39 results on '"Nicola Stephens"'
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2. Antibodies against Spike protein correlate with broad autoantigen recognition 8 months post SARS-CoV-2 exposure, and anti-calprotectin autoantibodies associated with better clinical outcomes
- Author
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Rhiane Moody, Sabrina Sonda, Fay H. Johnston, Kylie J. Smith, Nicola Stephens, Michelle McPherson, Katie L. Flanagan, and Magdalena Plebanski
- Subjects
SARS-CoV-2 ,COVID-19 ,antibodies ,autoimmunity ,autoantibodies ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Autoantibodies to multiple targets are found during acute COVID-19. Whether all, or some, persist after 6 months, and their correlation with sustained anti-SARS-CoV-2 immunity, is still controversial. Herein, we measured antibodies to multiple SARS-CoV-2 antigens (Wuhan-Hu-1 nucleoprotein (NP), whole spike (S), spike subunits (S1, S2 and receptor binding domain (RBD)) and Omicron spike) and 102 human proteins with known autoimmune associations, in plasma from healthcare workers 8 months post-exposure to SARS-CoV-2 (n=31 with confirmed COVID-19 disease and n=21 uninfected controls (PCR and anti-SARS-CoV-2 negative) at baseline). IgG antibody responses to SARS-CoV-2 antigens were significantly higher in the convalescent cohort than the healthy cohort, highlighting lasting antibody responses up to 8 months post-infection. These were also shown to be cross-reactive to the Omicron variant spike protein at a similar level to lasting anti-RBD antibodies (correlation r=0.89). Individuals post COVID-19 infection recognised a common set of autoantigens, specific to this group in comparison to the healthy controls. Moreover, the long-term level of anti-Spike IgG was associated with the breadth of autoreactivity post-COVID-19. There were further moderate positive correlations between anti-SARS-CoV-2 responses and 11 specific autoantigens. The most commonly recognised autoantigens were found in the COVID-19 convalescent cohort. Although there was no overall correlation in self-reported symptom severity and anti-SARS-CoV-2 antibody levels, anti-calprotectin antibodies were associated with return to healthy normal life 8 months post infection. Calprotectin was also the most common target for autoantibodies, recognized by 22.6% of the overall convalescent cohort. Future studies may address whether, counter-intuitively, such autoantibodies may play a protective role in the pathology of long-COVID-19.
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- 2022
- Full Text
- View/download PDF
3. Serving the Vulnerable: The World Health Organization's Scaled Support to Countries During the First Year of the COVID-19 Pandemic
- Author
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Micaela Pereira Bajard, Nicola Stephens, Johan Eidman, Kathleen Taylor Warren, Paul Molinaro, Constance McDonough-Thayer, Rafael Rovaletti, Shambhu P. Acharya, Peter J. Graaff, and Gina Samaan
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COVID-19 ,World Health Organization ,country-vulnerability ,United Nations ,humanitarian ,pandemic ,Public aspects of medicine ,RA1-1270 - Abstract
The Inter-Agency Standing Committee (IASC), created by the United Nations (UN) General Assembly in 1991, serves as the global humanitarian coordination forum of the UN s system. The IASC brings 18 agencies together, including the World Health Organization (WHO), for humanitarian preparedness and response policies and action. Early in the COVID-19 pandemic, the IASC recognized the importance of providing intensified support to countries with conflict, humanitarian, or complex emergencies due to their weak health systems and fragile contexts. A Global Humanitarian Response Plan (GHRP) was rapidly developed in March 2020, which reflected the international support needed for 63 target countries deemed to have humanitarian vulnerability. This paper assessed whether WHO provided intensified technical, financial, and commodity inputs to GHRP countries (n = 63) compared to non-GHRP countries (n = 131) in the first year of the COVID-19 pandemic. The analysis showed that WHO supported all 194 countries regardless of humanitarian vulnerability. Health commodities were supplied to most countries globally (86%), and WHO implemented most (67%) of the $1.268 billion spent in 2020 at country level. However, proportionally more GHRP countries received health commodities and nearly four times as much was spent in GHRP countries per capita compared to non-GHRP countries ($232 vs. $60 per 1,000 capita). In countries with WHO country offices (n = 149), proportionally more GHRP countries received WHO support for developing national response plans and monitoring frameworks, training of technical staff, facilitating logistics, publication of situation updates, and participation in research activities prior to the characterization of the pandemic or first in-country COVID-19 case. This affirms WHO's capacity to scale country support according to its humanitarian mandate. Further work is needed to assess the impact of WHO's inputs on health outcomes during the COVID-19 pandemic, which will strengthen WHO's scaled support to countries during future health emergencies.
- Published
- 2022
- Full Text
- View/download PDF
4. Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance
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Jennifer H. MacLachlan, Nicole Romero, Nasra Higgins, Rachel Coutts, Rachel Chan, Nicola Stephens, and Benjamin C. Cowie
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surveillance ,epidemiology ,viral hepatitis ,migrant health ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objective: To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations. Methods: Notified cases of non‐acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior to July 2015–June 2016, and during enhanced surveillance of the period July 2016–June 2017, during which time doctors were contacted for information about new diagnoses. Results: During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18–37% to 48–65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight‐fold to 11.4‐fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers. Conclusions: Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health: Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.
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- 2020
- Full Text
- View/download PDF
5. Genomics-informed responses in the elimination of COVID-19 in Victoria, Australia: an observational, genomic epidemiological study
- Author
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Courtney R Lane, MAE, Norelle L Sherry, MBBS, Ashleigh F Porter, PhD, Sebastian Duchene, PhD, Kristy Horan, PhD, Patiyan Andersson, PhD, Mathilda Wilmot, MPH, Annabelle Turner, MPH, Sally Dougall, MPH, Sandra A Johnson, MPH, Michelle Sait, PhD, Anders Gonçalves da Silva, PhD, Susan A Ballard, PhD, Tuyet Hoang, MPH, Timothy P Stinear, ProfPhD, Leon Caly, PhD, Vitali Sintchenko, ProfPhD, Rikki Graham, PhD, Jamie McMahon, BSc, David Smith, ProfMBBS, Lex EX Leong, PhD, Ella M Meumann, MBBS, Louise Cooley, MBBS, Benjamin Schwessinger, PhD, William Rawlinson, ProfPhD, Sebastiaan J van Hal, ProfPhD, Nicola Stephens, PhD, Mike Catton, MBChB, Clare Looker, MBBS, Simon Crouch, PhD, Brett Sutton, MBBS, Charles Alpren, MBChB, Deborah A Williamson, ProfPhD, Torsten Seemann, PhD, and Benjamin P Howden, ProfPhD
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: A cornerstone of Australia's ability to control COVID-19 has been effective border control with an extensive supervised quarantine programme. However, a rapid recrudescence of COVID-19 was observed in the state of Victoria in June, 2020. We aim to describe the genomic findings that located the source of this second wave and show the role of genomic epidemiology in the successful elimination of COVID-19 for a second time in Australia. Methods: In this observational, genomic epidemiological study, we did genomic sequencing of all laboratory-confirmed cases of COVID-19 diagnosed in Victoria, Australia between Jan 25, 2020, and Jan 31, 2021. We did phylogenetic analyses, genomic cluster discovery, and integrated results with epidemiological data (detailed information on demographics, risk factors, and exposure) collected via interview by the Victorian Government Department of Health. Genomic transmission networks were used to group multiple genomic clusters when epidemiological and genomic data suggested they arose from a single importation event and diversified within Victoria. To identify transmission of emergent lineages between Victoria and other states or territories in Australia, all publicly available SARS-CoV-2 sequences uploaded before Feb 11, 2021, were obtained from the national sequence sharing programme AusTrakka, and epidemiological data were obtained from the submitting laboratories. We did phylodynamic analyses to estimate the growth rate, doubling time, and number of days from the first local infection to the collection of the first sequenced genome for the dominant local cluster, and compared our growth estimates to previously published estimates from a similar growth phase of lineage B.1.1.7 (also known as the Alpha variant) in the UK. Findings: Between Jan 25, 2020, and Jan 31, 2021, there were 20 451 laboratory-confirmed cases of COVID-19 in Victoria, Australia, of which 15 431 were submitted for sequencing, and 11 711 met all quality control metrics and were included in our analysis. We identified 595 genomic clusters, with a median of five cases per cluster (IQR 2–11). Overall, samples from 11 503 (98·2%) of 11 711 cases clustered with another sample in Victoria, either within a genomic cluster or transmission network. Genomic analysis revealed that 10 426 cases, including 10 416 (98·4%) of 10 584 locally acquired cases, diagnosed during the second wave (between June and October, 2020) were derived from a single incursion from hotel quarantine, with the outbreak lineage (transmission network G, lineage D.2) rapidly detected in other Australian states and territories. Phylodynamic analyses indicated that the epidemic growth rate of the outbreak lineage in Victoria during the initial growth phase (samples collected between June 4 and July 9, 2020; 47·4 putative transmission events, per branch, per year [1/years; 95% credible interval 26·0–85·0]), was similar to that of other reported variants, such as B.1.1.7 in the UK (mean approximately 71·5 1/years). Strict interventions were implemented, and the outbreak lineage has not been detected in Australia since Oct 29, 2020. Subsequent cases represented independent international or interstate introductions, with limited local spread. Interpretation: Our study highlights how rapid escalation of clonal outbreaks can occur from a single incursion. However, strict quarantine measures and decisive public health responses to emergent cases are effective, even with high epidemic growth rates. Real-time genomic surveillance can alter the way in which public health agencies view and respond to COVID-19 outbreaks. Funding: The Victorian Government, the National Health and Medical Research Council Australia, and the Medical Research Future Fund.
