Trachoma surveillance in Australia, 2009. A report by the National Trachoma Surveillance and Reporting Unit

Trachoma is highly prevalent in remote Indigenous communities in Australia. The National Trachoma Surveillance and Reporting Unit was established in 2006 as a result of a Federal Government initiative to provide comprehensive surveillance data from regional and remote Indigenous communities considered by the jurisdictional population health staff to be 'At Risk' for endemic trachoma, defined as a trachoma prevalence of 5% or more. This report details the findings from the 2009 trachoma screening program together with trends in trachoma prevalence and screening coverage since 2006. Aboriginal children aged 1-9 years resident in At Risk communities were examined for trachoma using the World Health Organization (WHO) simplified trachoma grading criteria. In the Northern Territory, screening was conducted by staff from the Healthy School Age Kids program and the Aboriginal Community Controlled Health Services. In South Australia, screening was conducted by the Eye Health and Chronic Disease Specialist Support Program and a team of visiting ophthalmologists and optometrists. In Western Australia, screening was conducted by staff from State Government population health units and Aboriginal Community Controlled Health Services. In the Northern Territory, 53 of 86 At Risk communities were screened and data were reported for 2283 children. In South Australia, 12 of 72 At Risk communities were screened and data were reported for 149 children. In Western Australia, 68 of 74 At Risk communities were screened and data were reported for 1684 children. The prevalence of active trachoma ranged from 1%-44% in the Northern Territory, 0%-57% in South Australia and 13%-15% in Western Australia. Trend analysis across all three jurisdictions combined found that neither the prevalence of trachoma nor community screening coverage changed significantly between 2006 and 2009. When trend analysis was "done by jurisdiction, there was a significant decrease in trachoma prevalence and a significant increase in community screening coverage only for Western Australia over the same 4 year period. The implementation of the and Environmental improvement (SAFE) strategy has been variable. Surgery referral processes for trichiasis were reported as available in all screened communities in the Northern Territory and South Australia but only in 35% of screened communities in Western Australia. Antibiotics were distributed according to Communicable Diseases Network Australia guidelines in 89% of communities where treatment was indicated. Facial cleanliness programs and resources were reported as poorly implemented in South Australia and Western Australia while minimal data were reported for environmental conditions in all jurisdictions. No significant change was found in bacterial resistance to azithromycin from 2007 to 2009. Significant gaps remain in community screening coverage and in the full implementation of the SAFE strategy. However, the parallel increase in community screening coverage and decrease in trachoma prevalence in Western Australia suggests that the SAFE strategy might have had an effect in reducing trachoma prevalence in that jurisdiction.     

Pufferfish attack on Thursday Island

In rural Australia animal attacks and bites are an increasingly common phenomenon. The pufferfish is native to the north‐eastern coast of Australia and is becoming increasingly tempted closer ashore. We present the first case and review of the literature of a vicious fish bite from this animal in a child in rural Australia.     

The migration of UK trained GPs to Australia: Does risk attitude matter?

BackgroundLittle is known about the drivers of migration of GPs. Risk attitude may play an important role as migration is fundamentally a risky decision that balances the risks of staying with the risks associated with leaving. This paper examines the association between risk attitudes and the migration of UK GPs to Australia.MethodsGPs who qualified in the UK but work in Australia and who responded to the Medicine in Australia: Balancing Employment and Life (MABEL) national longitudinal survey of doctors, were compared with GPs based in Scotland who responded to a survey. Risk attitudes were elicited for financial risks, career and professional risks and clinical risks on a scale from 1 to 5.ResultsGPs in Scotland and UK trained GPs in Australia have similar risk attitudes for financial risk. However, UK trained GPs in Australia are less willing to take clinical and career risks.ConclusionGPs who migrated to Australia after qualifying in the UK were more risk averse about their career and clinical risks. This may suggest that more risk averse GPs migrate to Australia due to pull factors such as less uncertainty around career and clinical outcomes in Australia. The uncertain NHS climate may push more risk averse doctors away from the UK.     

Reappearance of human cases due to Murray Valley encephalitis virus and Kunjin virus in central Australia after an absence of 26 years.

Murray Valley encephalitis (MVE) and Kunjin virus disease are endemic in the tropical parts of the Northern Territory and Western Australia, but have been absent from Central Australia since 1974. In 2000, 5 laboratory-confirmed cases of encephalitis occurred over a short period in the normally dry inland region of Central Australia. The sudden occurrence of cases in March and April 2000 followed unusually high rainfall in the preceding months and evidence of flavivirus activity in the endemic areas in the Kimberley region of Western Australia. Further cases were reported in the following wet season, without preceding human cases in known endemic areas. These findings indicate the reintroduction of these viruses into Central Australia and establishment of local cycles of infection with an ongoing risk to the local population. This area may also act as a potential source for reintroduction of MVE into south-eastern Australia.     

