Socio-Economic Index For Areas index and geographical location based on school education areas.
Subjects:  A total of 2224 out of 5206 (42.7%) primary school children from randomly selected government primary schools representing year 1 to year 6 ( x  = 9.61 ± 1.7).
Setting:  Sixteen government primary schools in the Hunter Region of New South Wales.
Main outcome measures:  Overweight and obesity were assessed using the international body mass index cut points, standardised for both age and gender as defined by Cole.
Data analyses:  Chi square (α = 0.05) was used to compare prevalence across categories of gender, age, SES or geographical location.
Results:  Of the 2224 children who had their height and weight measured, 28.35% (n = 606) were either overweight (n = 415, 19.3%) or obese (n = 191, 9.06%). Significant differences in the prevalence of combined overweight and obesity were observed between children residing in high and low socioeconomic areas, by ages and between boys and girls.
Conclusion or application:  The prevalence of childhood obesity is high and appears more prevalent in girls, in children residing in low-income areas and at specific ages. Determinants of the observed differences will need to be investigated in order to address the higher prevalence of childhood obesity in high-risk population groups.