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- 2021
- Full Text
- View/download PDF
6. Epidemic forecasts as a tool for public health: interpretation and (re)calibration
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Robert Moss, James E. Fielding, Lucinda J. Franklin, Nicola Stephens, Jodie McVernon, Peter Dawson, and James M. McCaw
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influenza ,epidemics ,forecasting ,public health ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objective: Recent studies have used Bayesian methods to predict timing of influenza epidemics many weeks in advance, but there is no documented evaluation of how such forecasts might support the day‐to‐day operations of public health staff. Methods: During the 2015 influenza season in Melbourne, Australia, weekly forecasts were presented at Health Department surveillance unit meetings, where they were evaluated and updated in light of expert opinion to improve their accuracy and usefulness. Results: Predictive capacity of the model was substantially limited by delays in reporting and processing arising from an unprecedented number of notifications, disproportionate to seasonal intensity. Adjustment of the predictive algorithm to account for these delays and increased reporting propensity improved both current situational awareness and forecasting accuracy. Conclusions: Collaborative engagement with public health practitioners in model development improved understanding of the context and limitations of emerging surveillance data. Incorporation of these insights in a quantitative model resulted in more robust estimates of disease activity for public health use. Implications for public health: In addition to predicting future disease trends, forecasting methods can quantify the impact of delays in data availability and variable reporting practice on the accuracy of current epidemic assessment. Such evidence supports investment in systems capacity.
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- 2018
- Full Text
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7. Exploration of testing practices and population characteristics support an increase in chlamydia positivity in Tasmania between 2001 and 2010
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Nicola Stephens, David Coleman, Kelly Shaw, Maree O'Sullivan, Hassan Vally, and Alison Venn
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chlamydia positivity ,testing practices ,public health surveillance ,population level ,symptom status ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objective: The proportion of positive chlamydia tests in young people in Tasmania increased significantly between 2001 and 2010. While female positivity rates increased steadily, male positivity rose steeply to 2005 then stabilised. Crude positivity rates can be influenced by a variety of factors making interpretation difficult. Unique Tasmanian datasets were used to explore whether symptom status, reason for testing or sexual exposure could explain the observed positivity trends. Methods: Population‐level chlamydia positivity rates in Tasmania over a 10‐year period were compared with surveillance data collected on people aged 15 to 29 years notified with chlamydia. Results: The proportion of asymptomatic chlamydia cases increased, with the largest increase in males aged 15 to 19 years (28%). Opportunistic testing of cases increased (greatest in males, range 17–32%). Sexual exposure remained consistent. Conclusions: After allowing for any changes in sexual exposure, symptom status and reason for testing, an increase in chlamydia positivity occurred over the 10 years. Healthcare providers have increased chlamydia testing in high‐risk groups. Implications: Monitoring chlamydia testing patterns and positivity rates at a population level is a step forward in surveillance practices. Targeted surveys provide valuable information to supplement routine surveillance data.
- Published
- 2016
- Full Text
- View/download PDF
8. Associations between <scp>COVID</scp> ‐19 and hospitalisation with respiratory and non‐respiratory conditions: a record linkage study
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Stacey L Rowe, Karin Leder, Kylie Dyson, Lalitha Sundaresan, Dennis Wollersheim, Brigid Lynch, Ifrah Abdullahi, Benjamin C Cowie, Nicola Stephens, Terence M Nolan, Sheena G Sullivan, Brett Sutton, and Allen C Cheng
- Subjects
General Medicine - Abstract
To assess associations between SARS-CoV-2 infection and the incidence of hospitalisation with selected respiratory and non-respiratory conditions in a largely SARS-CoV-2 vaccine-naïve population .Self-control case series; analysis of population-wide surveillance and administrative data for all laboratory-confirmed COVID-19 cases notified to the Victorian Department of Health (onset, 23 January 2020 - 31 May 2021; ie, prior to widespread vaccination rollout) and linked hospital admissions data (admission dates to 30 September 2021).Hospitalisation of people with acute COVID-19; incidence rate ratios (IRRs) comparing incidence of hospitalisations with defined conditions (including cardiac, cerebrovascular, venous thrombo-embolic, coagulative, and renal disorders) from three days before to within 89 days of onset of COVID-19 with incidence during baseline period (60-365 days prior to COVID-19 onset).A total of 20 594 COVID-19 cases were notified; 2992 people (14.5%) were hospitalised with COVID-19. The incidence of hospitalisation within 89 days of onset of COVID-19 was higher than during the baseline period for several conditions, including myocarditis and pericarditis (IRR, 14.8; 95% CI, 3.2-68.3), thrombocytopenia (IRR, 7.4; 95% CI, 4.4-12.5), pulmonary embolism (IRR, 6.4; 95% CI, 3.6-11.4), acute myocardial infarction (IRR, 3.9; 95% CI, 2.6-5.8), and cerebral infarction (IRR, 2.3; 95% CI, 1.4-3.9).SARS-CoV-2 infection is associated with higher incidence of hospitalisation with several respiratory and non-respiratory conditions. Our findings reinforce the value of COVID-19 mitigation measures such as vaccination, and awareness of these associations should assist the clinical management of people with histories of SARS-CoV-2 infection.
- Published
- 2022
9. Lessons learnt from the first large outbreak of COVID-19 in health-care settings in Tasmania, Australia
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Fay Johnston, Tara Anderson, Michelle Harlock, Natasha Castree, Louise Parry, Therese Marfori, Michelle McPherson, Mark Veitch, Kylie Smith, and Nicola Stephens
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SARS-CoV-2 ,Australia ,COVID-19 ,Humans ,General Medicine ,Pandemics ,Tasmania ,Aged ,Disease Outbreaks - Abstract
Problem: One month after the initial case of coronavirus disease 2019 (COVID-19) in Tasmania, an island state of Australia, two health-care workers (HCWs) from a single regional hospital were notified to public health authorities following positive tests for SARS-CoV-2 nucleic acid. These were the first recognized cases in an outbreak that overwhelmed the hospital’s ability to function. Context: The outbreak originated from two index cases. Both had returned to Tasmania following travel on a cruise ship and required hospital admission for management of COVID-19. A total of 138 cases were subsequently linked to this outbreak: 81 HCWs (most being nurses) and 23 patients across three hospitals, one resident of an aged-care facility and 33 close contacts. Action: The outbreak was controlled through the identification and isolation of cases, identification and quarantining of close contacts and their household members, closure of the affected facilities and community-level restrictions to reduce social mixing in the affected region. Lessons learnt: Factors that were likely to have contributed to ongoing transmission in this setting included workplace practices that prevented adequate physical distancing, attending work while symptomatic, challenges in rapidly identifying contacts, mobility of staff and patients between facilities, and challenges in the implementation of infection control practices. Discussion: Many commonly accepted hospital practices before the COVID-19 pandemic amplified the outbreak. The lessons learnt from this investigation changed work practices for HCWs and led to wider public health interventions in the management of potential primary and secondary contacts.
- Published
- 2021
10. Primary and pharmaceutical care usage concurrent associations with a severe smoke episode and low ambient air pollution in early life
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Myriam Ziou, Caroline X. Gao, Amanda J. Wheeler, Graeme R. Zosky, Nicola Stephens, Luke D. Knibbs, Grant J. Williamson, Shannon M. Melody, Alison J. Venn, Marita F. Dalton, Shyamali C. Dharmage, and Fay H. Johnston
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Environmental Engineering ,Environmental Chemistry ,Pollution ,Waste Management and Disposal - Published
- 2023
11. The first confirmed outbreak of Barmah Forest virus in Tasmania – 2019
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Hayley Dyke, Kerryn Lodo, Nicola Stephens, and Scott Carver
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Public Health, Environmental and Occupational Health - Published
- 2023
12. Serving the Vulnerable: The World Health Organization's Scaled Support to Countries During the First Year of the COVID-19 Pandemic
- Author
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Micaela Pereira Bajard, Nicola Stephens, Johan Eidman, Kathleen Taylor Warren, Paul Molinaro, Constance McDonough-Thayer, Rafael Rovaletti, Shambhu P. Acharya, Peter J. Graaff, and Gina Samaan
- Subjects
Public Health, Environmental and Occupational Health ,COVID-19 ,Humans ,Global Health ,World Health Organization ,Pandemics - Abstract
The Inter-Agency Standing Committee (IASC), created by the United Nations (UN) General Assembly in 1991, serves as the global humanitarian coordination forum of the UN s system. The IASC brings 18 agencies together, including the World Health Organization (WHO), for humanitarian preparedness and response policies and action. Early in the COVID-19 pandemic, the IASC recognized the importance of providing intensified support to countries with conflict, humanitarian, or complex emergencies due to their weak health systems and fragile contexts. A Global Humanitarian Response Plan (GHRP) was rapidly developed in March 2020, which reflected the international support needed for 63 target countries deemed to have humanitarian vulnerability. This paper assessed whether WHO provided intensified technical, financial, and commodity inputs to GHRP countries (n = 63) compared to non-GHRP countries (n = 131) in the first year of the COVID-19 pandemic. The analysis showed that WHO supported all 194 countries regardless of humanitarian vulnerability. Health commodities were supplied to most countries globally (86%), and WHO implemented most (67%) of the $1.268 billion spent in 2020 at country level. However, proportionally more GHRP countries received health commodities and nearly four times as much was spent in GHRP countries per capita compared to non-GHRP countries ($232 vs. $60 per 1,000 capita). In countries with WHO country offices (n = 149), proportionally more GHRP countries received WHO support for developing national response plans and monitoring frameworks, training of technical staff, facilitating logistics, publication of situation updates, and participation in research activities prior to the characterization of the pandemic or first in-country COVID-19 case. This affirms WHO's capacity to scale country support according to its humanitarian mandate. Further work is needed to assess the impact of WHO's inputs on health outcomes during the COVID-19 pandemic, which will strengthen WHO's scaled support to countries during future health emergencies.
