ORCID Profile
0000-0001-5432-5984
Current Organisations
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
,
Australian National University
,
Catholic University of the Sacred Heart
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Public Health and Health Services | Environmental and Occupational Health and Safety | Biological Mathematics | Biostatistics | Applied Mathematics | Agricultural Systems Analysis and Modelling | Epidemiology | Environmental Monitoring | Public Health and Health Services not elsewhere classified | Health Information Systems (incl. Surveillance) |
Food Safety | Disease Distribution and Transmission (incl. Surveillance and Response) | Expanding Knowledge in the Mathematical Sciences | Environmental Health | Infectious Diseases
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.AJIC.2016.12.006
Abstract: Clostridium difficile is the principal cause of infectious diarrhea in hospitalized patients. The aim of this study was to describe and compare length of stay (LOS), costs, and in-hospital deaths for C difficile infection (CDI) and non-CDI hospitalizations, in a cohort of middle-aged and older Australians. We used survey data from the 45 and Up Study, linked to hospitalization and death data. We calculated the average LOS and costs per hospitalization, and the proportion of in-hospital deaths for CDI and non-CDI hospitalizations. We then compared hospitalizations with CDI as a secondary diagnosis to non-CDI hospitalizations by stratifying hospitalizations based on principal diagnosis and then using generalized linear models to compare LOS and in-hospital costs, and logistic regression for in-hospital deaths, adjusting for age and sex. There were 641 CDI hospitalizations during 2006-2012. The average LOS was 17 days the average cost per hospitalization was AUD 12,704 and in 7.3% of admissions (47 out of 641) the patient died. After adjusting for age and sex, hospitalizations with CDI were associated with longer LOS, higher costs, and a greater proportion of in-hospital deaths compared with hospitalizations with similar principal diagnosis but without CDI. CDI places additional burden on the Australian hospital system, with CDI patients having relatively lengthy hospital stays and high costs.
Publisher: Public Library of Science (PLoS)
Date: 18-03-2018
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.IJHEH.2019.03.004
Abstract: Increased public awareness of PFAS contamination in Australia has resulted in serum biomonitoring efforts in in iduals in potentially affected communities. However, population-based reference values for assessing whether in idual results exceed the typical range in the Australian general population are not currently available. Estimate population upper bound reference values based on updated serum PFAS concentrations in pooled s les from southeast Queensland, Australia and population variation observed in the US National Health and Nutrition Examination Survey (NHANES) datasets. We calculated ratios of 95th percentile to arithmetic mean (P95:AM ratios) using data from the NHANES 2013-14 and 2015-16 cycle s les for frequently detected PFASs: PFOA, linear and branched PFOS, perfluorononanoate (PFNA), perfluorodecanoate (PFDA), and perfluorohexanesulfonate (PFHxS). We estimated Australian age-specific means for PFAS using pooled serum s les collected in 2014-15 and 2016-17. We used the P95:AM ratios to estimate 95th percentile concentrations in the Australian population based on the results of the 2016-17 pooled s les. P95:AM ratios for each PFAS were similar across NHANES cycle and age group, so overall compound-specific ratios were estimated for PFOA (2.1), PFNA (2.4), PFDA (2.7), PFHxS (2.7), and linear (2.4) and summed PFOS (2.3). Australian mean PFAS concentrations continued previously reported declining trends. The estimated P95 values can be used as preliminary substitutes for more rigorous population reference values to identify s les with clearly elevated serum PFAS concentrations in Australian biomonitoring efforts. Given uncertainties and variability inherent in this evaluation, the estimated P95 values should be interpreted with caution. Mean and estimated P95 serum PFAS concentrations in Australia should continue to be monitored to document declining trends in population serum concentrations.
Publisher: Cambridge University Press (CUP)
Date: 16-06-2016
DOI: 10.1017/S0950268816001187
Abstract: In October 2013, public health authorities were notified of a suspected outbreak of gastroenteritis in students and guests following a catered function at a university residential college. A retrospective cohort study was undertaken to examine whether foods served at the function caused illness. A total of 56 cases of gastroenteritis, including seven laboratory-confirmed cases of C ylobacter jejuni infection, were identified in 235 eligible respondents. Univariate analysis showed a significant association with a chicken liver pâté entrée [relative risk (RR) 3·64, 95% confidence interval (CI) 2·03–6·52, P 0·001], which retained significance after adjustment for confounding via multivariable analysis (adjusted RR 2·80, 95% CI 1·26–6·19, P = 0·01). C. jejuni and C. coli were also isolated in chicken liver pâté recovered from the college's kitchen. Subsequent whole genome multilocus sequence typing (wgMLST) of clinical and food-derived C. jejuni isolates showed three genetically distinct sequence types (STs) comprising ST528, ST535 (both clinically derived) and ST991 (food derived). The study demonstrates the value of utilizing complementary sources of evidence, including genomic data, to support public health investigations. The use of wgMLST highlights the potential for significant C. jejuni ersity in epidemiologically related human and food isolates recovered during outbreaks linked to poultry liver.
Publisher: Cambridge University Press (CUP)
Date: 26-05-2005
Publisher: Wiley
Date: 03-2003
DOI: 10.1046/J.1440-1746.2003.02959.X
Abstract: Gastroenteritis is a common illness that causes considerable morbidity in developed countries. Endemic gastroenteritis that is not associated with outbreaks causes the greatest number of cases, but information is limited about the burden of this disease, and the resources required to manage its impact on society. In the present study, we estimated the rate of endemic gastroenteritis, the number of visits to the local doctor, use of medication, and the cost of gastroenteritis in Australia. Data from a community-based study of gastroenteritis, a general practice surveillance network, the Australian Bureau of Statistics and the Health Insurance Commission were used to measure endemic gastroenteritis and other study outcomes. The results were then extrapolated to the Australian Community. There were an estimated 0.8 cases of gastroenteritis per person per year in Australia. This equated to 15,173,430 cases of gastroenteritis in Australia annually. The age-standardized estimate of the total number of visits to the general practitioner (GP) for gastroenteritis was 1024,214 at a cost of 26,722,691 Australian dollars. The average cost of prescribed medication per visit was 6.83 Australia dollars the estimated total cost of prescribed medication was 6995,381 Australian dollars. The estimated cost of over-the-counter medication was 14,587,477 Australia dollars. It was estimated that people working full or part-time had 0.13 days-off per person per year because of gastroenteritis, at a cost of 137,924,170 Australian dollars. The estimated total cost of endemic gastroenteritis in Australia was 342,855,616 Australian dollars of which 75,908,274 Australian dollars was direct medical costs and 266,947,342 Australian dollars was time costs and the costs for time off work to care for a sick family member. Endemic gastroenteritis is an important illness in both developed and developing countries. Although in developed countries, the majority of in idual cases are mild to moderate in their severity the overall costs are significant. The results highlight the need for ongoing research to identify the main causes of endemic gastroenteritis.
Publisher: Oxford University Press (OUP)
Date: 19-01-2005
DOI: 10.1093/IJE/DYH413
Abstract: Studies in several countries have estimated the prevalence of diarrhoea in the community. However, the use of different study designs and varying case definitions has made international comparisons difficult. Similar cross-sectional telephone surveys were conducted in Australia, Canada, Ireland (including Northern Ireland), and the United States over 12 month periods between 2000 and 2002. Each survey asked about diarrhoea in the four weeks before the interview. For this comparative analysis, uniform definitions were used. Questionnaires were completed for 6087 respondents in Australia, 3496 in Canada, 9903 in Ireland, and 14,647 in the United States. In the four weeks prior to interview, at least one episode of diarrhoea was reported by 7.6% of respondents in Canada, 7.6% in the United States, 6.4% in Australia, and 3.4% in Ireland. The prevalence of diarrhoea was consistently higher in females. In all countries, the prevalence of diarrhoea was highest in children or =65 years of age. When diarrhoea and vomiting was considered, the prevalence was almost identical in the four studies (range: 2.0-2.6%). Despite different health care structures, a similar proportion of respondents sought medical care (approximately one in five). Antibiotic usage for the treatment of diarrhoea was reported by 8.3% of respondents in the United States, 5.6% in Ireland, 3.8% in Canada, and 3.6% in Australia. Diarrhoea is a common illness among persons in the community in Australia, Canada, Ireland, and the United States. With similar methodologies and a standard case definition, age and sex patterns and health care seeking behaviour were remarkably consistent between countries.
