Community and Public Health

Christchurch, New Zealand

Community and Public Health

Christchurch, New Zealand
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Gilpin B.J.,Institute of Environmental Science and Research Ltd | Walsh G.,Institute of Environmental Science and Research Ltd | On S.L.,Institute of Environmental Science and Research Ltd | Smith D.,Community and Public Health | And 2 more authors.
Epidemiology and Infection | Year: 2013

Pulsed-field gel electrophoresis genotypes of Campylobacter isolates from 603 human patients were compared with 485 isolates from retail offal (primarily chicken and lamb) to identify temporal clusters and possible sources of campylobacteriosis. Detailed epidemiological information was collected from 364 of the patients, and when combined with genotyping data allowed a putative transmission pathway of campylobacteriosis to be assigned for 88% of patients. The sources of infection were 47% food, 28% direct animal contact, 7% overseas travel, 4% person-to-person transmission and 3% water-related. A significant summer increase in campylobacteriosis cases was primarily attributed to an increase in food-related cases. Genotyping of isolates was essential for identifying the likely cause of infection for individuals. However, a more rapid and cheaper typing tool for Campylobacter is needed, which if applied to human and animal isolates on a routine basis could advance greatly our understanding of the ongoing problem of Campylobacter infection in New Zealand. Copyright © 2012 Cambridge University Press.


Cox B.,University of Otago | Richardson A.,Community and Public Health | Graham P.,University of Otago | Gislefoss R.E.,Institute of Population based Cancer Research | And 2 more authors.
British Journal of Cancer | Year: 2010

Background:We investigated whether elevation in serum cytomegalovirus (CMV) or Epstein-Barr virus (EBV) immunoglobulin G (IgG) antibody levels precedes the development of breast cancer.Methods:A nested case-control study was carried out within the Janus Serum Bank cohort. Two serum samples, one taken at least 4 years before diagnosis (sample 2) and an earlier sample (sample 1) from 399 women with invasive breast cancer and from 399 controls, matched for date of blood samples and age were tested for CMV and EBV IgG antibodies. Odds ratios (ORs) with 95% confidence intervals (CIs) for CMV and EBV seroconversion between the samples and unit changes in IgG optical density (OD) examined as a continuous variable were calculated using conditional logistic regression.Results:Eleven cases and three controls seroconverted for CMV IgG between the first and second blood samples, with an adjusted OR for CMV IgG seroconversion of 4.0 (95% CI1.1-14.4). The risk of breast cancer, adjusted for parity, increased per unit difference in CMV OD between samples (OR1.7, 95% CI1.1-2.5). In an analysis restricted to parous cases and age-matched parous controls, the OR for CMV seroconversion for IgG between the two samples, adjusted for parity and age at first birth, was 9.7 (95% CI1.2-77.3). The EBV seroconversion or change in EBV OD was not associated with risk of breast cancer.Conclusion:Our hypothesis that elevation in serum CMV IgG antibody levels precedes the development of breast cancer in some women is supported by the results of this study. Changes in EBV IgG antibody are not associated with risk of breast cancer. © 2010 Cancer Research UK All rights reserved.


Priest P.,University of Otago | McKenzie J.E.,University of Otago | McKenzie J.E.,Monash University | Audas R.,University of Otago | And 4 more authors.
PLoS Medicine | Year: 2015

The potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand. Methods and Findings: This parallel-group cluster randomised trial took place in 68 primary schools, where schools were allocated using restricted randomisation (1:1 ratio) to the intervention or control group. All children (aged 5 to 11 y) in attendance at participating schools received an in-class hand hygiene education session. Schools in the intervention group were provided with alcohol-based hand sanitiser dispensers in classrooms for the winter school terms (27 April to 25 September 2009). Control schools received only the hand hygiene education session. The primary outcome was the number of absence episodes due to any illness among 2,443 follow-up children whose caregivers were telephoned after each absence from school. Secondary outcomes measured among follow-up children were the number of absence episodes due to specific illness (respiratory or gastrointestinal), length of illness and illness absence episodes, and number of episodes where at least one other member of the household became ill subsequently (child or adult). We also examined whether provision of sanitiser was associated with experience of a skin reaction. The number of absences for any reason and the length of the absence episode were measured in all primary school children enrolled at the schools. Children, school administrative staff, and the school liaison research assistants were not blind to group allocation. Outcome assessors of follow-up children were blind to group allocation. Of the 1,301 and 1,142 follow-up children in the hand sanitiser and control groups, respectively, the rate of absence episodes due to illness per 100 child-days was similar (1.21 and 1.16, respectively, incidence rate ratio 1.06, 95% CI 0.94 to 1.18). The provision of an alcohol-based hand sanitiser dispenser in classrooms was not effective in reducing rates of absence episodes due to respiratory or gastrointestinal illness, the length of illness or illness absence episodes, or the rate of subsequent infection for other members of the household in these children. The percentage of children experiencing a skin reaction was similar (10.4% hand sanitiser versus 10.3% control, risk ratio 1.01, 95% CI 0.78 to 1.30). The rate or length of absence episodes for any reason measured for all children also did not differ between groups. Limitations of the study include that the study was conducted during an influenza pandemic, with associated public health messaging about hand hygiene, which may have increased hand hygiene among all children and thereby reduced any additional effectiveness of sanitiser provision. We did not quite achieve the planned sample size of 1,350 follow-up children per group, although we still obtained precise estimates of the intervention effects. Also, it is possible that follow-up children were healthier than non-participating eligible children, with therefore less to gain from improved hand hygiene. However, lack of effectiveness of hand sanitiser provision on the rate of absences among all children suggests that this may not be the explanation. Conclusions: The provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence. © 2014 Priest et al.