Which Australian food composition database should I use?

Aim:  This paper describes the differences between the NUTTAB and AUSNUT food composition databases now available in Australia.
Method:  The NUTTAB and AUSNUT food composition databases are described in detail by officers of Food Standards Australia New Zealand directly involved in the database management and development. The positions of Food Standards Australia New Zealand in terms of revisions and policy directions are given from an authoritative perspective.
Results:  Food Standards Australia New Zealand develops two different sets of food composition databases, NUTTAB and AUSNUT. NUTTAB is a reference database that contains primarily analysed data for Australian foods. AUSNUT is a survey database that contains only data that are directly relevant to the particular national nutrition survey for which it was developed. These databases are available free of change from the Food Standards Australia New Zealand website.
Conclusions:  Food Standards Australia New Zealand develops two distinct series of food composition databases. Users will need to be aware of the similarities and differences of each database type to be able to determine which is the most suitable for their needs.     

Surveillance report for active trachoma, 2006: National Trachoma Surveillance and Reporting Unit

The National Trachoma Surveillance and Reporting Unit (NTSRU) was established in November 2006 to improve the quality and consistency of data collection and reporting of active trachoma in Australia. Active trachoma data collected in 2006, prior to the commencement of the NTSRU, were reported by the Northern Territory, South Australia and Western Australia. In most regions, Aboriginal children aged 5-9 years were screened for signs of active trachoma, following the World Health Organization simplified trachoma grading system. In the Northern Territory the Healthy School Aged Kids program conducted school-based screening for active trachoma in 74 schools in five regions (n = 2,253). In South Australia Aboriginal school children presented for active trachoma screening when an eye team visited five Aboriginal Community Controlled Health Services (n = 275). In Western Australia population health units in collaboration with staff from population health care services, conducted school based screening for active trachoma in 53 schools in four regions (n = 1,719). Regional active trachoma prevalence for 2006 varied between the states and the Northern Territory with reported prevalences ranging from: Northern Territory = 2.5%-30%, South Australia = 0%-25%, and Western Australia = 18%-53%. Few data were reported on facial cleanliness or other aspects of the SAFE strategy, and no data were reported for trichiasis.     

A large outbreak of conjunctivitis caused by a single genotype of Neisseria gonorrhoeae distinct from those causing genital tract infections

Several epidemics of gonococcal conjunctivitis have occurred in Aboriginal populations in Central Australia. In 1997, the first outbreak in the Kimberley region of Western Australia occurred, spreading to Central Australia with a total of 447 cases. A genotyping method was applied directly to DNA extracted from patient samples to characterize the gonococcus causing the epidemic and to compare it with contemporaneous genital isolates. Those positive conjunctival specimens from Kimberley and Central Australia that could be genotyped were all indistinguishable, but were distinct from the genital gonococci, even when they shared the same auxotype and serotype. This suggested that the outbreak was due to a single genotype of Neisseria gonorrhoeae that had probably been carried between communities by infected individuals. We did not find evidence to support the existence of a genital reservoir of the types causing epidemic gonococcal conjunctivitis.     

Consensus statement for the prevention of vascular disease

This consensus statement for the prevention of vascular disease in people over 50 years of age aims to consolidate key messages from a number of evidence based guidelines and studies. It addresses the assessment and principles of management of risk factors for vascular disease, including those developed by Diabetes Australia, Kidney Health Australia, the National Heart Foundation of Australia, and the National Stroke Foundation of Australia. For more detailed information, particularly concerning treatments and levels of evidence to support the recommendations outlined in this statement, refer to the source guidelines and literature (see References).     

Professional mental health support seeking in Women of Refugee Background resettled in Australia: An exploratory study of facilitators and barriers

The present study is the first to investigate factors influencing professional mental health support seeking in Women of Refugee Background (WoRB) in Australia. WoRB are a vulnerable population with a range of complex mental health needs. Despite this, research has indicated that WoRB are an underrepresented population in the utilisation of mental health support services. This is a particular concern in Australia, due to an increasing number of WoRB being resettled. A multivariate logistical regression was conducted on a sample of 450 WoRB resettled in Australia from the Building a New Life in Australia (BNLA) data set to investigate factors associated with seeking professional mental health support. Several factors were identified as being significantly associated with professional mental health support seeking in WoRB resettled in Australia, including age, resettlement location, marital status, prearrival trauma involving violence against women, language barriers and health-related variables, including mental distress and long-term disability. The current study provides a unique insight into professional mental health support seeking from a gendered perspective in WoRB resettled in Australia. Insights into factors that influence seeking professional mental health support in this highly vulnerable population must inform mental health practice, service delivery and policies.     