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BMJOPEN-2018-026630
Abstract: The C ySource project aims to identify risk factors for human C ylobacter infection in Australia. We will investigate locally relevant risk factors and those significant in international studies in a case–control study. Case isolates and contemporaneous isolates from food and animal sources will be sequenced to conduct source attribution modelling, and findings will be combined with the case–control study in a source-assigned analysis. The case–control study will include 1200 participants (600 cases and 600 controls) across three regions in Australia. Cases will be recruited from c ylobacteriosis notifications to health departments. Only those with a pure and viable C ylobacter isolate will be eligible for selection to allow for whole genome sequencing of isolates. Controls will be recruited from notified cases of influenza, frequency matched by sex, age group and geographical area of residence. All participants will be interviewed by trained telephone interviewers using a piloted questionnaire. We will collect C ylobacter isolates from retail meats and companion animals (specifically dogs), and all food, animal and human isolates will undergo whole genome sequencing. We will use sequence data to estimate the proportion of human infections that can be attributed to animal and food reservoirs (source attribution modelling), and to identify spatial clusters and temporal trends. Source-assigned analysis of the case–control study data will also be conducted where cases are grouped according to attributed sources. Human and animal ethics have been approved. Genomic data will be published in online archives accompanied by basic metadata. We anticipate several publications to come from this study.
Publisher: Public Library of Science (PLoS)
Date: 22-09-2015
Publisher: Public Library of Science (PLoS)
Date: 11-10-2013
Publisher: BMJ
Date: 12-2015
Publisher: Mary Ann Liebert Inc
Date: 04-2012
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.JHIN.2017.12.014
Abstract: Clostridium difficile infections occur frequently among hospitalized patients, with some infections acquired in hospital and others in the community. International guidelines classify cases as hospital-acquired if symptom onset occurs more than two days after admission. This classification informs surveillance and infection control, but has not been verified by empirical or modelling studies. To assess current classification of C. difficile acquisition using a simulation model as a reference standard. C. difficile transmission was simulated in a range of hospital scenarios. The sensitivity, specificity and precision of classifications that use cut-offs ranging from 0.25 h to 40 days were calculated. The optimal cut-off that correctly estimated the proportion of cases that were hospital acquired and the balanced cut-off that had equal sensitivity and specificity were identified. The recommended two-day cut-off overestimated the incidence of hospital-acquired cases in all scenarios and by >100% in the base scenario. The two-day cut-off had good sensitivity (96%) but poor specificity (48%) and precision (52%) to identify cases acquired during the current hospitalization. A five-day cut-off was balanced, and a six-day cut-off was optimal in the base scenario. The optimal and balanced cut-offs were more than two days for nearly all scenarios considered (ranges: four to nine days and two to eight days, respectively). Current guidelines for classifying C. difficile infections overestimate the proportion of cases acquired in hospital in all model scenarios. To reduce misclassification bias, an infection should be classified as being acquired prior to admission if symptoms begin within five days of admission.
Publisher: Public Library of Science (PLoS)
Date: 17-07-2014
Publisher: Public Library of Science (PLoS)
Date: 06-06-2019
Publisher: Mary Ann Liebert Inc
Date: 03-2018
Abstract: In Australia, the incidence of Salmonella Typhimurium has increased dramatically over the past decade. Whole-genome sequencing (WGS) is transforming public health microbiology, but poses challenges for surveillance. To compare WGS-based approaches with conventional typing for Salmonella surveillance, we performed concurrent WGS and multilocus variable-number tandem-repeat analysis (MLVA) of Salmonella Typhimurium isolates from the Australian Capital Territory (ACT) for a period of 5 months. We exchanged data via a central shared virtual machine and performed comparative genomic analyses. Epidemiological evidence was integrated with WGS-derived data to identify related isolates and sources of infection, and we compared WGS data for surveillance with findings from MLVA typing. We found that WGS data combined with epidemiological data linked an additional 9% of isolates to at least one other isolate in the study in contrast to MLVA and epidemiological data, and 19% more isolates than epidemiological data alone. Analysis of risk factors showed that in one WGS-defined cluster, human cases had higher odds of purchasing a single egg brand. While WGS was more sensitive and specific than conventional typing methods, we identified barriers to uptake of genomic surveillance around complexity of reporting of WGS results, timeliness, acceptability, and stability. In conclusion, WGS offers higher resolution of Salmonella Typhimurium laboratory surveillance than existing methods and can provide further evidence on sources of infection in case and outbreak investigations for public health action. However, there are several challenges that need to be addressed for effective implementation of genomic surveillance in Australia.
Publisher: Mary Ann Liebert Inc
Date: 05-2018
Abstract: Salmonella Typhimurium is a common cause of foodborne illness in Australia. We report on seven outbreaks of Salmonella Typhimurium multilocus variable-number tandem-repeat analysis (MLVA) 03-26-13-08-523 (European convention 2-24-12-7-0212) in three Australian states and territories investigated between November 2015 and March 2016. We identified a common egg grading facility in five of the outbreaks. While no Salmonella Typhimurium was detected at the grading facility and eggs could not be traced back to a particular farm, whole genome sequencing (WGS) of isolates from cases from all seven outbreaks indicated a common source. WGS was able to provide higher discriminatory power than MLVA and will likely link more Salmonella Typhimurium cases between states and territories in the future. National harmonization of Salmonella surveillance is important for effective implementation of WGS for Salmonella outbreak investigations.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 03-2012
Publisher: The Sax Institute
Date: 2013
DOI: 10.1071/NB12122
Publisher: Cambridge University Press (CUP)
Date: 30-11-2007
DOI: 10.1017/S0950268806007576
Abstract: There are an estimated 277 000 cases of c ylobacteriosis in Australia each year, most of which are thought to be sporadically acquired. To explore causes for these infections, we conducted a multi-centre case-control study of patients and community controls across five Australian States during 2001–2002. A total of 881 c ylobacter cases and 833 controls aged ⩾5 years were recruited into the study. Crude logistic analyses were conducted within various food and non-food exposure groups. A final most parsimonious multivariable logistic regression model was developed and adjusted odds ratios (aOR), 95% confidence intervals (95% CI) were derived together with adjusted population attributable risks (PAR). Consumption of undercooked chicken (aOR 4·7, 95% CI 2·6–8·4) and offal (aOR 2·0, 95% CI 1·0–4·0), ownership of domestic chickens aged months (aOR 12·4, 95% CI 2·6–59·3) and domestic dogs aged months (aOR 2·1, 95% CI 1·1–4·2) were found to be independent risk factors for illness in the final model. The PAR proportions indicate that eating chicken meat, either cooked or undercooked may account for approximately 30% of c ylobacter cases that occur each year in Australia. These results justify the continued need for education of consumers and foodhandlers about the risks associated with the handling of raw chicken and the potential for cross-contamination.