Mitchell P.,Community and Public Health | Turner N.,University of Auckland | Jennings L.,Canterbury Health Laboratories | Dong H.,Community and Public Health
Journal of Primary Health Care | Year: 2013

INTRODUCTION: Measles that develops in previously vaccinated cases has been reported to be associated with modified disease, although severity has usually been assessed by the presence or absence of symptoms. To date no studies have attempted to subjectively grade the severity of the clinical features. AIM: To investigate both the objective and subjective severity of measles in vaccinated and unvaccinated cases in the context of a community outbreak. METHODS: A retrospective observational cohort study conducted in Christchurch in 2009 using notified data compared the presentation of measles in 14 confirmed cases that had received at least one MMR (measles, mumps, rubella) vaccination and 14 age-matched unvaccinated confirmed cases. Additional details on the subjective and objective severity of the illness were obtained from parents/guardians using a standardised telephone questionnaire. RESULTS: The vaccinated group had significantly fewer clinical features on presentation (p=0.01, RR=1.3, 95% CI 1.1-1.6) and a less severe illness objectively, as measured by height and duration of fever, the number of days needing medication other than paracetamol and days required in bed. Unvaccinated cases were 2.8 times more likely to have more severe clinical features than vaccinated cases (OR=2.8, 95% CI 1.5-5.0). Unvaccinated cases were 3.0 times more likely to develop IgM antibody (RR=3.0, 95% CI 0.9-9.3). DISCUSSION: Previously vaccinated children who develop measles are likely to have less severe disease and serology results that may be inconclusive, particularly for IgM antibody if tested in the first few days after the rash onset.


Gearry R.B.,University of Otago | Gearry R.B.,Christchurch Hospital | Richardson A.K.,Community and Public Health | Frampton C.M.,University of Otago | And 3 more authors.
Journal of Gastroenterology and Hepatology (Australia) | Year: 2010

Background and Aim: The rapid increase in inflammatory bowel disease (IBD) incidence confirms the importance of environment in its etiology. We aimed to assess the role of childhood and other environmental risk factors in IBD. Methods: A population-based case-control study was carried out in Canterbury, New Zealand. Participants comprised 638 prevalent Crohn's disease (CD) cases, 653 prevalent ulcerative colitis (UC) cases and 600 randomly-selected sex and age matched controls. Exposure rates to environmental risk factors were compared. Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (CI) are presented. Results: A family history of IBD (CD OR 3.06 [2.18-4.30], UC OR 2.52 [1.90-3.54]), cigarette smoking at diagnosis (CD OR 1.99 [1.48-2.68], UC OR 0.67 [0.48-0.94]), high social class at birth (CD and UC trend, P < 0.001) and Caucasian ethnicity (CD OR 2.04 [1.05-4.38], UC OR 1.47 [1.01-2.14]) were significantly associated with IBD. City living was associated with CD (P < 0.01). Being a migrant was associated with UC (UC OR 1.40 [1.14-2.01]). Having a childhood vegetable garden was protective against IBD (CD OR 0.52 [0.36-0.76], UC OR 0.65 [0.45-0.94]) as was having been breast-fed (CD OR 0.55 [0.41-0.74], UC OR 0.71 [0.52-0.96]) with a duration-response effect. Appendicectomy, tonsillectomy, infectious monomucleosis and asthma were more common in CD patients than controls (P < 0.01). Conclusions: The importance of childhood factors in the development of IBD is confirmed. The duration-response protective association between breast-feeding and subsequent development of IBD requires further evaluation, as does the protective effect associated with a childhood vegetable garden. © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.


