North Sydney, Australia
North Sydney, Australia

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Freeman E.,NSW Public Health Officer Training Program | Freeman E.,University of New South Wales | Lawrence G.,University of New South Wales | McAnulty J.,University of New South Wales | And 3 more authors.
Vaccine | Year: 2014

Background: In 2009, national guidelines for hepatitis A control in Australia changed to recommend hepatitis A vaccine (HAV), instead of normal human immune globulin (NHIG), for post-exposure prophylaxis (PEP). Aims: (1) Determine whether the uptake of PEP among contacts of hepatitis A cases changed after the introduction of the new guidelines, and (2) assess the field effectiveness of the HAV used as PEP in preventing infection among contacts of hepatitis A cases. Methods: A retrospective cohort of contacts from hepatitis A cases reported to metropolitan Public Health Units in Sydney, Australia, between October 2008 and June 2010, was identified. Contacts were analysed by time period, age, PEP type, and susceptibility to hepatitis A. The relative risk (RR) of hepatitis A infection among susceptible contacts who received HAV, compared with susceptible contacts who had not received HAV, was calculated to estimate the effectiveness of the HAV when used as PEP. Results: The uptake of PEP by susceptible contacts increased from 76% (n = 133) to 89% (n = 127) after the introduction of the new guidelines. Before the change in guidelines, no one who received PEP was later reported with hepatitis A. After the change in guidelines, one of the 123 contacts who received HAV as PEP was subsequently reported with hepatitis A. However, this case was likely to have been co-exposed with a primary case. Conservatively, assuming this was a secondary case, the vaccine effectiveness of HAV was 95.6% (66.1%-99.4%). Nine of 10 incident cases of hepatitis A were contacts who did not receive any PEP. Conclusion: The improved uptake of PEP and the high estimate of the effectiveness of HAV provides support for using HAV for PEP. The very high occurrence of hepatitis A among contacts who did not receive any PEP further highlights the importance of PEP in preventing hepatitis A infection. © 2014 Elsevier Ltd. All rights reserved.


PubMed | Communicable Diseases Branch, University of New South Wales and Immunisation Unit
Type: Journal Article | Journal: Western Pacific surveillance and response journal : WPSAR | Year: 2016

In response to a significant increase of measles cases and a high percentage of unvaccinated adolescents in New South Wales, Australia, a measles high school catch-up vaccination programme was implemented between August and December 2014. This study aimed to explore the factors affecting school-based supplementary immunization activities (SIAs) and to inform future SIA and routine school-based vaccination programme implementation and service provision.Focus group analysis was conducted among public health unit (PHU) staff responsible for implementing the SIA catch-up programme. Key areas discussed were pre-programme planning, implementation, resources, consent materials, media activity and future directions for school vaccination programme delivery. Sessions were audio recorded, transcribed verbatim and reviewed. Thematic analysis was conducted to identify the major themes.Two independent focus groups with 32 participants were conducted in January 2015. Barriers to the SIA implementation included lead time, consent processes, interagency collaboration, access to the targeted cohort and the impact of introducing a SIA to an already demanding curriculum and school programme immunization schedule. A positive PHU school coordinator rapport and experience of PHU staff facilitated the implementation. Consideration of different approaches for pre-clinic vaccination status checks, student involvement in the vaccination decision, online consent, workforce sharing between health districts and effective programme planning time were identified for improving future SIA implementation.Although many barriers to school programme implementation have been identified in this study, with adequate resourcing and lead time, SIAs implemented via a routine school vaccination programme are an appropriate model to target adolescents.


PubMed | Communicable Diseases Branch and North Coast Public Health Unit
Type: Case Reports | Journal: Public health research & practice | Year: 2015

Hendra virus (HeV) infection is a zoonosis of importance in Australia. An outbreak of HeV occurred on the mid-north coast region of New South Wales (NSW) in June and July 2013. Four unvaccinated horses on four separate properties were confirmed to have HeV infection. A pet dog that had close contact with one of the horses was also confirmed to be infected with HeV. This paper documents the response to the canine infection and the resulting change to the public health management of HeV infection.