Publisher: Public Library of Science (PLoS)
Date: 14-09-2017
Publisher: Elsevier BV
Date: 10-2015
Publisher: Elsevier
Date: 2013
Publisher: American Society for Microbiology
Date: 2007
DOI: 10.1128/JCM.01012-06
Abstract: Multilocus sequence typing (MLST) has provided important new insights into the population structure of C ylobacter jejuni and is rapidly becoming the gold standard for typing this species. However, the methodology is comparatively costly and slow to perform for the routine surveillance testing of large numbers of isolates required by public health laboratories. Restriction fragment length polymorphism analysis of the flaA gene (RFLP- flaA ) and sequencing of the variable region in the fla locus (SVR- fla ) were compared to MLST to determine if a low cost alternative could be found that reliably predicts clonal lineage (as determined by MLST). An isolate of C. jejuni from each of 153 patients from New South Wales, Australia, collected sequentially over a period of 30 months from 1999 to 2001 and comprising 40 sequence types (ST) from 15 clonal complexes (CC) was examined. Of 15 CC, 12 were represented by more than one isolate and a predominant RFLP- flaA type was found for 10 (83%). Of these, seven (70%) correctly predicted the predominant MLST CC with a probability of .8. Of 40 STs detected, 19 were reported for the first time, 9 of which were represented by more than one isolate. Eight of these were represented by a single RFLP- flaA type. Only two of eight major SVR- fla types were able to predict CC with a probability of .8, indicating that flaA -RFLP is a more reliable predictor of CC than SVR- fla and thus offers an alternative to MLST for use in routine surveillance.
Publisher: Cambridge University Press (CUP)
Date: 04-06-2010
DOI: 10.1017/S0950268809990112
Abstract: Estimates of the burden of foodborne disease rely on attributing a proportion of syndromic gastroenteritis to foodborne transmission. Persons with syndromic diarrhoea/vomiting can also present with concurrent respiratory symptoms that could be due to respiratory infections, gastrointestinal infections, or both. This distinction is important when estimating the foodborne disease burden but has rarely been considered. Using data from population surveys from Australia, Canada and the USA we describe the effect of excluding persons with respiratory and associated symptoms from the case definition of gastroenteritis. Excluding persons first with respiratory symptoms, or second with respiratory symptoms plus fever and headache, resulted in a decrease in the weighted estimates of acute gastroenteritis of about 10–50% depending on the exclusion criteria. This has the potential to have a very significant impact on estimates of the burden of foodborne infections using syndromic case definitions of acute gastroenteritis.
Publisher: Public Library of Science (PLoS)
Date: 15-06-2015
Publisher: Elsevier
Date: 2013
Publisher: Emerald
Date: 06-02-2017
Abstract: The purpose of this paper is to assess the usefulness of nutrition labels in Thailand during nutrition transition from traditional to modern diets that increase salt, sugar, and calorie intake and to note socio-demographic interactions and associations with consumption of transitional processed foods. The authors studied 42,750 distance learning Open University adults aged 23-96 years in 2013 residing nationwide and participating in an ongoing community-based prospective cohort study. The authors used multivariable logistic regression to relate nutrition label experiences (“read”, “good understand”, “frequent use”), socio-demographic factors, and consumption of four transitional foods. These foods included “unhealthy” instant foods, carbonated soft drinks, and sweet drinks, or “healthy” milk. Overall, two-thirds reported good understanding and frequent use of nutrition labels. Unhealthy transition-indicator processed foods were frequently consumed: instant foods (7 per cent), (carbonated) soft drinks (15 per cent), and sweet drinks (41 per cent). Frequent users of nutrition labels (e.g. females, older persons, professionals) were less likely to consume unhealthy indicator foods. Those with the most positive overall nutrition label experience (“read” + “good understanding” + “frequent use”) had the best indicator food profiles: instant foods (odds ratio (OR) 0.63 95%CI, 0.56-0.70) soft drinks (OR 0.56 95%CI, 0.52-0.61) sweet drinks (OR 0.79 95%CI, 0.74-0.85) milk (OR 1.87 95%CI, 1.74-2.00). Knowledge protected – those with most nutrition label experience were least likely to consume unhealthy foods. Results support government regulated nutrition labels, expanding to include sweet drinks. The study is remarkable for its large size and nationwide footprint. Study subjects were educated, represent Thais of the future, and show high awareness of transition-indicator foods.
Publisher: Cambridge University Press (CUP)
Date: 06-2002
DOI: 10.1017/S0950268802006933
Abstract: Few studies have assessed risk factors for sporadic cryptosporidiosis in industrialized countries, even though it may be numerically more common than outbreaks of disease. We carried out case-control studies assessing risk factors for sporadic disease in Melbourne and Adelaide, which have water supplies from different ends of the raw water spectrum. In addition to examining drinking water, we assessed several other exposures. 201 cases and 795 controls were recruited for Melbourne and 134 cases and 536 controls were recruited for Adelaide. Risk factors were similar for the two cities, with swimming in public pools and contact with a person with diarrhoea being most important. The consumption of plain tap water was not found to be associated with disease. This study emphasizes the need for regular public health messages to the public and swimming pool managers in an attempt to prevent sporadic cryptosporidiosis, as well as outbreaks of disease.
Publisher: Cold Spring Harbor Laboratory
Date: 09-02-2022
DOI: 10.1101/2022.02.09.22270715
Abstract: We critically appraise the literature regarding in-flight transmission of a range of respiratory infections to provide an evidence base for public health policies for contact tracing passengers, given the limited pathogen-specific data for SARS-CoV-2 currently available. Using PubMed, Web of Science, and other databases including preprints, we systematically reviewed evidence of in-flight transmission of infectious respiratory illnesses. A meta-analysis was conducted where total numbers of persons on board a specific flight was known, to calculate a pooled Attack Rate (AR) for a range of pathogens. The quality of the evidence provided was assessed using a bias assessment tool developed for in-flight transmission investigations. We identified 103 publications detailing 165 flight investigations. Overall, 43.7% (72/165) of investigations provided evidence for in-flight transmission. H1N1 influenza A virus had the highest reported pooled attack rate per 100 persons (AR= 1.17), followed by SARS-CoV-2 (AR=0.54) and SARS-CoV (AR = 0.32), Mycobacterium tuberculosis (AR= 0.25), and measles virus (AR= 0.09). There was high heterogeneity in estimates between studies, except for TB. Of the 72 investigations that provided evidence for in-flight transmission, 27 investigations were assessed as having a high level of evidence, 23 as medium, and 22 as low. One third of the investigations that reported on proximity of cases showed transmission occurring beyond the 2×2 seating area. We suggest that for emerging pathogens, in the absence of pathogen-specific evidence, the 2×2 system should not be used for contact tracing. Instead, alternate contact tracing protocols and close contact definitions for enclosed areas, such as the same cabin on an aircraft or other forms of transport, should be considered as part of a whole of journey approach.
Publisher: Public Library of Science (PLoS)
Date: 03-12-2015
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 09-2008
Publisher: Public Library of Science (PLoS)
Date: 03-12-2015
Publisher: Oxford University Press (OUP)
Date: 08-2008
DOI: 10.1086/589861
Publisher: Elsevier BV
Date: 04-2016
Abstract: Modelling the relationship between weather, climate and infectious diseases can help identify high-risk periods and provide understanding of the determinants of longer-term trends. We provide a detailed examination of the non-linear and delayed association between temperature and salmonellosis in three New Zealand cities (Auckland, Wellington and Christchurch). Salmonella notifications were geocoded to the city of residence for the reported case. City-specific associations between weekly maximum temperature and the onset date for reported salmonella infections (1997-2007) were modelled using non-linear distributed lag models, while controlling for season and long-term trends. Relatively high temperatures were positively associated with infection risk in Auckland (n=3,073) and Christchurch (n=880), although the former showed evidence of a more immediate relationship with exposure to high temperatures. There was no significant association between temperature and salmonellosis risk in Wellington. Projected increases in temperature with climate change may have localised health impacts, suggesting that preventative measures will need to be region-specific. This evidence contributes to the increasing concern over the public health impacts of climate change.