Bartholomew N.,Community and Public Health | Brunton C.,Community and Public Health | Mitchell P.,Community and Public Health | Williamson J.,Community and Public Health | Gilpin B.,Institute of Environmental Science and Research
Journal of Water and Health | Year: 2014

Outbreaks of waterborne gastroenteritis continue to occur in developed countries. Darfield, a rural town in the South Island of New Zealand experienced an outbreak of campylobacteriosis following a transgression of Escherichia coli on 16 August 2012. A descriptive outbreak investigation was performed. As a result, 29 cases had a laboratory-confirmed diagnosis of campylobacteriosis and 138 were identified as probable cases. Heavy rains, contamination of water with animal effluent from nearby paddocks and failures in the treatment of drinking water led to pathogens being distributed through the town's water supply. A multi-barrier approach is advocated to ensure the quality of water and many countries have legislation or programmes to address this. Although legislation for water safety plans based on a multi-barrier approach is in place in New Zealand, at the time of the outbreak it was not a requirement for the Darfield water supply. In addition, despite the awareness of the importance of a multi-barrier approach, competing interests, including those from the agricultural industry and financial restraints on water suppliers, can prevent it from being implemented. Governments need to be more willing to enforce legislation and standards to protect the public from waterborne disease. © IWA Publishing 2014.


Calder K.,Community and Public Health | Bidwell S.,Community and Public Health | Brunton C.,Community and Public Health | Pink R.,Community and Public Health
New Zealand Medical Journal | Year: 2014

Aim To evaluate the performance of the 2013 Canterbury under-18 seasonal influenza vaccination programme (Christchurch, New Zealand). Methods Routinely collected under 18 influenza vaccination uptake data were analysed to determine levels of vaccination uptake and equity of uptake across ethnic groups (NZ European, Maori and Pacific) and by level of deprivation. Qualitative data were collected to identify strategies that helped to achieve high uptake in primary care practices and schools. Results Overall uptake of influenza vaccination in 2013 was 32.9%, (compared to 18.5% in 2012), close to the target of 40%. Overall uptake in primary care was higher than in the school-based programme (29.2% versus 19.7%). Maori students had higher uptake than NZ European students in the school-based programme. In primary care, uptake for both Maori and Pacific children was lower than overall uptake and there was a marked gradient in uptake by socioeconomic quintile, with 30.2% uptake in the least deprived quintile compared to 21.9% uptake in the most deprived quintile. Conclusions The cumulative effect of 3 years’ consistency in offering the under-18 influenza vaccination in primary care practices, assisted by a timely media campaign and additional awareness generated by the school-based programme, has resulted in a marked increase in uptake of the vaccine in primary care in 2013. However, this was not equitably distributed. The school-based programme achieved better equity of uptake by deprivation and ethnicity. The challenge is to achieve both high and equitable uptake. ©NZMA.


Williams D.,Community and Public Health | Garbutt B.,Rehabilitation and Population Health | Peters J.,Auckland Regional Public Health Service
New Zealand Medical Journal | Year: 2015

This special article defines the public health principles and core public health functions that are combined to produce the public health services essential for a highly-functioning New Zealand health system. The five core functions are: health assessment and surveillance; public health capacity development; health promotion; health protection; and preventive interventions. The core functions are interconnected and are rarely delivered individually. Public health services are not static, but evolve in response to changing needs, priorities, evidence and organisational structures. The core functions describe the different ways public health contributes to health outcomes in New Zealand and provide a framework for ensuring services are comprehensive and robust. © NZMA.


PubMed | Community and Public Health
Type: Journal Article | Journal: The New Zealand medical journal | Year: 2014

To evaluate the performance of the 2013 Canterbury under-18 seasonal influenza vaccination programme (Christchurch, New Zealand).Routinely collected under 18 influenza vaccination uptake data were analysed to determine levels of vaccination uptake and equity of uptake across ethnic groups (NZ European, Maori and Pacific) and by level of deprivation. Qualitative data were collected to identify strategies that helped to achieve high uptake in primary care practices and schools.Overall uptake of influenza vaccination in 2013 was 32.9%, (compared to 18.5% in 2012), close to the target of 40%. Overall uptake in primary care was higher than in the school-based programme (29.2% versus 19.7%). Maori students had higher uptake than NZ European students in the school-based programme. In primary care, uptake for both Maori and Pacific children was lower than overall uptake and there was a marked gradient in uptake by socioeconomic quintile, with 30.2% uptake in the least deprived quintile compared to 21.9% uptake in the most deprived quintile.The cumulative effect of 3 years consistency in offering the under-18 influenza vaccination in primary care practices, assisted by a timely media campaign and additional awareness generated by the school-based programme, has resulted in a marked increase in uptake of the vaccine in primary care in 2013. However, this was not equitably distributed. The school-based programme achieved better equity of uptake by deprivation and ethnicity. The challenge is to achieve both high and equitable uptake.


PubMed | Auckland Regional Public Health Service, Community and Public Health and Rehabilitation and Population Health
Type: Journal Article | Journal: The New Zealand medical journal | Year: 2015

This special article defines the public health principles and core public health functions that are combined to produce the public health services essential for a highly-functioning New Zealand health system. The five core functions are: health assessment and surveillance; public health capacity development; health promotion; health protection; and preventive interventions. The core functions are interconnected and are rarely delivered individually. Public health services are not static, but evolve in response to changing needs, priorities, evidence and organisational structures. The core functions describe the different ways public health contributes to health outcomes in New Zealand and provide a framework for ensuring services are comprehensive and robust.

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