- Published
- 2021
13. Injury Incidence and Severity in Musical Theatre Dance Students: 5-year Prospective Study
- Author
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Nicola Stephens, Alan M. Nevill, and Matthew A. Wyon
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Male ,medicine.medical_specialty ,Dance ,Universities ,Ballet ,Cumulative Trauma Disorders ,Physical Therapy, Sports Therapy and Rehabilitation ,Musical ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Dancing ,Prospective cohort study ,Students ,030222 orthopedics ,Academic year ,business.industry ,Incidence (epidemiology) ,Incidence ,030229 sport sciences ,Modern dance ,Athletic Injuries ,Etiology ,Physical therapy ,Female ,business ,Music - Abstract
Dance injury research has mainly focused on ballet and modern dance with little data on musical theatre dancers. The purpose was to assess the incidence and severity of injuries in a musical theatre dance college over a 5-year period; 198 pre-professional musical theatre dancers (3 cohorts on a 3-year training course) volunteered for the study; 21 students left the course over the study period. Injury aetiology data were collected by an in-house physiotherapy team. Differences between academic year and sex were analysed using a Poisson distribution model; significant difference was set at p≤0.05. In total, 913 injuries were recorded, and more injuries occurred in academic year 1 than year 2 and 3. Overall injury incidence was 1.46 injuries per 1000 hours (95% CI 1.34, 1.56); incidence significantly decreased between year 1, 2 and 3 (p0.05). There was no significant sex difference for incidence or severity. Most injuries were classified as overuse (71% female, 67% male). Pre-professional musical theatre dancers report a high proportion of lower limb and overuse injuries comparable to other dance genres. Unlike other studies on pre-professional dancers, injury incidence and severity decreased with academic year, even though workload increased across the course.Dance injury research has mainly focused on ballet and modern dance with little data on musical theatre dancers. The purpose was to assess the incidence and severity of injuries in a musical theatre dance college over a 5-year period; 198 pre-professional musical theatre dancers (3 cohorts on a 3-year training course) volunteered for the study; 21 students left the course over the study period. Injury aetiology data were collected by an in-house physiotherapy team. Differences between academic year and sex were analysed using a Poisson distribution model; significant difference was set at p≤0.05. In total, 913 injuries were recorded, and more injuries occurred in academic year 1 than year 2 and 3. Overall injury incidence was 1.46 injuries per 1000 hours (95% CI 1.34, 1.56); incidence significantly decreased between year 1, 2 and 3 (p0.05). There was no significant sex difference for incidence or severity. Most injuries were classified as overuse (71% female, 67% male). Pre-professional musical theatre dancers report a high proportion of lower limb and overuse injuries comparable to other dance genres. Unlike other studies on pre-professional dancers, injury incidence and severity decreased with academic year, even though workload increased across the course.
- Published
- 2021
14. Genomics-informed responses in the elimination of COVID-19 in Victoria, Australia: an observational, genomic epidemiological study
- Author
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Sally Dougall, Nicola Stephens, Vitali Sintchenko, Ashleigh F. Porter, Norelle L Sherry, Mike Catton, Sebastián Duchêne, David W. Smith, Kristy A. Horan, Louise Cooley, Sandra A Johnson, Timothy P. Stinear, Anders Gonçalves da Silva, Benjamin Schwessinger, Rikki M. A. Graham, Courtney R Lane, William D. Rawlinson, Charles Alpren, Michelle Sait, Brett Sutton, Jamie McMahon, Patiyan Andersson, Simon Crouch, Deborah A Williamson, Tuyet Hoang, Benjamin P Howden, Annabelle Turner, Clare Looker, Leon Caly, Sebastiaan J. van Hal, Ella M. Meumann, Torsten Seemann, Lex Ex Leong, Mathilda Wilmot, and Susan A Ballard
- Subjects
medicine.medical_specialty ,Lineage (genetic) ,Victoria ,SARS-CoV-2 ,Public health ,Public Health, Environmental and Occupational Health ,Outbreak ,COVID-19 ,Genomics ,Articles ,law.invention ,Coronavirus ,Epidemiologic Studies ,Transmission (mechanics) ,Geography ,law ,Quarantine ,Epidemiology ,medicine ,Humans ,Observational study ,Public aspects of medicine ,RA1-1270 ,Demography - Abstract
Summary: Background: A cornerstone of Australia's ability to control COVID-19 has been effective border control with an extensive supervised quarantine programme. However, a rapid recrudescence of COVID-19 was observed in the state of Victoria in June, 2020. We aim to describe the genomic findings that located the source of this second wave and show the role of genomic epidemiology in the successful elimination of COVID-19 for a second time in Australia. Methods: In this observational, genomic epidemiological study, we did genomic sequencing of all laboratory-confirmed cases of COVID-19 diagnosed in Victoria, Australia between Jan 25, 2020, and Jan 31, 2021. We did phylogenetic analyses, genomic cluster discovery, and integrated results with epidemiological data (detailed information on demographics, risk factors, and exposure) collected via interview by the Victorian Government Department of Health. Genomic transmission networks were used to group multiple genomic clusters when epidemiological and genomic data suggested they arose from a single importation event and diversified within Victoria. To identify transmission of emergent lineages between Victoria and other states or territories in Australia, all publicly available SARS-CoV-2 sequences uploaded before Feb 11, 2021, were obtained from the national sequence sharing programme AusTrakka, and epidemiological data were obtained from the submitting laboratories. We did phylodynamic analyses to estimate the growth rate, doubling time, and number of days from the first local infection to the collection of the first sequenced genome for the dominant local cluster, and compared our growth estimates to previously published estimates from a similar growth phase of lineage B.1.1.7 (also known as the Alpha variant) in the UK. Findings: Between Jan 25, 2020, and Jan 31, 2021, there were 20 451 laboratory-confirmed cases of COVID-19 in Victoria, Australia, of which 15 431 were submitted for sequencing, and 11 711 met all quality control metrics and were included in our analysis. We identified 595 genomic clusters, with a median of five cases per cluster (IQR 2–11). Overall, samples from 11 503 (98·2%) of 11 711 cases clustered with another sample in Victoria, either within a genomic cluster or transmission network. Genomic analysis revealed that 10 426 cases, including 10 416 (98·4%) of 10 584 locally acquired cases, diagnosed during the second wave (between June and October, 2020) were derived from a single incursion from hotel quarantine, with the outbreak lineage (transmission network G, lineage D.2) rapidly detected in other Australian states and territories. Phylodynamic analyses indicated that the epidemic growth rate of the outbreak lineage in Victoria during the initial growth phase (samples collected between June 4 and July 9, 2020; 47·4 putative transmission events, per branch, per year [1/years; 95% credible interval 26·0–85·0]), was similar to that of other reported variants, such as B.1.1.7 in the UK (mean approximately 71·5 1/years). Strict interventions were implemented, and the outbreak lineage has not been detected in Australia since Oct 29, 2020. Subsequent cases represented independent international or interstate introductions, with limited local spread. Interpretation: Our study highlights how rapid escalation of clonal outbreaks can occur from a single incursion. However, strict quarantine measures and decisive public health responses to emergent cases are effective, even with high epidemic growth rates. Real-time genomic surveillance can alter the way in which public health agencies view and respond to COVID-19 outbreaks. Funding: The Victorian Government, the National Health and Medical Research Council Australia, and the Medical Research Future Fund.
- Published
- 2021
15. Use of data linkage to improve communicable disease surveillance and control in Australia: existing practices, barriers and enablers
- Author
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Terry Nolan, Karin Leder, Stacey L Rowe, Allen C. Cheng, Benjamin C Cowie, and Nicola Stephens
- Subjects
0303 health sciences ,medicine.medical_specialty ,Communicable disease ,030309 nutrition & dietetics ,Public health ,Control (management) ,Australia ,Public Health, Environmental and Occupational Health ,Information Storage and Retrieval ,Communicable Diseases ,Variety (cybernetics) ,Health data ,03 medical and health sciences ,0302 clinical medicine ,Disparate system ,Key informants ,Population Surveillance ,Environmental health ,Communicable Disease Control ,medicine ,Humans ,030212 general & internal medicine ,Business ,Data Linkage - Abstract
Objectives: To review the use of data linkage by Australian state and territory communicable disease control units, and to identify barriers to and enablers of data linkage to inform communicable disease surveillance and control activities. Methods: Semi-structured telephone interviews were carried out with one key informant from communicable disease control units in all eight Australian states and territories between October 2017 and January 2018. Results: Key informants from all Australian states and territories participated in the interview. A variety of existing practices were identified, with few jurisdictions making systematic use of available data linkage infrastructure. Key barriers identified from the review included: a lack of perceived need; system factors; and resources. Existing regulatory tools enable data linkage to enhance communicable disease surveillance and control. Conclusions: We identified considerable variation in the use of data linkage to inform communicable disease surveillance and control activities between jurisdictions. We suggest that routinely collected, disparate data are systematically integrated into existing surveillance and response policy cycle to improve communicable disease prevention and control efforts. Implications for public health: Existing gaps in communicable disease surveillance data may affect prevention and control efforts. Data linkage is recognised as a valuable method to close surveillance gaps and should be used to enhance the value of publicly held health data.