Publisher: Public Library of Science (PLoS)
Date: 03-12-2015
Publisher: Mary Ann Liebert Inc
Date: 12-2016
Abstract: Salmonella infection is one of the most common foodborne bacterial pathogens, and causes a significant health burden globally. We investigated the incidence and risk factors for notification and hospitalization due to Salmonella infection in older adults. We used the 45 and Up Study, a large-scale Australian prospective study of adults aged ≥45 years, with record linkage to multiple databases for the years 2006-2012 to estimate the incidence of notification and hospitalization for Salmonella infection and estimate hazard ratios using Cox regression. Over a total follow-up of 1,120,242 person-years, 333 adults had laboratory-confirmed Salmonella infection and 101 were hospitalized the notification and hospitalization incidence were 29.7 (95% confidence interval [CI]: 26.9-33.3) and 9.0 (95% CI: 7.4-10.9) per 100,000 person-years, respectively. The risk of Salmonella infection notification did not differ by age, but risk of hospitalization increased with age. Elderly males had the highest risk of infection-related hospitalization. The risk of notification was higher for those living in rural or remote areas (adjusted hazard ratio [aHR] 1.7, 95% CI 1.3-2.2), those taking proton pump inhibitors (aHR 1.9, 95% CI 1.4-2.4), and those reporting chicken oultry intake at least seven times per week (aHR 3.2, 95% CI 1.3-7.9). Chicken consumption remains a significant risk factor for Salmonella infection, highlighting the importance of reducing contamination of poultry and improving food safety advice for older people.
Publisher: Public Library of Science (PLoS)
Date: 19-01-2016
Publisher: American Society for Microbiology
Date: 13-12-2022
DOI: 10.1128/AEM.01368-22
Abstract: Currently, relatedness between bacterial isolates impacting human health is easily monitored by molecular typing methods. These approaches rely on discrete loci or whole-genome sequence (WGS) analyses. C ylobacter lari is an emergent human pathogen isolated from erse ecological niches, including fecal material from humans and animals, aquatic environments, and seafood.
Publisher: Cambridge University Press (CUP)
Date: 08-2010
DOI: 10.1086/654000
Abstract: We estimated the incidence of gastroenteritis in 16 Australian long-term care facilities. During 12 months' surveillance, 245 (96%) of 254 episodes of gastroenteritis among long-term care residents were associated with 17 outbreaks in 11 facilities. Incidence in long-term care residents was 0.64 episodes per 1,000 bed-days (95% confidence interval, 0.29-1.42).
Publisher: Cold Spring Harbor Laboratory
Date: 07-02-2022
DOI: 10.1101/2022.02.07.22270575
Abstract: To describe characteristics of COVID-19 outbreaks in Australia to guide policy development for mitigation of future outbreaks, we conducted a retrospective analysis of COVID-19 outbreaks affecting two or more people reported to COVID-Net—an Australian national surveillance network—from 28 January until 27 December 2020. The COVID-Net surveillance network covered all Australian states and territories, with an estimated population of 25,649,985 persons as at 31 June 2020. We reported the epidemiology of COVID-19 outbreaks in Australia, including the setting in which they occurred, size, and duration. 853 outbreaks of COVID-19 were reported associated with 13,957 confirmed cases, of whom 2,047 were hospitalised, and 800 died. The pattern of outbreaks followed a similar trend to the epidemic in Australia, defined by two distinct peaks in mid-March and July. Victoria reported the greatest number of outbreaks across all settings aligned with the second wave of infections. Outbreaks most commonly occurred in the workplace/industry setting (22%, 190/853), followed by education (14%, 122/853), residential aged care (13%, 114/853) and hospitals (10%, 83/853). The majority (40%, 340/853) of outbreaks had 6 to 24 cases, and the median outbreak duration increased in proportion with the number of associated cases. This report summarising COVID-19 outbreaks in Australia identifies settings of highest risk. Surveillance of outbreaks informs our understanding of transmission dynamics in Australia relative to national and jurisdictional interventions. For settings that are high risk for COVID-19, it is important to prioritise planning, surveillance, and implementation of control measures.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2007
Publisher: Cambridge University Press (CUP)
Date: 10-01-2012
DOI: 10.1017/S0950268811002834
Abstract: We analysed two large national surveys conducted in 2001 and 2008 to examine incidence and outcomes of gastroenteritis in older Australians. A case was someone reporting ⩾3 loose stools or ⩾1 episode of vomiting in 24 h, excluding non-infectious causes. We compared cases arising in the elderly (⩾65 years) and in other adults (20–64 years). Elderly people experienced 0·33 [95% confidence interval (CI) 0·24–0·42] episodes of gastroenteritis erson per year, compared to 0·95 (95% CI 0·74–1·15) in other adults. Elderly cases reported less stomach cr s, fever and myalgia than younger cases, and were more likely to be hospitalized, although this was not statistically significant. In multivariable analysis, gastroenteritis in elderly people was associated with travelling within the state (odds ratio 1·35, 95% CI 1·07–1·71). Elderly people were less concerned about food safety than other adults. Older Australians were less likely to report gastroenteritis and experienced different symptoms and outcomes from other adults.
Publisher: Oxford University Press (OUP)
Date: 15-10-2010
DOI: 10.1086/656406
Abstract: Each year in Australia, health departments investigate hundreds of gastroenteritis outbreaks. Long-term care facilities (LTCFs) for elderly persons are a common setting for these outbreaks and can result in potentially serious outcomes. We established surveillance for gastroenteritis outbreaks in 2001, and analyzed data on outbreaks occurring from 1 July 2002 through 30 June 2008 to estimate the incidence in Australian LTCFs and residents. We summarized outbreaks by mode of transmission and etiological agent. We used negative binomial regression to examine variation in the number of fecal specimens collected in outbreaks-a marker of investigation intensity. During surveillance, 3257 (52%) of 6295 outbreaks of gastroenteritis and foodborne disease in Australia were reported in LTCFs. These outbreaks affected 84,769 people, with 1577 people hospitalized and 209 deaths. There were 0.19 (95% confidence interval, 0.14-0.26) residents affected per 1000 bed days and 16.8 (95% confidence interval, 12.4-22.7) outbreaks per 100 LTCFs annually. LTCF outbreaks were most commonly transmitted from person to person. Only 43 (1.3% ) of 3257 outbreaks were foodborne, although 47 (6.4%) of 733 residents were hospitalized and 20 (2.7%) of 733 died. Norovirus was responsible for 1136 (35%) of all 3257 outbreaks. Higher numbers of fecal specimens per outbreak were collected in 4 Australian States, in later years of surveillance, and where the etiology was identified. Norovirus outbreaks spread from person to person are common in LTCFs, although clinicians should be alert for foodborne outbreaks with more serious consequences. There is a need to identify effective infection control measures to assist facilities in managing outbreaks of gastroenteritis.
Publisher: Oxford University Press (OUP)
Date: 15-05-2006
DOI: 10.1086/503426
Abstract: Ciprofloxacin-resistant C ylobacter jejuni isolates obtained from infected patients in Australia have not been detected in studies of isolates from specific geographic areas. The Australian government has prohibited the use of fluoroquinolone in food-producing animals. To assess the impact of this policy, we have examined the antimicrobial susceptibility of isolates from 5 Australian states. We conducted a period-prevalence survey of the susceptibility of C. jejuni isolates to 10 antimicrobial agents. C. jejuni isolates obtained from 585 patients from 5 Australian states (Queensland, South Australia, Tasmania, Victoria, and Western Australia) were identified by means of notifiable disease databases and were systematically selected from September 2001 to August 2002. Among locally acquired infections, only 2% of isolates (range, 0%-8% in different states) were resistant to ciprofloxacin. The locally acquired isolates also exhibited resistance to sulfisoxazole (55%), icillin (46%), roxithromycin (38%), tetracycline (7%), nalidixic acid (6%), chlor henicol (3%), erythromycin (3%), gentamicin (2%), and kanamycin (0.2%). Treatment with antimicrobial agents in the 4 weeks before onset was not associated with ciprofloxacin resistance. The very low level of ciprofloxacin resistance in C. jejuni isolates likely reflects the success of Australia's policy of restricting use of fluoroquinolones in food-producing animals.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.SCITOTENV.2018.05.254
Abstract: Climate change is expected to bring about global warming and an increase in the frequency of extreme weather events. This may consequently influence the transmission of food-borne diseases. The short term associations between climatic conditions and Salmonella infections are well documented in temperate climates but not in the tropics. We conducted an ecological time series analysis to estimate the short term associations between non-outbreak, non-travel associated reports of Salmonella infections and observed climatic conditions from 2005 to 2015 for Singapore. We used a negative binomial time series regression model to analyse the associations on a weekly scale, controlling for season, long term trend, delayed weather effects, autocorrelation and the period where Salmonella was made legally notifiable. There were a total of 11,324 Salmonella infections reported during our study period. A 1 °C increase in mean ambient air temperature was associated with a 4.3% increase (Incidence Rate Ratio [IRR]: 1.043, 95% confidence interval [CI] = 1.003, 1.084) in reported Salmonella infections in the same week and a 6.3% increase (IRR: 1.063, 95% CI = 1.022, 1.105) three weeks later. A 1% increase in the mean relative humidity was associated with a 1.3% decrease (IRR: 0.987, 95% CI = 0.981, 0.994) in cases six weeks later, while a 10 mm increase in weekly cumulative rainfall was associated with a 0.8% increase (IRR: 1.008, 95% CI = 1.002, 1.015) in cases 2 weeks later but a 0.9% decrease (IRR: 0.991, 95% CI = 0.984, 0.998) in cases 5 weeks later. No thresholds for these weather effects were detected. This study confirms the short-term influence of climatic conditions on Salmonella infections in Singapore and the potential impact of climate change on Salmonellosis in the tropics.