Chua K.Y.L.,Westmead Hospital | Thapa K.,Westmead Hospital | Yapa C.M.,Communicable Diseases Branch | Yapa C.M.,Australian National University | And 8 more authors.
Journal of Clinical Virology | Year: 2015

Background: Despite the World Health Organization (WHO)-reported elimination of measles in Australia, importation of cases especially in travellers from Asia continues in Sydney, Australia's largest city. Laboratory confirmation supports clinico-epidemiological evidence of measles virus infection, and is needed to establish elimination. Objectives: To evaluate the performance of a random access real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay using the moderate complexity SmartCycler® platform, and measles antigen detection by immunofluorescence (IFA), for the detection of measles virus in patient samples. Study design: One hundred samples comprising nose and throat swabs, nasopharyngeal aspirates and urine, collected from patients with suspected measles were tested in parallel using IFA and nucleic acid testing using the SmartCycler® and LightCycler® RT-PCR platforms. The LightCycler® RT-PCR was used as the reference assay against which the SmartCycler® RT-PCR and IFA were compared. Results: Using the LightCycler® RT-PCR, measles virus was detected in 35 clinical samples. There was 100% concordance between the results of the SmartCycler® and the LightCycler®-based RT-PCR. Measles genotypes detected included B3, D8, and D9. Testing urine in addition to NTS did not improve diagnostic yield. In contrast, the sensitivity and specificity of IFA compared to the reference LightCycler® RT-PCR was 34.3% and 96.7%, respectively. Conclusion: The performance of the SmartCycler® is comparable to the LightCycler® for the detection of measles virus. However, IFA had poor sensitivity and should not be used to confirm measles virus infection where nucleic acid testing is available. © 2015 Elsevier B.V.


PubMed | Communicable Diseases Branch, University of New South Wales and Westmead Hospital
Type: | Journal: Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology | Year: 2015

Despite the World Health Organization (WHO)-reported elimination of measles in Australia, importation of cases especially in travellers from Asia continues in Sydney, Australias largest city. Laboratory confirmation supports clinico-epidemiological evidence of measles virus infection, and is needed to establish elimination.To evaluate the performance of a random access real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay using the moderate complexity SmartCycler() platform, and measles antigen detection by immunofluorescence (IFA), for the detection of measles virus in patient samples.One hundred samples comprising nose and throat swabs, nasopharyngeal aspirates and urine, collected from patients with suspected measles were tested in parallel using IFA and nucleic acid testing using the SmartCycler() and LightCycler() RT-PCR platforms. The LightCycler() RT-PCR was used as the reference assay against which the SmartCycler() RT-PCR and IFA were compared.Using the LightCycler() RT-PCR, measles virus was detected in 35 clinical samples. There was 100% concordance between the results of the SmartCycler() and the LightCycler()-based RT-PCR. Measles genotypes detected included B3, D8, and D9. Testing urine in addition to NTS did not improve diagnostic yield. In contrast, the sensitivity and specificity of IFA compared to the reference LightCycler() RT-PCR was 34.3% and 96.7%, respectively.The performance of the SmartCycler() is comparable to the LightCycler() for the detection of measles virus. However, IFA had poor sensitivity and should not be used to confirm measles virus infection where nucleic acid testing is available.


PubMed | Communicable Diseases Branch and University of New South Wales
Type: Journal Article | Journal: Vaccine | Year: 2014

In 2009, national guidelines for hepatitis A control in Australia changed to recommend hepatitis A vaccine (HAV), instead of normal human immune globulin (NHIG), for post-exposure prophylaxis (PEP).(1) Determine whether the uptake of PEP among contacts of hepatitis A cases changed after the introduction of the new guidelines, and (2) assess the field effectiveness of the HAV used as PEP in preventing infection among contacts of hepatitis A cases.A retrospective cohort of contacts from hepatitis A cases reported to metropolitan Public Health Units in Sydney, Australia, between October 2008 and June 2010, was identified. Contacts were analysed by time period, age, PEP type, and susceptibility to hepatitis A. The relative risk (RR) of hepatitis A infection among susceptible contacts who received HAV, compared with susceptible contacts who had not received HAV, was calculated to estimate the effectiveness of the HAV when used as PEP.The uptake of PEP by susceptible contacts increased from 76% (n=133) to 89% (n=127) after the introduction of the new guidelines. Before the change in guidelines, no one who received PEP was later reported with hepatitis A. After the change in guidelines, one of the 123 contacts who received HAV as PEP was subsequently reported with hepatitis A. However, this case was likely to have been co-exposed with a primary case. Conservatively, assuming this was a secondary case, the vaccine effectiveness of HAV was 95.6% (66.1%-99.4%). Nine of 10 incident cases of hepatitis A were contacts who did not receive any PEP.The improved uptake of PEP and the high estimate of the effectiveness of HAV provides support for using HAV for PEP. The very high occurrence of hepatitis A among contacts who did not receive any PEP further highlights the importance of PEP in preventing hepatitis A infection.

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