- Published
- 2019
16. Co-circulation of Multidrug-resistant Shigella Among Men Who Have Sex With Men in Australia
- Author
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Anders Gonçalves da Silva, Torsten Seemann, Nicola Stephens, James Adamopoulos, Danielle J. Ingle, Jason C Kwong, Glen P. Carter, Martyn D. Kirk, Kathryn E. Holt, Sarah L. Baines, Deborah A Williamson, Benjamin P Howden, Mary Valcanis, Marion Easton, Eric P F Chow, Marcus Y Chen, and Christopher K Fairley
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,Shigellosis ,Adolescent ,Victoria ,030106 microbiology ,Sexually Transmitted Diseases ,Microbial Sensitivity Tests ,Drug resistance ,Azithromycin ,medicine.disease_cause ,Men who have sex with men ,Young Adult ,03 medical and health sciences ,Antibiotic resistance ,Shigella flexneri ,Ciprofloxacin ,Risk Factors ,Drug Resistance, Bacterial ,Trimethoprim, Sulfamethoxazole Drug Combination ,Humans ,Medicine ,Shigella ,Homosexuality, Male ,Child ,Antiinfective agent ,Whole Genome Sequencing ,biology ,business.industry ,Computational Biology ,biology.organism_classification ,medicine.disease ,Virology ,Anti-Bacterial Agents ,3. Good health ,Multiple drug resistance ,030104 developmental biology ,Infectious Diseases ,Mutation ,Female ,business ,Plasmids - Abstract
BackgroundIn urban Australia, the burden of shigellosis is either in returning travelers from shigellosis-endemic regions or in men who have sex with men (MSM). Here, we combine genomic data with comprehensive epidemiological data on sexual exposure and travel to describe the spread of multidrug-resistant Shigella lineages.MethodsA population-level study of all cultured Shigella isolates in the state of Victoria, Australia, was undertaken from 1 January 2016 through 31 March 2018. Antimicrobial susceptibility testing, whole-genome sequencing, and bioinformatic analyses of 545 Shigella isolates were performed at the Microbiological Diagnostic Unit Public Health Laboratory. Risk factor data on travel and sexual exposure were collected through enhanced surveillance forms or by interviews.ResultsRates of antimicrobial resistance were high, with 17.6% (95/541) and 50.6% (274/541) resistance to ciprofloxacin and azithromycin, respectively. There were strong associations between antimicrobial resistance, phylogeny, and epidemiology. Specifically, 2 major MSM-associated lineages were identified: a Shigellasonnei lineage (n = 159) and a Shigella flexneri 2a lineage (n = 105). Of concern, 147/159 (92.4%) of isolates within the S. sonnei MSM-associated lineage harbored mutations associated with reduced susceptibility to recommended oral antimicrobials: namely, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Long-read sequencing demonstrated global dissemination of multidrug-resistant plasmids across Shigella species and lineages, but predominantly associated with MSM isolates.ConclusionsOur contemporary data highlight the ongoing public health threat posed by resistant Shigella, both in Australia and globally. Urgent multidisciplinary public health measures are required to interrupt transmission and prevent infection.
- Published
- 2019
17. Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-producing Enterobacterales
- Author
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Annaliese van Diemen, Claire L. Gorrie, Siobhan St. George, Susan A Ballard, Marion Easton, Torsten Seemann, Mark B. Schultz, Courtney R Lane, Donna R. M. Cameron, Michelle Sait, Allen C. Cheng, Anton Y. Peleg, Brett Sutton, Benjamin P Howden, Norelle L Sherry, Rhonda L. Stuart, Andrew J. Stewardson, Judith Brett, Anders Gonçalves da Silva, Deborah A Williamson, Jason C Kwong, Kerrie Stevens, Nicola Stephens, Denis Spelman, Mary Jo Waters, and Finn Romanes
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,Victoria ,Population ,beta-Lactamases ,law.invention ,Antibiotic resistance ,Public health surveillance ,Bacterial Proteins ,law ,Environmental health ,Epidemiology ,medicine ,Infection control ,Humans ,Prospective Studies ,antimicrobial resistance ,education ,Online Only Articles ,education.field_of_study ,business.industry ,Public health ,Incidence (epidemiology) ,carbapenemase-producing Enterobacterales ,Enterobacteriaceae Infections ,Genomics ,infection control ,public health surveillance ,Major Articles and Commentaries ,Infectious Diseases ,Transmission (mechanics) ,AcademicSubjects/MED00290 ,business - Abstract
Background Multiresistant organisms (MROs) pose a critical threat to public health. Population-based programs for control of MROs such as carbapenemase-producing Enterobacterales (CPE) have emerged and evaluation is needed. We assessed the feasibility and impact of a statewide CPE surveillance and response program deployed across Victoria, Australia (population 6.5 million). Methods A prospective multimodal intervention including active screening, carrier isolation, centralized case investigation, and comparative pathogen genomics was implemented. We analyzed trends in CPE incidence and clinical presentation, risk factors, and local transmission over the program’s first 3 years (2016–2018). Results CPE case ascertainment increased over the study period to 1.42 cases/100 000 population, linked to increased screening without a concomitant rise in active clinical infections (0.45–0.60 infections/100 000 population, P = .640). KPC-2 infection decreased from 0.29 infections/100 000 population prior to intervention to 0.03 infections/100 000 population in 2018 (P = .003). Comprehensive case investigation identified instances of overseas community acquisition. Median time between isolate referral and genomic and epidemiological assessment for local transmission was 11 days (IQR, 9–14). Prospective surveillance identified numerous small transmission networks (median, 2; range, 1–19 cases), predominantly IMP and KPC, with median pairwise distance of 8 (IQR, 4–13) single nucleotide polymorphisms; low diversity between clusters of the same sequence type suggested genomic cluster definitions alone are insufficient for targeted response. Conclusions We demonstrate the value of centralized CPE control programs to increase case ascertainment, resolve risk factors, and identify local transmission through prospective genomic and epidemiological surveillance; methodologies are transferable to low-prevalence settings and MROs globally., A statewide multimodal intervention for the control of carbapenemase-producing Enterobacterales was associated with a significant increase in case ascertainment, with no rise in clinical infections. Timely prospective epidemiological and genomic surveillance identified numerous small local transmission networks permitting rapid response.
- Published
- 2020
18. Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-Producing Enterobacterales
- Author
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Brett Sutton, Courtney R Lane, Michelle Sait, Allen C. Cheng, Annaliese van Diemen, Benjamin P Howden, Rhonda L. Stuart, Jason C Kwong, Anton Y. Peleg, Andrew J. Stewardson, Torsten Seemann, Kerrie Stevens, Mark B. Schultz, Finn Romanes, Marion Easton, Donna R. M. Cameron, Claire L. Gorrie, Judith Brett, Anders Gonçalves da Silva, Deborah A Williamson, Susan A Ballard, Siobhan St. George, Nicola Stephens, Denis Spelman, Mary Jo Waters, and Norelle L Sherry
- Subjects
medicine.medical_specialty ,education.field_of_study ,Referral ,business.industry ,Transmission (medicine) ,Incidence (epidemiology) ,Public health ,Population ,Public health surveillance ,Environmental health ,Epidemiology ,Medicine ,Infection control ,business ,education - Abstract
Background: Multi-resistant organisms (MROs) pose a critical threat to public health. Recently, population-based systems for surveillance and control of MROs such as Carbapenemase-producing Enterobacterales (CPE) have emerged globally and evaluation is needed. In this study, we assess the feasibility and impact of a state-wide CPE surveillance and response program deployed in December 2015 across Victoria, Australia (population 6·5 million). Methods: A prospective population-based multi-modal intervention, including active screening, carrier isolation, centralised case investigation and comparative pathogen genomics was implemented. We assess impact by analysing trend in CPE incidence and clinical presentation, risk factors for acquisition and local transmission, using data from the first three years of implementation (January 2016 to December 2018). Findings: CPE case ascertainment increased over the study period to 1·42 cases/100,000 population, linked to increased screening without a concomitant rise in active clinical infections (0·45-0·60 infections/100,000 population, p=0·640). Occurrence of KPC-2 infection decreased from 0·29 infections/100,000 population prior to intervention to 0·03 infections/100,000 population in 2018 (p=0·003). Comprehensive case investigation enabled identification of novel risk factors, including non-healthcare-related overseas acquisition. Median time between isolate referral and initial centralised genomic and epidemiological assessment for local transmission was 11 days (IQR 9-14). Prospective surveillance identified numerous small transmission networks (median 2, range 1-19 cases), predominantly IMP- and KPC-producing organisms. Genomic and epidemiologically defined clusters had a median pairwise distance of 8 (IQR 4-13) single nucleotide polymorphisms, however low diversity between clusters of the same sequence type suggested genomic cluster definitions alone are insufficient for targeted control measures. Interpretation: Our results demonstrate the value of centralised CPE surveillance and control programs to increase case ascertainment, resolve risk factors and identify putative local transmission through combined genomic and epidemiological surveillance; methodologies are transferable to other low-prevalence settings and MROs globally. Funding Statement: National Health and Medical Research Council (NHMRC) partnership grant (GNT1149991) and the Victorian Government. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: All data were collected in accordance with the Victorian Public Health and Wellbeing Act 2008. Ethical approval was obtained from the Human Ethics Advisory Group of the School of Biomedical Sciences, University of Melbourne (Ethics ID 1954615.2).