Publisher: Elsevier BV
Date: 11-2014
Publisher: Cambridge University Press (CUP)
Date: 04-06-2009
DOI: 10.1017/S0950268809990161
Abstract: Laboratory-based surveillance by OzFoodNet in Australia and FoodNet in the USA indicated that the incidence of C ylobacter infections in 2001 in Australia was about nine times higher than in the USA. We assessed whether this disparity could be explained by differences in the frequency of stool culturing. Using data from population surveys of diarrhoea and symptom profiles for C ylobacter from case-control studies, indices of healthcare behaviour taking into account the severity of C ylobacter infections were calculated. These suggest that culture-confirmed C ylobacter infections underestimate the incidence of community cases by similar ratios in the two countries. The incidence of C ylobacter infections in Australia was about 12 times higher than in the USA after consideration of healthcare system differences.
Publisher: AMPCo
Date: 30-10-2017
DOI: 10.5694/MJA17.00089
Abstract: To identify groups at risk of methicillin-resistant Staphylococcus aureus (MRSA) infection, patterns of antimicrobial resistance, and the proportion of patients with MRSA infections but no history of recent hospitalisation. Case series of 39 231 patients with S. aureus isolates from specimens processed by the Hunter New England Local Health District (HNELHD) public pathology provider during 2008-2014. Proportion of MRSA infections among people with S. aureus isolates antimicrobial susceptibility of MRSA isolates origin of MRSA infections (community- or health care-associated) demographic factors associated with community-associated MRSA infections. There were 71 736 S. aureus-positive specimens during the study period and MRSA was isolated from 19.3% of first positive specimens. Most patients (56.9%) from whom MRSA was isolated had not been admitted to a public hospital in the past year. Multiple regression identified that patients with community-associated MRSA were more likely to be younger (under 40), Indigenous Australians (odds ratio [OR], 2.6 95% CI, 2.3-2.8), or a resident of an aged care facility (OR, 4.7 95% CI, 3.8-5.8). The proportion of MRSA isolates that included the dominant multi-resistant strain (AUS-2/3-like) declined from 29.6% to 3.4% during the study period (P < 0.001), as did the rates of hospital origin MRSA in two of the major hospitals in the region. The prevalence of MRSA in the HNELHD region decreased during the study period, and was predominantly acquired in the community, particularly by young people, Indigenous Australians, and residents of aged care facilities. While the dominance of the multi-resistant strain decreased, new strategies for controlling infections in the community are needed to reduce the prevalence of non-multi-resistant strains.
Publisher: Cambridge University Press (CUP)
Date: 21-01-2008
DOI: 10.1017/S0950268807000246
Abstract: We aimed to explore C ylobacter genotype-specific risk factors in Australia. Isolates collected prospectively from cases recruited into a case-control study were genotyped using flaA restriction fragment-length polymorphism typing ( flaA genotyping). Exposure information for cases and controls was collected by telephone interview. Risk factors were examined for major flaA genotypes using logistic and multinomial regression. Five flaA genotypes accounted for 325 of 590 (55%) cases – flaA -6b ( n =129), flaA -6 ( n =70), flaA -10 ( n =48), flaA -2 ( n =43), flaA -131 ( n =35). In Australia, infections due to flaA- 10 and flaA- 2 were found to be significantly associated with eating non-poultry meat (beef and ham, respectively) in both case-control and inter-genotype comparisons. All major genotypes apart from flaA -10 were associated with chicken consumption in the case-control comparisons. Based on several clinical criteria, infections due to flaA -2 were more severe than those due to other genotypes. Thus genotype analysis may reveal genotype-specific niches and differences in virulence and transmission routes.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Elsevier BV
Date: 06-2000
DOI: 10.1111/J.1467-842X.2000.TB01567.X
Abstract: To describe an outbreak of Cryptosporidium gastroenteritis in a swimming pool in Melbourne in early 1998 that was not detected through routine surveillance, and discuss difficulties in identifying such outbreaks. The Water Quality Study (WQS) was a large community-based study of gastroenteritis. Following suspicion of an outbreak of cryptosporidiosis within the study group, due to pool "X", a nested case control study was performed. Each case of Cryptosporidium gastroenteritis was matched with six controls and data from weekly Health Diaries from the WQS were reviewed. The Department of Human Services also instigated active surveillance among patrons at pool "X" using a systematic s le of 50 people from the pool's swim-school enrollment list. There were seven cases of Cryptosporidium gastroenteritis in the case control study. Five cases and eight controls swam at pool "X" during the outbreak period. The adjusted odds of developing cryptosporidial diarrhoea if an in idual swam at pool "X" was 34.5 (CI 2.3-2548). DHS identified another 11 laboratory confirmed cases associated with pool "X" as well as cases not linked to pool "X". 125 cases were identified throughout Melbourne with the suspected involvement of seven swimming pools. Despite a high odds ratio of developing cryptosporidiosis this outbreak was not detected by routine surveillance methods. Current outbreak detection methods lack sensitivity, specificity or timeliness. Improved surveillance systems are required if outbreaks of gastroenteritis are to be detected early so an intervention can be instigated to reduce the amount of subsequent illness.
Publisher: Oxford University Press (OUP)
Date: 2007
DOI: 10.1111/J.1365-2672.2006.03049.X
Abstract: Multilocus sequence typing (MLST) was used to examine the ersity and population structure of C ylobacter jejuni isolates associated with sporadic cases of gastroenteritis in Australia, and to compare these isolates with those from elsewhere. A total of 153 C . jejuni isolates were genotyped. Forty sequence types (STs) were found, 19 of which were previously undescribed and 21 identified in other countries. The 19 newly described STs accounted for 43% of isolates, 16 of which were assigned to known clonal complexes. Eighty-eight percent of isolates were assigned to a total of 15 clonal complexes. Of these, four clonal complexes accounted for 60% of isolates. Three STs accounted for nearly 40% of all isolates and appeared to be endemic, while 21 STs were represented by more than one isolate. Seven infections were acquired during international travel, and the associated isolates all had different STs, three of which were exclusive to the travel-acquired cases. Comparison of serotypes among isolates from clonal complexes revealed further ersity. Eight serotypes were identified among isolates from more than one clonal complex, while isolates from six clonal complexes displayed serotypes not previously associated with those clonal complexes. Multilocus sequence typing is a useful tool for the discrimination of subtypes and examination of the population structure of C . jejuni associated with sporadic infections. This study highlights the genotypic ersity of C . jejuni in Australia, demonstrating that STs causing disease have both a global and a local distribution evident from the typing of domestically and internationally acquired C . jejuni isolates.