The effects of partial decriminalisation on cannabis use in South Australia, 1985 to 1993

In 1987 the Cannabis Expiation Notice scheme decreased penalties for the personal use of cannabis in South Australia. Data from four National Campaign Against Drug Abuse (NCADA) household drug-use surveys covering the period 1985 to 1993 were analysed to measure the effect of the decriminalisation on cannabis use. The main outcomes used were the self-reported prevalence rates of having ever used cannabis and current weekly use. Logistic regression was used to control for the potentially confounding effects of age and sex. Other outcomes were rates of having ever been offered cannabis and willingness to use cannabis if offered it. Between 1985 and 1993 the adjusted prevalence rate of ever having used cannabis increased in South Australia from 26 per cent to 38 per cent There were also significant increases in Victoria and Tasmania, and to a lesser extent in New South Wales. The increase in South Australia was not significantly greater than the average increase (P = 0.1). Adjusted rates of weekly use increased between 1988 and 1991 in South Australia, but did not change through 1993. Although the effect was in the direction of a greater increase in Soudi Australia, this was not statistically significant when compared to increases in the rest of Australia (P = 0.07). The greatest increase in adjusted weekly use occurred in Tasmania between 1991 and 1993, from 2 per cent to 7 per cent. Although the NCADA survey data indicate that there were increases in cannabis use in South Australia in 1985–1993, they cannot be attributed to the effects of partial decriminalisation, because similar increases occurred in other states.     

Sentinel Chicken Surveillance Programme in Australia, 1 July 2001 to 30 June 2002.

Detection of flavivirus seroconversions in sentinel chicken flocks located throughout Australia is used to provide an early warning of increased levels of Murray Valley encephalitis (MVE) and Kunjin virus activity in the region. During the 2001/2002 season low levels of flavivirus activity were detected in northern Australia compared to previous years. MVE and Kunjin virus activity was detected in the Kimberley and Pilbara regions of Western Australia and the Northern Territory but not in north Queensland, New South Wales or Victoria. This is in contrast to the previous season when MVE activity was detected both in northern Australia and, for the first time in over 20 years, in New South Wales. Two cases of Murray Valley encephalitis were reported from the north of Western Australia during the 2001/2002 wet season.     

Australia and New Zealand's contribution to Pacific Island health worker brain drain

Objective: The paper aims to quantify Australia and New Zealand's contribution to the brain drain of Pacific Island health workers and to contribute firm evidence to the ongoing, highly‐contested health professional migration issue. Methods: The study uses the Australian and New Zealand 2006 census data to examine the number of Pacific Island born health professionals living in Australia and New Zealand and uses World Health Organization data to compare it against the numbers of health workers in Pacific Island countries. Results: Six hundred and fifty‐two Pacific Island born doctors and 3,467 Pacific Island born nurses and midwives are working in Australia and New Zealand, more than half of whom are from Fiji with significant numbers from Papua New Guinea, Samoa and Tonga as well. There are almost as many Fiji‐born doctors in Australia and New Zealand as there are in Fiji. There are more Samoa, Tonga and Fiji‐born nurses and midwives in Australia and New Zealand than in the domestic workforce. Conclusions: Migration of Pacific Island health professionals to Australia and New Zealand is very high and contributes to the shortage of health workers in Pacific Island countries. Implications: Australia and New Zealand are encouraged to actively address the issue in collaboration with Pacific Island partners with a number of solutions proposed.     

Zoonotic tuberculosis: on the decline

Mycobacterium bovis is a zoonotic member of the Mycobacterium tuberculosis complex responsible for a clinical syndrome indistinguishable from that due to M. tuberculosis. In Australia, infection with M. bovis has historically been associated with employment in the livestock industry or immigration from countries in which animal disease is endemic. It currently accounts for 0.2% of all human cases of tuberculosis within Australia. This paper describes a case of pulmonary M. bovis in a butcher and reviews factors responsible for the declining incidence of this disease in Australia.     

The personal cost of farming: the results of a phone-in on rural health

In March 1987 a 2-day phone-in on rural stress was conductedin Adelaide, South Australia. The phone-in, the first of itskind in Australia, elicited an overwhelming response from therural community in all parts of South Australia. The findingshighlighted very high levels of physical and psychological ill-healthamongst the callers, along with associated high levels of stress.In the present paper attention is drawn to the implicationsof these findings for rural health-care workers.     