- Published
- 2020
19. Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015-2017
- Author
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Helen C Pitcher, Karin Leder, Benjamin C Cowie, Nicola Stephens, Terry Nolan, Allen C. Cheng, Stacey L Rowe, Brett Sutton, Rosemary Morey, and Kirsten P Perrett
- Subjects
medicine.medical_specialty ,Vaccination Coverage ,Whooping Cough ,Population ,Prenatal care ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Influenza, Human ,medicine ,Humans ,030212 general & internal medicine ,Young adult ,education ,Whooping cough ,education.field_of_study ,Obstetrics ,business.industry ,Vaccination ,General Medicine ,medicine.disease ,Immunization ,Female ,business - Abstract
Objectives: To assess variations by time of year and hospital in the uptake of influenza and pertussis vaccinations by pregnant women in Victoria; to identify factors associated with vaccination uptake. Design, setting: Retrospective analysis of data in the Victorian Perinatal Data Collection (VPDC), a population surveillance system for obstetric conditions, procedures, and pregnancy and birth outcomes. Participants: Women whose pregnancies ended in a live or stillbirth during July 2015-June 2017. Main outcome measures: Influenza and pertussis vaccinations during pregnancy. Results: 153 980 pregnancies in 67 hospitals ended during July 2015-June 2017; 59 968 pregnant women (39.0%) were vaccinated against influenza and 98 583 (64.0%) against pertussis. Coverage varied by pregnancy end date, rising for influenza during winter and spring, but for pertussis rising continuously across the two years from 37.5% to 82.2%. Differences between hospitals in coverage were marked. Factors associated with vaccination included greater maternal age, primigravidity, early antenatal care, and GP-led care. The odds of vaccination were statistically significantly lower for women born overseas and those who smoked during pregnancy; the odds of vaccination were also lower for Aboriginal and Torres Strait Islander women. Conclusions: Pertussis vaccination of pregnant women in Victoria has increased, but influenza vaccination rates remain moderate and variable. Structural changes at the system level may improve maternal vaccination rates. Embedding the delivery of maternal vaccination programs in antenatal care pathways should be a priority.
- Published
- 2019
20. Anorectal swabs as a marker of male-to-male sexual exposure in STI surveillance systems
- Author
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Anna L Bowring, Margaret Hellard, Eric P F Chow, C van Gemert, N. Bartnik, Nicola Stephens, Christopher K Fairley, Catriona S. Bradshaw, Paul A. Agius, Megan S. C. Lim, Frances H Ampt, and C. El Hayek
- Subjects
Adult ,Male ,Sexual partner ,medicine.medical_specialty ,Sexual health clinic ,Victoria ,Epidemiology ,Sexual Behavior ,Sexually Transmitted Diseases ,medicine.disease_cause ,Men who have sex with men ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Homosexuality, Male ,Reproductive health ,030505 public health ,Chlamydia ,business.industry ,virus diseases ,medicine.disease ,Original Papers ,Surgery ,Sexual Partners ,Infectious Diseases ,Population Surveillance ,0305 other medical science ,business ,Chlamydia trachomatis - Abstract
SUMMARYIdentification of priority populations such as men who have sex with men (MSM) is important in surveillance systems to monitor trends of sexually transmitted infections (STIs). We explored using routinely collected non-behavioural data as a means to establish MSM status in surveillance by assessing anorectal swab as a marker of male-to-male sexual exposure. We used chlamydia testing data from a sexual health clinic, 2007–2012. Men reporting any male sexual partner(s) in the previous 12 months were considered MSM. The dataset was split into development and validation samples to develop a univariate predictive model and assess the model fit. The dataset included 30 358 individual men and 48 554 episodes of STI testing; 45% were among reported MSM and an anorectal swab was performed in 40% of testing episodes. Anorectal swabbing had good diagnostic performance as a marker for MSM status (sensitivity = 87%, specificity = 99%, positive predictive value = 98·6%, negative predictive value = 90·3%). The model showed good fit against the internal validation sample (area under the curve = 0·93). Anorectal swabs are a valid marker of MSM behaviour in surveillance data from sexual health clinics, and they are likely to be particularly useful for monitoring STI trends among MSM with higher risk behaviour.
- Published
- 2017
21. Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance
- Author
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Rachel Coutts, Nicole Romero, Rachel Chan, Nicola Stephens, Benjamin C Cowie, Nasra Higgins, and Jennifer H MacLachlan
- Subjects
Male ,Native Hawaiian or Other Pacific Islander ,030309 nutrition & dietetics ,Liver disease ,0302 clinical medicine ,Risk Factors ,migrant health ,Epidemiology ,Medicine ,030212 general & internal medicine ,Child ,Aged, 80 and over ,0303 health sciences ,lcsh:Public aspects of medicine ,Incidence (epidemiology) ,Incidence ,Hepatitis C ,Hepatitis B ,Middle Aged ,Vietnam ,Child, Preschool ,Population Surveillance ,surveillance ,epidemiology ,Female ,Public Health ,Viral hepatitis ,Adult ,medicine.medical_specialty ,China ,Adolescent ,Victoria ,viral hepatitis ,03 medical and health sciences ,Young Adult ,Hepatitis B, Chronic ,Environmental health ,Humans ,Aged ,Hepatitis ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Australia ,Infant, Newborn ,Infant ,lcsh:RA1-1270 ,Hepatitis C, Chronic ,medicine.disease ,business - Abstract
Objective: To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations. Methods: Notified cases of non-acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior to July 2015–June 2016, and during enhanced surveillance of the period July 2016–June 2017, during which time doctors were contacted for information about new diagnoses. Results: During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18–37% to 48–65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight-fold to 11.4- fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers. Conclusions: Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health: Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.
- Published
- 2019
22. Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015-2017
- Author
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Stacey L Rowe, Kirsten P Perrett, Rosemary Morey, Nicola Stephens, Benjamin C Cowie, Terry M Nolan, Karin Leder, Helen Pitcher, Brett Sutton, and Allen C Cheng
- Subjects
Adult ,Young Adult ,Victoria ,Pregnancy ,Whooping Cough ,Influenza, Human ,Vaccination ,Humans ,Female ,Prenatal Care ,General Medicine ,Patient Acceptance of Health Care ,Pregnancy Complications, Infectious - Abstract
To assess variations by time of year and hospital in the uptake of influenza and pertussis vaccinations by pregnant women in Victoria; to identify factors associated with vaccination uptake.Retrospective analysis of data in the Victorian Perinatal Data Collection (VPDC), a population surveillance system for obstetric conditions, procedures, and pregnancy and birth outcomes.Women whose pregnancies ended in a live or stillbirth during July 2015 - June 2017.Influenza and pertussis vaccinations during pregnancy.153 980 pregnancies in 67 hospitals ended during July 2015 - June 2017; 59 968 pregnant women (39.0%) were vaccinated against influenza and 98 583 (64.0%) against pertussis. Coverage varied by pregnancy end date, rising for influenza during winter and spring, but for pertussis rising continuously across the two years from 37.5% to 82.2%. Differences between hospitals in coverage were marked. Factors associated with vaccination included greater maternal age, primigravidity, early antenatal care, and GP-led care. The odds of vaccination were statistically significantly lower for women born overseas and those who smoked during pregnancy; the odds of vaccination were also lower for Aboriginal and Torres Strait Islander women.Pertussis vaccination of pregnant women in Victoria has increased, but influenza vaccination rates remain moderate and variable. Structural changes at the system level may improve maternal vaccination rates. Embedding the delivery of maternal vaccination programs in antenatal care pathways should be a priority.
- Published
- 2018
23. The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance
- Author
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Jennie Musto, Chandini Raina MacIntyre, Heather Worth, Mitchell Smith, B. L. Forssman, Nicola Stephens, Nicholas Zwar, Anita E. Heywood, Mohamud Sheikh, Courtney R Lane, Ben Polkinghorne, and Holly Seale
- Subjects
Visiting friends and relatives ,Epidemiology ,030231 tropical medicine ,Population ,infectious diseases ,Measles ,Typhoid fever ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,medicine ,030212 general & internal medicine ,education ,enhanced surveillance ,travel ,education.field_of_study ,Communicable disease ,Surveillance ,business.industry ,immigrants ,Australia ,Hepatitis A ,medicine.disease ,Hepatitis E ,Original Papers ,visiting friends and relatives ,Optometry ,business ,human activities ,Malaria - Abstract
SUMMARYImmigrants and their children who return to their country of origin to visit friends and relatives (VFR) are at increased risk of acquiring infectious diseases compared to other travellers. VFR travel is an important disease control issue, as one quarter of Australia's population are foreign-born and one quarter of departing Australian international travellers are visiting friends and relatives. We conducted a 1-year prospective enhanced surveillance study in New South Wales and Victoria, Australia to determine the contribution of VFR travel to notifiable diseases associated with travel, including typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya. Additional data on characteristics of international travel were collected. Recent international travel was reported by 180/222 (81%) enhanced surveillance cases, including all malaria, chikungunya and paratyphoid cases. The majority of cases who acquired infections during travel were immigrant Australians (96, 53%) or their Australian-born children (43, 24%). VFR travel was reported by 117 (65%) travel-associated cases, highest for typhoid (31/32, 97%). Cases of children (aged P< 0·001). VFR travel is an important contributor to imported disease in Australia. Communicable disease control strategies targeting these travellers, such as targeted health promotion, are likely to impact importation of these travel-related infections.