Publisher: Springer Science and Business Media LLC
Date: 13-02-2023
DOI: 10.1186/S12913-023-09126-Y
Abstract: To describe epidemiologists’ experience of team dynamics and leadership during emergency response, and explore the utility of the Team Emergency Assessment Measure (TEAM) tool during future public health emergency responses. The TEAM tool included categories for leadership, teamwork, and task management. We conducted a cross-sectional survey between October 2019 and February 2020 with the global applied field epidemiology workforce. To validate the TEAM tool for our context, we used exploratory and confirmatory factor analysis. We analysed 166 completed surveys. Respondents included national and international emergency responders with representation of all WHO regions. We were unable to validate the TEAM tool for use with epidemiology teams involved in emergency response, however descriptive analysis provided insight into epidemiology emergency response team performance. We found female responders were less satisfied with response leadership than male counterparts, and national responders were more satisfied across all survey categories compared to international responders. Functional teams are a core attribute of effective public health emergency response. Our findings have shown a need for a greater focus on team performance. We recommend development of a fit-for-purpose performance management tool for teams responding to public health emergencies. The importance of building and supporting the development of the national workforce is another important finding of this study.
Publisher: Elsevier BV
Date: 02-2022
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
DOI: 10.1007/S11538-017-0328-8
Abstract: Clostridium difficile infections (CDIs) are some of the most common hospital-associated infections worldwide. Approximately 5% of the general population is colonised with the pathogen, but most are protected from disease by normal intestinal flora or immune responses to toxins. We developed a stochastic compartmental model of CDI in hospitals that captures the condition of the host's gut flora and the role of adaptive immune responses. A novel, derivative-based method for sensitivity analysis of in idual-level outcomes was developed and applied to the model. The model reproduced the observed incidence and recurrence rates for hospitals with high and moderate incidence of hospital-acquired CDI. In both scenarios, the reproduction number for within-hospital transmission was less than 1 (0.67 and 0.44, respectively), but the proportion colonised with C. difficile at discharge (7.3 and 6.1%, respectively) exceeded the proportion colonised at admission (5%). The transmission and prevalence of CDI were most sensitive to the average length of stay and the transmission rate of the pathogen. Recurrent infections were most strongly affected by the treatment success rate and the immune profile of patients. Transmission within hospitals is substantial and leads to a net export of colonised in iduals to the broader community. However, within-hospital transmission alone is insufficient to sustain endemic conditions in hospitals without the constant importation of colonised in iduals. Improved hygiene practices to reduce transmission from symptomatic and asymptomatic in iduals and reduced length of stay are most likely to reduce within-hospital transmission and infections however, these interventions are likely to have a smaller effect on the probability of recurrence. Immunising inpatients against the toxins produced by C. difficile will reduce the incidence of CDI but may increase transmission.
Publisher: Springer Science and Business Media LLC
Date: 26-03-2014
Publisher: Cambridge University Press (CUP)
Date: 09-01-2009
DOI: 10.1017/S0950268808001829
Abstract: We investigated an outbreak of Shigella sonnei infections in Denmark and Australia associated with imported baby corn from one packing shed in Thailand. We reviewed nationwide surveillance and undertook case finding, food trace-back and microbiological investigation of human, food and environmental s les. A recall of baby corn and sugar snaps was based on descriptive epidemiological evidence. In Denmark, we undertook a retrospective cohort study in one workplace. In total, 215 cases were laboratory-confirmed in Denmark, and 12 in Australia. In a multivariable analysis, baby corn was the only independent risk factor. Antibiotic resistance and PFGE outbreak profiles in Denmark and Australia were indistinguishable, linking the outbreaks. Although we did not detect S. sonnei in baby corn, we isolated high levels of other enteric pathogens. We identified a packing shed in Thailand that supplied baby corn to Denmark and Australia, and uncovered unhygienic practices in the supply chain. This outbreak highlights the importance of international communication in linking outbreaks and pinpointing the source.
Publisher: Oxford University Press (OUP)
Date: 15-07-2009
DOI: 10.1086/599370
Abstract: Shiga toxin-producing Escherichia coli (STEC) is an important cause of foodborne illness. In Australia, risk factors for STEC infection have not been examined at a national level. We conducted a case-control study in 6 Australian jurisdictions from 2003 through 2007. A case patient was defined as a person from whom STEC was isolated or toxin production genes were detected in stool. Case patients were recruited from notifiable disease registers, and 3 control subjects frequency matched by age were selected from databases of controls. Using structured questionnaires, interviewers collected data on clinical illness, foods consumed, and exposures to potential environmental sources. We recruited 43 case patients infected with STEC serogroup O157, 71 case patients infected with non-O157 serogroups, and 304 control subjects. One patient infected with serogroup O157 and 7 infected with non-O157 serogroups developed hemolytic uremic syndrome. Compared with control subjects, case patients infected with STEC O157 were more likely to eat hamburgers, visit restaurants, have previously used antibiotics, or have family occupational exposure to red meat. Case patients infected with non-O157 STEC were more likely to eat sliced chicken meat or corned beef from a delicatessen, c in the bush, eat catered meals, or have family occupational exposure to animals. Negative associations were observed for certain foods, particularly homegrown vegetables, fruits, or herbs. This study of risk factors for STEC infection by serogroup highlights risks associated with eating hamburgers and occupational handling of raw meat. To prevent infection, hamburgers must be cooked thoroughly, and people handling raw meat or who have close contact with animals must ensure adequate hygiene.
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.JHIN.2010.04.009
Abstract: We conducted a systematic review and meta-analysis of the literature in order to estimate the incidence of gastroenteritis in long term care facility (LTCF) residents from published accounts of infection surveillance. PubMed, Web of Science and Google Scholar were searched using keywords 'long-term care facility', 'nursing home', 'gastroenteritis', 'surveillance', and 'incidence'. We manually searched reference lists of all articles included. The number of cases of gastroenteritis and bed-days under surveillance was recorded so as to calculate incidence and assess the influence of the study country and case definition using random effects meta-analysis and regression. We included one trial and 14 surveillance studies in the analysis, with 47% (7/15) conducted after 1995. One study focused only on gastroenteritis in residents the remainder considered a range of infections. There were 2,071,330 combined bed-days under surveillance and 717 cases of gastroenteritis. In all, 194 cases were associated with 10 outbreaks during these studies. We observed heterogeneity between studies, which may have been due to unreported clustering of gastroenteritis cases. The mean incidence of gastroenteritis in LTCF residents was 0.40 (95% confidence interval: 0.27-0.56) episodes per 1000 bed-days. Investigators conducting studies in the USA reported incidence three times lower than investigators in other countries. Use of a case definition developed specifically for LTCFs was not associated with a higher incidence of gastroenteritis. From our analysis, residents could expect to experience gastroenteritis once every 5-10 years, which is a lower rate than that estimated from point prevalence surveys. New studies are needed to better assess the incidence and causes of gastroenteritis in LTCF residents.
Publisher: Microbiology Society
Date: 05-2019
Publisher: Public Library of Science (PLoS)
Date: 02-02-2023
DOI: 10.1371/JOURNAL.PONE.0264294
Abstract: We critically appraised the literature regarding in-flight transmission of a range of respiratory infections to provide an evidence base for public health policies for contact tracing passengers, given the limited pathogen-specific data for SARS-CoV-2 currently available. Using PubMed, Web of Science, and other databases including preprints, we systematically reviewed evidence of in-flight transmission of infectious respiratory illnesses. A meta-analysis was conducted where total numbers of persons on board a specific flight was known, to calculate a pooled Attack Rate (AR) for a range of pathogens. The quality of the evidence provided was assessed using a bias assessment tool developed for in-flight transmission investigations of influenza which was modelled on the PRISMA statement and the Newcastle-Ottawa scale. We identified 103 publications detailing 165 flight investigations. Overall, 43.7% (72/165) of investigations provided evidence for in-flight transmission. H1N1 influenza A virus had the highest reported pooled attack rate per 100 persons (AR = 1.17), followed by SARS-CoV-2 (AR = 0.54) and SARS-CoV (AR = 0.32), Mycobacterium tuberculosis (TB, AR = 0.25), and measles virus (AR = 0.09). There was high heterogeneity in estimates between studies, except for TB. Of the 72 investigations that provided evidence for in-flight transmission, 27 investigations were assessed as having a high level of evidence, 23 as medium, and 22 as low. One third of the investigations that reported on proximity of cases showed transmission occurring beyond the 2x2 seating area. We suggest that for emerging pathogens, in the absence of pathogen-specific evidence, the 2x2 system should not be used for contact tracing. Instead, alternate contact tracing protocols and close contact definitions for enclosed areas, such as the same cabin on an aircraft or other forms of transport, should be considered as part of a whole of journey approach.