Australia declared polio free.

For Australia to be declared polio free, evidence of the absence of circulation of wild poliovirus was required by the Regional Commission for the Certification of Eradication of Poliomyelitis in the Western Pacific in August 2000. Data on surveillance of poliomyelitis, acute flaccid paralysis (AFP), vaccine associated paralytic polio and enteroviruses were provided to document the absence of circulation of wild poliovirus. The last wild poliomyelitis virus case in Australia was in 1972. AFP surveillance has improved since it was initiated in 1995 and achieved a rate of 0.94 per 100,000 population in 1999. No wild polioviruses have been isolated from stool samples of AFP cases. Australia has in place a comprehensive network of laboratories for enterovirus surveillance and this provides further evidence for the absence of wild poliovirus infection. The immunisation coverage in the country has been over 80 per cent over the last 3 years. If there were an importation of a case of poliomyelitis into Australia, a national outbreak response would be coordinated through the Communicable Diseases Network Australia. Plans for containment of laboratory stocks of wild poliovirus are being implemented. The evidence provided was sufficient to satisfy the Regional Commission that there was no wild poliovirus circulating in the region and enabled Australia to be declared polio free on October 29, 2000 along with the other 36 countries in the Western Pacific Region. Australia must remain vigilant against importations of wild poliovirus from endemic countries and maintain high immunisation coverage and sensitive surveillance systems.     

Comparative genomic analysis of the first Ehrlichia canis detections in Australia

Ehrlichia canis (Rickettsiales; Anaplasmataceae) is one of the most prevalent tick-borne pathogens of dogs globally. The bacterium infects monocytes and is the aetiological agent of canine monocytic ehrlichiosis. For many decades Australia was thought to be free of the pathogen, but this abruptly changed in May 2020 when E. canis was detected in several dogs from Kununurra, Western Australia. Subsequent surveillance activities found unexpectedly large scale spread of E. canis throughout much of northern Australia. To gain insight into the genetic relationships of the Australian strain and its potential origin, we undertook a genomic analysis of E. canis positive domestic dog and tick (Rhipicephalus linnaei) samples from the north of Western Australia, the far north of South Australia and the Northern Territory, covering thousands of square kilometres. We obtained complete E. canis genomes from each of the three states, plus an additional 16 partial genomes, substantially increasing publicly available E. canis genetic resources. The Australian E. canis genomes were highly conserved across large geographic distances. Outside of Australia, the genomes were most similar to E. canis YZ-1 from China, although few reference sequences were available. We analysed the variable trp36 gene to obtain greater phylogenetic signal, which demonstrated that the Australian E. canis belonged to the Taiwan genotype, comprised of samples from Taiwan, China, Thailand and Turkey. Taken together, our findings suggest that E. canis in Australia may have originated from Asia or the Middle East and spread throughout northern and central Australia following its introduction.     

Rabbit haemorrhagic disease: are Australian rabbits (Oryctolagus cuniculus) evolving resistance to infection with Czech CAPM 351 RHDV?

SUMMARY Rabbit haemorrhagic disease is a major tool for the management of introduced, wild rabbits in Australia. However, new evidence suggests that rabbits may be developing resistance to the disease. Rabbits sourced from wild populations in central and southeastern Australia, and domestic rabbits for comparison, were experimentally challenged with a low 60 ID50 oral dose of commercially available Czech CAPM 351 virus - the original strain released in Australia. Levels of resistance to infection were generally higher than for unselected domestic rabbits and also differed (0-73% infection rates) between wild populations. Resistance was lower in populations from cooler, wetter regions and also low in arid regions with the highest resistance seen within zones of moderate rainfall. These findings suggest the external influences of non-pathogenic calicivirus in cooler, wetter areas and poor recruitment in arid populations may influence the development rate of resistance in Australia.     

Circulation of 2 Barmah Forest Virus Lineages in Military Training Areas,Australia

During 2017–2018, Barmah Forest virus was recovered from mosquitoes trapped in military training areas in Australia and from a soldier infected at 1 of these areas. Phylogenies of the nucleotide sequences of the envelope glycoprotein gene E2 and the 3′ untranslated region suggest that 2 lineages are circulating in eastern Australia.     

First records of Culex gelidus from Australia

Culex gelidus Theobald was recorded for the 1st time in Australia in May 1999 from 2 locations (Brisbane and Mackay, Queensland) approximately 820 km apart. Larval samples were collected from a semi-permanent freshwater swamp and an open drain and reared to adults in laboratories. Implications for Australia are discussed.