- Published
- 2016
24. OUTCOME AFTER ULTRASOUND GUIDED THORACIC PARAVERTEBRAL IN RIB FRACTURES: A RETROSPECTIVE ANALYSIS OF 4 YEARS’ PRACTICE AT A U.K. MAJOR TRAUMA CENTRE
- Author
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Nicola Stephens, Jon Pearson, and Womack Jonathan
- Published
- 2018
25. Waterparks are high risk for cryptosporidiosis: A case-control study in Victoria, 2015
- Author
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Tanyth E, de Gooyer, Joy, Gregory, Marion, Easton, Nicola, Stephens, Emily, Fearnley, and Martyn, Kirk
- Subjects
Adult ,Male ,Adolescent ,Victoria ,Parks, Recreational ,Cryptosporidiosis ,Cryptosporidium ,Fresh Water ,Middle Aged ,Health Surveys ,Disease Outbreaks ,Logistic Models ,Risk Factors ,Case-Control Studies ,Child, Preschool ,Waterborne Diseases ,Odds Ratio ,Animals ,Humans ,Female ,Child - Abstract
An increase in notifications of cryptosporidiosis was observed in Victoria between March and April 2015. Cases mostly resided in one metropolitan region and hypothesis-generating interviews identified common exposures to aquatic facilities. We conducted a case-control study to determine exposure source(s) and facilitate control measures.Laboratory-confirmed cases of cryptosporidiosis from the region of interest notified between 1 March and 23 April 2015 were included. Controls residing in the same region were recruited from participants in a population health survey and frequency matched (2 per case) by age group. Details of exposure to potential risk factors were collected using a standardised telephone questionnaire for the 14-days prior to illness for cases, and an analogous exposure period for controls. Univariable and multivariable logistic regression were used to determine risk factors associated with illness using STATA SE 13.1.Thirty cases and 66 controls were included in the study. Half the cases were less than 12 years of age and 62% were female. Illness was most strongly associated with recreational water exposure at any waterpark (adjusted odds ratio (aOR)=73.5; 95% confidence interval (CI):6.74-802), and specifically at Victorian waterparks (aOR=45.6; 95% CI:5.20-399). Cases were linked with attendance at either a waterpark in the region or an adjacent region. As a result of this investigation, hyperchlorination was completed at identified facilities and swim hygiene information distributed.This study reinforces the potential for recreational water facilities, particularly waterparks, to act as a transmission source of Cryptosporidium infections. Continued communication to patrons is required to ensure healthy swimming practice in Victorian aquatic facilities.
- Published
- 2017
26. Epidemic forecasts as a tool for public health: interpretation and (re)calibration
- Author
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James E Fielding, James M. McCaw, Lucinda J Franklin, Jodie McVernon, Robert Moss, Peter Dawson, and Nicola Stephens
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Situation awareness ,Computer science ,Context (language use) ,Disease ,Unit (housing) ,03 medical and health sciences ,Bayes' theorem ,0302 clinical medicine ,Public health surveillance ,Influenza, Human ,medicine ,Humans ,Public Health Surveillance ,030212 general & internal medicine ,Epidemics ,Actuarial science ,Models, Statistical ,Public health ,lcsh:Public aspects of medicine ,public health ,Public Health, Environmental and Occupational Health ,Australia ,lcsh:RA1-1270 ,Bayes Theorem ,030104 developmental biology ,Calibration ,influenza ,Health department ,Forecasting - Abstract
Objective: Recent studies have used Bayesian methods to predict timing of influenza epidemics many weeks in advance, but there is no documented evaluation of how such forecasts might support the day‐to‐day operations of public health staff. Methods: During the 2015 influenza season in Melbourne, Australia, weekly forecasts were presented at Health Department surveillance unit meetings, where they were evaluated and updated in light of expert opinion to improve their accuracy and usefulness. Results: Predictive capacity of the model was substantially limited by delays in reporting and processing arising from an unprecedented number of notifications, disproportionate to seasonal intensity. Adjustment of the predictive algorithm to account for these delays and increased reporting propensity improved both current situational awareness and forecasting accuracy. Conclusions: Collaborative engagement with public health practitioners in model development improved understanding of the context and limitations of emerging surveillance data. Incorporation of these insights in a quantitative model resulted in more robust estimates of disease activity for public health use. Implications for public health: In addition to predicting future disease trends, forecasting methods can quantify the impact of delays in data availability and variable reporting practice on the accuracy of current epidemic assessment. Such evidence supports investment in systems capacity.
- Published
- 2017
27. Infectious diseases notification practices, Victoria 2013
- Author
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Katherine B, Gibney, Lucinda J, Franklin, and Nicola, Stephens
- Subjects
Adult ,Male ,Native Hawaiian or Other Pacific Islander ,Time Factors ,Adolescent ,Victoria ,Infant ,Middle Aged ,Communicable Diseases ,Molecular Diagnostic Techniques ,Child, Preschool ,Communicable Disease Control ,Humans ,Female ,Public Health Surveillance ,Child ,Laboratories ,Disease Notification - Abstract
Infectious disease notification practices in Victoria were reviewed to identify areas for potential improvement.Confirmed or probable cases of certain infectious diseases required to be notified to the Department of Health and Human Services (DHHS) Victoria in 2013, excluding elevated blood lead, foodborne or water-borne illness with 2 or more related cases and chlamydial infection, were analysed according to: notification source of doctor ± laboratory vs. laboratory-only; routine follow-up by public health staff for selected conditions vs. not routine; priority for Indigenous status reporting for 18 priority conditions with a target of ≥ 95% completeness vs. other conditions with a target of ≥ 80% completeness; and urgency of notification (conditions requiring immediate [same day] notification vs. conditions requiring notification within 5 days).Almost half (49%) the 34,893 confirmed and probable cases were notified by laboratory report alone. Indigenous status was complete for 48% of cases. Indigenous status was more likely to be completed for conditions with active vs. no active follow-up (RR 1.88 (95% CI 1.84-1.92)) and priority conditions for Indigenous status reporting vs. other conditions (RR 1.62 (95% CI 1.59-1.66)). Among conditions without active follow-up, doctor-notified cases had more complete Indigenous status reporting than laboratory-only notified cases (86% vs. 6%, RR 15.06 (95% CI 14.15-16.03)). Fewer notifications requiring same day notification were received within the legislated time frame (59%) than notifications required to be notified within 5 days (90%).DHHS Victoria handles a large volume of infectious disease notifications. Incomplete Indigenous status reporting, particularly for conditions without active follow-up, and delayed notification of conditions requiring immediate attention warrant attention. These findings will be used to improve notification practices in Victoria. Commun Dis Intell 2016;40(3):E317-E325.
- Published
- 2017
28. Transmission ofMycobacterium tuberculosisfrom an Asian elephant (Elephas maximus) to a chimpanzee (Pan troglodytes) and humans in an Australian zoo
- Author
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Nicola Stephens, Jeremy McAnulty, Larry Vogelnest, Guy B. Marks, Vitali Sintchenko, Chris P. Lowbridge, and Amanda Christensen
- Subjects
Male ,Tuberculosis ,Pan troglodytes ,Epidemiology ,Elephants ,Tuberculin ,Mycobacterium tuberculosis ,Elephas ,Tuberculosis diagnosis ,Latent Tuberculosis ,Asian elephant ,Zoonoses ,medicine ,Animals ,Humans ,biology ,Tuberculin Test ,Transmission (medicine) ,biology.organism_classification ,medicine.disease ,Antibodies, Bacterial ,Original Papers ,Virology ,Ape Diseases ,Infectious Diseases ,Fomites ,Animals, Zoo ,Female ,Contact Tracing ,New South Wales ,Biomarkers ,Contact tracing - Abstract
SUMMARYMycobacterium tuberculosisis primarily a pathogen of humans. Infections have been reported in animal species and it is emerging as a significant disease of elephants in the care of humans. With the close association between humans and animals, transmission can occur. In November 2010, a clinically healthy Asian elephant in an Australian zoo was found to be sheddingM. tuberculosis; in September 2011, a sick chimpanzee at the same zoo was diagnosed with tuberculosis caused by an indistinguishable strain ofM. tuberculosis.Investigations included staff and animal screening. Four staff had tuberculin skin test conversions associated with spending at least 10 hours within the elephant enclosure; none had disease. Six chimpanzees had suspected infection. A pathway of transmission between the animals could not be confirmed. Tuberculosis in an elephant can be transmissible to people in close contact and to other animals more remotely. The mechanism for transmission from elephants requires further investigation.
- Published
- 2013
29. An outbreak ofSalmonellaInfantis gastroenteritis in a residential aged care facility associated with thickened fluids
- Author
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Nicola Stephens, Stephen Conaty, Z Najjar, P Maywood, Geoff Hogg, Craig Shadbolt, and C Furlong
- Subjects
Diarrhea ,Male ,Salmonella ,Pediatrics ,medicine.medical_specialty ,Vomiting ,Epidemiology ,medicine.disease_cause ,Disease Outbreaks ,Beverages ,Thickened fluids ,Environmental health ,Confidence Intervals ,Odds Ratio ,medicine ,Homes for the Aged ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Food poisoning ,Viscosity ,business.industry ,Transmission (medicine) ,Salmonella enterica ,Outbreak ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Original Papers ,Confidence interval ,Diet ,Gastroenteritis ,Logistic Models ,Infectious Diseases ,Salmonella Infections ,Food Microbiology ,Female ,New South Wales ,business - Abstract
SUMMARYTwenty-two confirmed cases ofSalmonellaInfantis were identified in 70 residents of high-level care areas of a residential aged care facility in Sydney in April 2010 during an outbreak of gastroenteritis. A retrospective cohort study was conducted to identify a possible cause. Consuming a soft diet, puréed diet, or thickened fluid were each independently associated with illness. A logistic regression showed consumption of thickened fluid to be the only significant exposure associated with illness (adjusted odds ratio 11·8, 95% confidence interval 1·9–75·9). It was postulated that the thickened fluid had been contaminated by chicken mince, a sample of which also culturedS. Infantis. This finding reinforces the need to educate food-handlers on the risk of potential cross-contamination; it also highlights the need to consider all dietary components, such as thickened fluids, as potential vehicles for transmission in an outbreak.