Publisher: AMPCo
Date: 19-03-2019
DOI: 10.5694/MJA2.50063
Publisher: Cambridge University Press (CUP)
Date: 04-05-2006
DOI: 10.1017/S0950268806006224
Abstract: Salmonella Mississippi infections are very common in Australia's island state – Tasmania – with an annual rate of 17 cases/100000 population. A case-control study conducted during 2001–2002 found single variable associations with indirect exposure to many native animal species, untreated drinking water, travelling within the state, hand–mouth behaviours and contact with pet faeces. No associations were detected with farm animal or pet species or with any food. Indirect contact with native birds, untreated drinking water and travel within the state remained significant predictors of infection in the final model with population attributable fractions of 0·57 and 0·54 for native animals and untreated drinking water respectively. In Tasmania, Australian wildlife species are the likely reservoir for S . Mississippi, contaminating land and water environments. To decrease infection rates requires treatment of water supplies, particularly private rainwater collection systems and advising people to wash their hands after being outdoors and prior to eating.
Publisher: Mary Ann Liebert Inc
Date: 09-2014
Abstract: Estimates of the burden of illness acquired from food inform public health policy and prioritize interventions. A key component of such estimates is the proportion of illnesses that are acquired by foodborne transmission. In view of the shortage of requisite data, these proportions are commonly obtained through a process known as expert elicitation. We report findings from an elicitation process used to assess the importance of the foodborne transmission route for nine pathogens in Australia, circa 2010. Eleven experts were asked to estimate the proportion of illness acquired by five transmission routes: food, environmental, water, person, and zoonotic, together with a 90% certainty interval for foodborne transmission. Foodborne estimates and intervals from each expert were combined using both modified triangular and Program Evaluation and Review Technique (PERT) distributions, in @Risk version 6, to generate final distributions from which median estimates and 95% Credible Intervals (CrI) were calculated. Shiga toxin-producing Escherichia coli (STEC) was the only pathogen believed to have an important zoonotic transmission route, while norovirus, hepatitis A virus, non-STEC pathogenic E. coli, and Shigella spp. were all thought to be primarily spread from person to person. Foodborne transmission was the main route for Clostridium perfringens (98%, CrI: 84-100), Listeria monocytogenes (98%, CrI: 86-100), nontyphoidal Salmonella spp. (72%, CrI: 50-87), and C ylobacter spp. (77%, CrI: 60-90). Foodborne estimates using the modified triangular distribution had wider CrI than these calculated using the PERT distribution. Foodborne proportions for most pathogens in this study were the same or lower than those estimated circa 2000 in Australia, with the greatest decline for non-STEC pathogenic E. coli. Inclusion of certainty intervals from experts helps to quantify the precision of foodborne proportions. A decline in estimates of the foodborne proportion for common pathogens will influence final estimates of the burden of illness acquired from food.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 11-2014
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 11-2014
Publisher: Elsevier
Date: 2008
Publisher: Oxford University Press (OUP)
Date: 02-2017
Publisher: Cambridge University Press (CUP)
Date: 09-07-2004
DOI: 10.1017/S095026880400216X
Abstract: Salmonellosis is a global problem caused by the international movement of foods and high incidence in exporting countries. In September 2001, in an outbreak investigation Australia isolated Salmonella Stanley from imported peanuts, which resulted in a wider investigation in Canada, England & Wales and Scotland. Patients infected with Salmonella serotypes known to be isolated from peanuts and reported to surveillance systems were interviewed to determine exposure histories. Tagged image file format (TIFF) images of pulsed-field gel electrophoresis (PFGE) patterns of Salmonella isolates were shared electronically amongst laboratories. Laboratories tested packets of ‘Brand X’ peanuts from various lots and product lines. In total, 97 cases of S . Stanley and 12 cases of S . Newport infection were found. Seventy-three per cent (71/97) of S . Stanley cases were in persons of Asian ethnicity. Twenty-eight per cent of cases recalled eating Brand X peanuts and a further 13% had peanuts in their house in the previous month or had eaten Asian-style peanuts. Laboratories isolated S . Stanley, S . Newport, S . Kottbus, S . Lexington and S . Unnamed from Brand X peanuts. Isolates of S . Stanley from peanuts and human patients were indistinguishable by PFGE. This international outbreak resulted from a product originating from one country affecting several others. Rapid sharing of electronic DNA images was a crucial factor in delineating the outbreak multinational investigations would benefit from a harmonized approach.
Publisher: Cambridge University Press (CUP)
Date: 30-04-2011
DOI: 10.1017/S0950268810000944
Abstract: Listeriosis is a foodborne disease associated with significant mortality. This study attempts to identify risk factors for sporadic listeriosis in Australia. Information on underlying illnesses was obtained from cases' treating doctors and other risk factors were elicited from the patient or a surrogate. We attempted to recruit two controls per case matched on age and primary underlying immune condition. Between November 2001 and December 2004 we recruited 136 cases and 97 controls. Of perinatal cases, living in a household where a language other than English was spoken was the main risk factor associated with listeriosis (OR 11·3, 95% CI 1·5–undefined). Of non-perinatal cases we identified the following risk factors for listeriosis: prior hospitalization (OR 4·3, 95% CI 1·0–18·3), use of gastric acid inhibitors (OR 9·4, 95% CI 2·4–37·4), and consumption of camembert (OR 4·7, 95% CI 1·1–20·6). Forty percent of cases with prior hospitalization were exposed to high-risk foods during hospitalization.
Publisher: Public Library of Science (PLoS)
Date: 29-08-2019
Publisher: Mary Ann Liebert Inc
Date: 2011
Abstract: Shiga toxin-producing Escherichia coli (STEC) infections are an important cause of foodborne disease in Australia. Three percent to 7% of sporadic patients develop hemolytic uremic syndrome (HUS) and 40% of patients with HUS develop chronic complications. To examine costs associated with illness, we interviewed patients notified to the South Australian Department of Health with a structured questionnaire regarding severity of illness, medical treatment, time lost from work, hospitalization, and other costs. In 2003-2006, we interviewed 46 patients of STEC infection, 2 of whom developed HUS. The median duration of illness was 7 days (range 3-31 days) and 41% (19/46) of patients were admitted to hospital. The estimated total cost for the 46 STEC cases in South Australia was AUD$144,087, equating to a mean cost of AUD$3132 per case. We estimate that the annual total costs of STEC infection in South Australia and Australia are AUD$200,283 and AUD$2,633,181, respectively. We used linear regression to identify that STEC infection costs increase by AUD$608 per day regardless of severity, and that more severe illness is strong predictor of cost. This is the first Australian study to examine costs of STEC infection and highlights the significant impact of this illness.