- Published
- 2012
30. Molecular Epidemiology and Spatial Distribution of a Waterborne Cryptosporidiosis Outbreak in Australia
- Author
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Belinda C. Ferrari, Paul J. Beggs, Michelle L. Power, Liette S. Waldron, Nicola Stephens, and Cristel Cheung-Kwok-Sang
- Subjects
Genotype ,Molecular Sequence Data ,Cryptosporidiosis ,Cryptosporidium ,Public Health Microbiology ,Applied Microbiology and Biotechnology ,Disease Outbreaks ,Feces ,Public swimming pool ,Environmental health ,parasitic diseases ,medicine ,Cluster Analysis ,Humans ,Molecular Epidemiology ,Ecology ,biology ,Molecular epidemiology ,Spatiotemporal Analysis ,Age Factors ,Water ,Outbreak ,Waterborne diseases ,Sequence Analysis, DNA ,DNA, Protozoan ,biology.organism_classification ,medicine.disease ,Phylogeography ,New South Wales ,Cryptosporidium hominis ,Food Science ,Biotechnology - Abstract
Cryptosporidiosis is one of the most common waterborne diseases reported worldwide. Outbreaks of this gastrointestinal disease, which is caused by the Cryptosporidium parasite, are often attributed to public swimming pools and municipal water supplies. Between the months of January and April in 2009, New South Wales, Australia, experienced the largest waterborne cryptosporidiosis outbreak reported in Australia to date. Through the course of the contamination event, 1,141 individuals became infected with Cryptosporidium . Health authorities in New South Wales indicated that public swimming pool use was a contributing factor in the outbreak. To identify the Cryptosporidium species responsible for the outbreak, fecal samples from infected patients were collected from hospitals and pathology companies throughout New South Wales for genetic analyses. Genetic characterization of Cryptosporidium oocysts from the fecal samples identified the anthroponotic Cryptosporidium hominis IbA10G2 subtype as the causative parasite. Equal proportions of infections were found in males and females, and an increased susceptibility was observed in the 0- to 4-year age group. Spatiotemporal analysis indicated that the outbreak was primarily confined to the densely populated coastal cities of Sydney and Newcastle.
- Published
- 2011
31. Chlamydia trachomatis in Tasmania 2001–2007: rising notification trends
- Author
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David C. Coleman, Nicola Stephens, Maree O'Sullivan, and Kelly A Shaw
- Subjects
Adult ,Male ,Rural Population ,Gerontology ,medicine.medical_specialty ,Adolescent ,National Health Programs ,Urban Population ,Sexual Behavior ,Population ,Chlamydia trachomatis ,medicine.disease_cause ,Tasmania ,Indigenous ,Young Adult ,Age Distribution ,Epidemiology ,medicine ,Humans ,Mass Screening ,Sex Distribution ,education ,Disease Notification ,Aged ,education.field_of_study ,Chlamydia ,business.industry ,Incidence ,Public health ,Public Health, Environmental and Occupational Health ,Chlamydia Infections ,Middle Aged ,medicine.disease ,Sexual Partners ,Health promotion ,Female ,business ,Sentinel Surveillance ,Contact tracing ,Demography - Abstract
Objectives: To investigate trends in notification rates of Chlamydia trachomatis in Tasmania, Australia, by population sub-groups, from 1 January 2001 to 31 December 2007. Methods: An enhanced surveillance dataset was used to supplement case notifications. Rates based on age group were analysed by sex, geographic region, indigenous status, sexual exposure, reason for testing and healthcare provider. Results: In all age groups, the notification rate increased steeply. The highest rates were seen in the ages 15-24 years; this age group represented 15% of the population but accounted for 74% of the chlamydial notifications. The increased rates in females aged 15-24 years and males 15-19 years in Tasmania were larger than the increases observed nationally. Rates were consistently higher in urban areas. Females were more likely to have been tested as a result of screening, and males were more likely to have been tested when presenting with symptoms or as a result of contact tracing. The majority of cases reported sexual exposure with opposite sex partners only. Conclusions: This study highlights the increasing significance of chlamydial infection as a public health issue, the gender differences in health-seeking behaviour, and the discrepancies in testing patterns. These findings will assist with the design of health promotion programs. ©2010 The Authors.
- Published
- 2010
32. Travel Destinations and Sexual Behavior as Indicators of Antibiotic Resistant Shigella Strains--Victoria, Australia
- Author
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Courtney R Lane, Karin Lalor, Martyn D. Kirk, Cathryn Walker, Nicola Stephens, Mary Valcanis, and Brett Sutton
- Subjects
0301 basic medicine ,Male ,medicine.disease_cause ,Men who have sex with men ,Disease Outbreaks ,Sexual and Gender Minorities ,0302 clinical medicine ,Anti-Infective Agents ,Ciprofloxacin ,Risk Factors ,Drug Resistance, Multiple, Bacterial ,Medicine ,Travel medicine ,Shigella sonnei ,Shigella ,030212 general & internal medicine ,Child ,Aged, 80 and over ,Travel ,Middle Aged ,Anti-Bacterial Agents ,Infectious Diseases ,Child, Preschool ,Female ,Microbiology (medical) ,Adult ,medicine.medical_specialty ,Shigellosis ,Adolescent ,Victoria ,Sexual Behavior ,030106 microbiology ,Microbial Sensitivity Tests ,03 medical and health sciences ,Young Adult ,Antibiotic resistance ,Environmental health ,Humans ,Risk factor ,Aged ,Dysentery, Bacillary ,business.industry ,Infant, Newborn ,Outbreak ,Infant ,medicine.disease ,Indonesia ,Immunology ,business ,Travel Medicine - Abstract
Background. Knowledge of relationships between antibiotic susceptibility of Shigella isolates and travel destination or other risk factors can assist clinicians in determining appropriate antibiotic therapy prior to susceptibility testing. We describe relationships between resistance patterns and risk factors for acquisition in Shigella isolates using routinely collected data for notified cases of shigellosis between 2008 and 2012 in Victoria, Australia. Methods. We included all shigellosis patients notified during the study period, where Shigella isolates were tested for antimicrobialsensitivity using Clinical and Laboratory Standards Institute breakpoints. Cases were interviewed to collect data on risk factors,including recent travel. Data were analyzed using Stata 13.1 to examine associations between risk factors and resistant strains. Results. Of the 500 cases of shigellosis, 249 were associated with overseas travel and 210 were locally acquired. Forty-six of 51 isolates of Indian origin displayed decreased susceptibility or resistance to ciprofloxacin. All isolates of Indonesian origin were susceptible to ciprofloxacin. Twenty-six travel-related isolates were resistant to all tested oral antimicrobials. Male-to-male sexual contact was the primary risk factor for 80% (120/150) of locally acquired infections among adult males, characterized by distinct periodic Shigella sonnei outbreaks. Conclusions. Clinicians should consider travel destination as a marker for resistance to common antimicrobials in returning travelers, where severe disease requires empirical treatment prior to receipt of individual sensitivity testing results. Repeated outbreaks of locally acquired shigellosis among men who have sex with men highlight the importance of prevention and control measures in this high-risk group.
- Published
- 2015
33. Structure and in vitro function of human subcutaneous small arteries in mild heart failure
- Author
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Nicola Stephens, Alistair S. Hall, Mark J. Drinkhill, Stephen G. Ball, and Anthony M. Heagerty
- Subjects
Male ,Ramipril ,medicine.medical_specialty ,Heart disease ,Physiology ,Vasodilator Agents ,medicine.medical_treatment ,Cardiac Output, Low ,Angiotensin-Converting Enzyme Inhibitors ,In Vitro Techniques ,Internal medicine ,medicine ,Humans ,Vasoconstrictor Agents ,Myocardial infarction ,Aged ,Skin ,Chemotherapy ,business.industry ,Arteries ,Cell Biology ,Middle Aged ,medicine.disease ,Electric Stimulation ,Surgery ,medicine.anatomical_structure ,Heart failure ,ACE inhibitor ,Cardiology ,Female ,medicine.symptom ,business ,Vasoconstriction ,medicine.drug ,Artery - Abstract
The structure and function of subcutaneous small arteries from patients with mild heart failure ( n = 27) 6–43 mo after myocardial infarction were compared with vessels from healthy control subjects ( n = 10). Patients were randomized to treatment with placebo or the angiotensin-converting enzyme inhibitor ramipril starting 3–10 days after myocardial infarction. Dissected arterial vessels were mounted on a wire myograph for measurement of morphology and isometric tension. Morphology was not different in arteries from the three groups. Responses to norepinephrine, angiotensin II, and electrical field stimulation were similar in arteries from placebo-treated patients with mild heart failure and control subjects. Similarly, endothelium-dependent and -independent relaxation was normal in arteries from patients with mild heart failure. Ramipril therapy was associated with functional alterations: vasoconstrictor responses to norepinephrine and angiotensin II were significantly enhanced compared with placebo ( P < 0.001). These data suggest that vascular structure and function are not different in vitro in subcutaneous arteries from placebo-treated patients with mild heart failure. Angiotensin-converting enzyme inhibitor therapy is associated with enhanced vasoconstriction to norepinephrine and angiotensin II, which may reflect upregulation of receptor-mediated events.
- Published
- 1998
34. Transmission of tuberculosis infection in a commercial office
- Author
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Nicola Stephens, Peter Trevan, Elaine Tay, Maria Globan, Mohammad Bagherirad, and Eugene Athan
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Tuberculosis ,Delayed Diagnosis ,Victoria ,business.industry ,Transmission (medicine) ,Tuberculin Test ,General Medicine ,Disease ,medicine.disease ,Delayed diagnosis ,Disease cluster ,Occupational Diseases ,Medicine ,Cluster Analysis ,Humans ,business ,Tuberculin test ,Workplace ,Interferon-gamma Release Tests ,Occupational Health - Abstract
We report a cluster of cases of tuberculosis in a commercial office in Victoria, possibly transmitted because of a delay in diagnosing, quarantining and treating a patient with an active case of the disease.
- Published
- 2012
35. Public health policies and management strategies for genital Chlamydia trachomatis infection
- Author
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Nicola Stephens, Maree O'Sullivan, Kelly A Shaw, and David C. Coleman
- Subjects
education.field_of_study ,medicine.medical_specialty ,Chlamydia ,Transmission (medicine) ,business.industry ,Public health ,screening ,Population ,public health ,Public Health, Environmental and Occupational Health ,chlamydia ,health policy ,Disease ,Review ,medicine.disease ,Partner notification ,medicine.disease_cause ,Environmental health ,Immunology ,medicine ,education ,business ,Chlamydia trachomatis ,Health policy - Abstract
Genital Chlamydia trachomatis is a sexually transmissible bacterial infection that is asymptomatic in the majority of infected individuals and is associated with significant short-term and long-term morbidity. The population prevalence of the infection appears to be increasing. C. trachomatis is of public health significance because of the impacts of untreated disease on reproductive outcomes, transmission of other sexually acquired infections, and the costs to health systems. At the individual level, C. trachomatis infection is readily treatable with antibiotics, although antibiotic resistance appears to be increasing. At the population level, public health control of spread of infection is more problematic. Approaches to control include primary preventive activities, increased access to testing and treatment for people with or at risk of infection, partner notification and treatment, and screening either opportunistically or as part of an organized population screening program. A combination of all of the above approaches is likely to be required to have a significant effect on the burden of disease associated with genital chlamdyia infection and to reduce population prevalence. The development of a vaccine for genital chlamydia infection could significantly reduce the public health burden associated with infection; however a vaccine is not expected to be available in the near future.
- Published
- 2012
36. The Sympathetic Nervous System and Small Artery Neuroeffector Function in Hypertension
- Author
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Nicola Stephens and Anthony M. Heagerty
- Subjects
030110 physiology ,0301 basic medicine ,medicine.medical_specialty ,Sympathetic nervous system ,Neuroeffector ,business.industry ,030204 cardiovascular system & hematology ,Small artery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 1994
37. Arterial neuroeffector responses in early and mature spontaneously hypertensive rats
- Author
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Nicola Stephens, Carol Jagger, Stuart J. Bund, and Anthony M. Heagerty
- Subjects
Male ,medicine.medical_specialty ,Neuroeffector ,Alpha (ethology) ,Stimulation ,Neurotransmission ,Rats, Inbred WKY ,Cocaine ,Rats, Inbred SHR ,Internal medicine ,Neuroeffector Junction ,Internal Medicine ,medicine ,Animals ,Mesenteric arteries ,business.industry ,Yohimbine ,Arteries ,Prazosin ,Receptors, Adrenergic, alpha ,Electric Stimulation ,Rats ,Endocrinology ,medicine.anatomical_structure ,Hypertension ,business ,Myograph ,medicine.drug ,Artery - Abstract
Intramural sympathetic neuroeffector responses and presynaptic regulation of neurotransmission by amine uptake and alpha 2-adrenergic receptors were examined in young (5-week-old) and mature (12-week-old) spontaneously hypertensive rats (SHR) and were compared with those of age-matched Wistar-Kyoto (WKY) control rats. Electrical field stimulation (20 V, 0.2-msec pulse width, 3-second pulse train each minute, 5-100 Hz) elicited contractile responses from isolated mesenteric arteries mounted in a myograph. There was a significant difference between the sensitivity of arteries to electrical field stimulation in the two age groups, with arteries from 12-week-old rats being more sensitive than arteries from 5-week-old animals. Also, there was a significant age-strain interaction: the sensitivity of arteries from SHR to electrical field stimulation increased dramatically with age compared with that of WKY rat arteries. Cocaine significantly increased the sensitivity to electrical field stimulation after inhibition of presynaptic alpha 2-adrenergic receptors, and had a significantly greater effect in arteries from 5-week-old SHR compared with WKY controls. This would reflect an overactive neuronal amine uptake mechanism in young SHR. At 12 weeks there was no significant interstrain difference in the effect of cocaine. Yohimbine increased the sensitivity to electrical field stimulation both before and after inhibition of neuronal amine uptake, but there was no difference in its effect with age or strain. Therefore, although sensitivity to sympathetic nerve stimulation varies with age in the SHR, there is no evidence that this can be ascribed to alpha 2-adrenergic receptor function.
- Published
- 1991
38. Influence of isradipine and spirapril on left ventricular hypertrophy and resistance arteries
- Author
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Gottfried Weidinger, Norbert Rietbrock, Petra A. Thürmann, Anthony M. Heagerty, Peter Kenedi, and Nicola Stephens
- Subjects
Male ,medicine.medical_specialty ,Heart disease ,Angiotensin-Converting Enzyme Inhibitors ,Blood Pressure ,Left ventricular hypertrophy ,Muscle hypertrophy ,Enalapril ,Internal medicine ,Biopsy ,Internal Medicine ,medicine ,Humans ,Spirapril ,Prospective Studies ,Antihypertensive Agents ,Isradipine ,medicine.diagnostic_test ,business.industry ,Arteries ,medicine.disease ,Surgery ,Drug Combinations ,Blood pressure ,Echocardiography ,ACE inhibitor ,Hypertension ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,Vascular Resistance ,business ,medicine.drug - Abstract
Left ventricular hypertrophy is a common clinical feature in hypertensive patients and may be associated with structural changes in vessel morphology. In an open prospective trial, we evaluated 14 patients with previously untreated hypertension (163±2/104±2 mm Hg) and an echocardiographically determined left ventricular mass index of 141.6±5.2 g/m 2 , indicating left ventricular hypertrophy. We obtained a gluteal skin biopsy sample before starting treatment to investigate subcutaneous small-artery (approximately 200 to 400 μm diameter) morphology and function. Patients then received antihypertensive treatment with a combination of spirapril (3 or 6 mg) and isradipine (2.5 or 5 mg). Echocardiographic recordings were made after 6 months and 1 year, and a final biopsy was taken after 1 year. After 1 year, blood pressure was significantly reduced to 142±3/90±1 mm Hg ( P 2 ( P
- Published
- 1996
39. Local level epidemiological analysis of TB in people from a high incidence country of birth
- Author
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Peter D Massey, David N Durrheim, Amanda Christensen, and Nicola Stephens
- Subjects
Adult ,Risk ,Low-incidence setting ,medicine.medical_specialty ,Pediatrics ,Tuberculosis ,Adolescent ,Epidemiology ,Young Adult ,Age Distribution ,Environmental health ,Humans ,Medicine ,Country of birth ,Child ,Aged ,business.industry ,lcsh:Public aspects of medicine ,Incidence ,Incidence (epidemiology) ,Public health ,Public Health, Environmental and Occupational Health ,Infant ,lcsh:RA1-1270 ,Country-of-birth ,Emigration and Immigration ,Middle Aged ,medicine.disease ,Child, Preschool ,Case finding ,High incidence ,New South Wales ,Biostatistics ,business ,Research Article - Abstract
Background The setting for this analysis is the low tuberculosis (TB) incidence state of New South Wales (NSW), Australia. Local level analysis of TB epidemiology in people from high incidence countries-of-birth (HIC) in a low incidence setting has not been conducted in Australia and has not been widely reported. Local level analysis could inform measures such as active case finding and targeted earlier diagnosis. The aim of this study was to use a novel approach to identify local areas in an Australian state that have higher TB rates given the local areas’ country of birth profiles. Methods TB notification data for the three year period 2006–2008 were analysed by grouping the population into those from a high-incidence country-of-birth and the remainder. Results During the study period there were 1401 notified TB cases in the state of NSW. Of these TB cases 76.5% were born in a high-incidence country. The annualised TB notification rate for the high-incidence country-of-birth group was 61.2/100,000 population and for the remainder of the population was 1.8/100,000. Of the 152 Local Government Areas (LGA) in NSW, nine had higher and four had lower TB notification rates in their high-incidence country-of-birth populations when compared with the high-incidence country-of-birth population for the rest of NSW. The nine areas had a higher proportion of the population with a country of birth where TB notification rates are >100/100,000. Those notified with TB in the nine areas also had a shorter length of stay in Australia than the rest of the state. The areas with higher TB notification rates were all in the capital city, Sydney. Among LGAs with higher TB notification rates, four had higher rates in both people with a high-incidence country of birth and people not born in a high-incidence country. The age distribution of the HIC population was similar across all areas, and the highest differential in TB rates across areas was in the 5–19 years age group. Conclusions Analysing local area TB rates and possible explanatory variables can provide useful insights into the epidemiology of TB. TB notification rates that take country of birth in local areas into account could enable health services to strategically target TB control measures.
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