Publisher: Cambridge University Press (CUP)
Date: 22-06-2016
DOI: 10.1017/S0950268815001375
Abstract: The aim of this study was to estimate the healthcare usage and loss of productivity due to gastroenteritis in Australia using the National Gastroenteritis Survey II. In 2008–2009, 7578 participants across Australia were surveyed about infectious gastroenteritis by telephone interview. A gastroenteritis case was defined as a person experiencing ⩾3 loose stools and/or ⩾2 vomits in a 24-h period, excluding cases with a non-infectious cause for their symptoms, such as pregnancy or consumption of alcohol. Lost productivity was considered any lost time from full- or part-time paid work due to having gastroenteritis or caring for someone with the illness. Interference with other daily activities was also examined along with predictors of healthcare-seeking practices using multivariable regression. Results were weighted to obtain nationally representative estimates using Stata v. 13·1. Of the 341 cases, 52 visited a doctor due to gastroenteritis, 126 reported taking at least one medication for their symptoms and 79 cases reported missing ⩾1 days’ paid work due to gastroenteritis. Gastroenteritis results in a total of 13·1 million (95% confidence interval 6·7–19·5) days of missed paid work each year in Australia. The indirect costs of gastroenteritis are significant, particularly from lost productivity.
Publisher: Oxford University Press (OUP)
Date: 15-04-2007
DOI: 10.1086/512807
Abstract: Between November 2003 and January 2004, outbreaks of norovirus in 3 Australian jurisdictions involving 83 cases of illness were associated with imported oyster meat. Cohort studies were conducted in 2 jurisdictions to identify relative risks of illness for the consumption of oysters. A case series was conducted in the third jurisdiction. The cohort studies conducted in the first 2 jurisdictions identified relative risks of illness of 17 (95% confidence interval, 5-51) and 35 (95% confidence interval, 5-243), respectively, for the consumption of oysters. Multiple strains of norovirus were detected in fecal specimens from 8 of 14 patients and in 1 of the 3 batches of implicated oyster meat using seminested reverse-transcriptase polymerase chain reaction methods. Traceback investigations revealed that all oyster meat was harvested from the same estuary system in Japan within the same month. These outbreaks demonstrate the potential of foodborne disease to spread internationally and the need for national and international collaboration to investigate such outbreaks. Foodborne illness related to norovirus is underestimated because of underreporting of human cases and challenges in laboratory detection of viruses in foods, both of which can delay public health action.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Oxford University Press (OUP)
Date: 17-12-2015
DOI: 10.1093/CID/CIV1018
Abstract: 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. We included all shigellosis patients notified during the study period, where Shigella isolates were tested for antimicrobial sensitivity 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. 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. 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 in idual 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.
Publisher: Mary Ann Liebert Inc
Date: 12-2015
Abstract: Foodborne disease surveillance aims to reduce the burden of illness due to contaminated food. There are several different types of surveillance systems, including event-based surveillance, indicator-based surveillance, and integrated food chain surveillance. These approaches are not mutually exclusive, have overlapping data sources, require distinct capacities and resources, and can be considered a hierarchy, with each level being more complex and resulting in a greater ability to detect and control foodborne disease. Event-based surveillance is generally the least resource-intensive system and makes use of informal data sources. Indicator-based surveillance is seen as traditional notifiable disease surveillance and consists of routinely collected data. Integrated food chain surveillance is viewed as the optimal practice for conducting continuous risk analysis for foodborne diseases, but also requires significant ongoing resources and greater multisectoral collaboration compared to the other systems. Each country must determine the most appropriate structure for their surveillance system for foodborne diseases based on their available resources. This review explores the evidence on the principles, minimum capabilities, and minimum requirements of each type of surveillance and discusses ex les from a range of countries. This review forms the evidence base for the Strengthening the Surveillance and Response for Foodborne Diseases: A Practical Manual.
Publisher: MDPI AG
Date: 18-09-2015
Publisher: Mary Ann Liebert Inc
Date: 08-2017
Publisher: Elsevier BV
Date: 08-2018
Publisher: Mary Ann Liebert Inc
Date: 06-2014
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.ENVRES.2022.114370
Abstract: Firefighters who used aqueous film forming foam in the past have experienced elevated exposures to perfluoroalkyl acids (PFAAs). The objective of this study was to examine the associations between clinical chemistry endpoints and serum concentrations of perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS) and perfluorooctane sulfonate (PFOS) in firefighters. Multiple linear regression was used to assess relationships between PFAA serum concentrations and biochemical markers for cardiovascular disease, kidney-, liver- and thyroid function, in a cross-sectional survey of 783 firefighters with elevated levels of PFHxS, PFHpS and PFOS in relation to the most recently reported levels in the general Australian population. Linear logistic regression was used to assess the odds ratios for selected self-reported health outcomes. Repeated measures linear mixed models were further used to assess relationships between PFAAs and biomarkers for cardiovascular disease and kidney function longitudinally in a subset of the firefighters (n = 130) where serum measurements were available from two timepoints, five years apart. In the cross-sectional analysis, higher levels of all PFAAs were significantly associated with higher levels of biomarkers for cardiovascular disease (total-cholesterol, and LDL-cholesterol). For ex le, doubling in PFOS serum concentration were associated with increases in total cholesterol (β:0.111, 95% confidence interval (95%CI): 0.026, 0.195 mmol/L) and LDL-cholesterol (β: 0.104, 95%CI:0.03, 0.178 mmol/L). Doubling in PFOA concentration, despite not being elevated in the study population, were additionally positively associated with kidney function marker urate (e.g., β: 0.010, 95%CI 0.004, 0.016 mmol/L) and thyroid function marker TSH (e.g., β: 0.087, 95%CI: 0.014, 0.161 mIU/L). PFAAs were not associated with any assessed self-reported health conditions. No significant relationships were observed in the longitudinal analysis. Findings support previous studies, particularly on the association between PFAAs and serum lipids.
Publisher: American Society for Microbiology
Date: 02-2018
DOI: 10.1128/AAC.02012-17
Abstract: Australia has high and increasing rates of salmonellosis. To date, the serovar distribution and associated antimicrobial resistance (AMR) patterns of nontyphoidal Salmonella enterica (NTS) in Australia have not been assessed. Such information provides critical knowledge about AMR in the food chain and informs decisions about public health. We reviewed longitudinal data on NTS in two Australian states over a 37-year period, between 1979 and 2015, and antimicrobial resistance since 1984. Overall, 17% of isolates were nonsusceptible to at least one antimicrobial, 4.9% were nonsusceptible to ciprofloxacin, and 0.6% were nonsusceptible to cefotaxime. In total, 2.5% of isolates were from invasive infections, with no significant difference in AMR profiles between invasive and noninvasive isolates. Most isolates with clinically relevant AMR profiles were associated with travel, particularly to Southeast Asia, with multiple “incursions” of virulent and resistant clones into Australia. Our findings represent the largest longitudinal surveillance system for NTS in Australia and provide valuable public health knowledge on the trends and distribution of AMR in NTS. Ongoing surveillance is critical to identify local emergence of resistant isolates.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 09-2019
Publisher: Springer Science and Business Media LLC
Date: 11-04-2022
DOI: 10.1186/S12960-022-00727-Y
Abstract: Improving the epidemiological response to emergencies requires an understanding of who the responders are, their role and skills, and the challenges they face during responses. In this paper, we explore the role of the epidemiologist and identify challenges they face during emergency response. We conducted a cross-sectional survey to learn more about epidemiologists who respond to public health emergencies. The online survey included open and closed-ended questions on challenges faced while responding, the roles of epidemiology responders, self-rating of skills, and support needed and received. We used purposive s ling to identify participants and a snowballing approach thereafter. We compared data by a number of characteristics, including national or international responder on their last response prior to the survey. We analysed the data using descriptive, content, and exploratory factor analysis. We received 166 responses from in iduals with experience in emergency response. The most frequently reported challenge was navigating the political dynamics of a response, which was more common for international responders than national. National responders experienced fewer challenges related to culture, language, and communication. Epidemiology responders reported a lack of response role clarity, limited knowledge sharing, and communication issues during emergency response. Sixty-seven percent of participants reported they needed support to do their job well males who requested support were statistically more likely to receive it than females who asked. Our study identified that national responders have additional strengths, such as better understanding of the local political environment, language, and culture, which may in turn support identification of local needs and priorities. Although this research was conducted prior to the COVID-19 pandemic, the results are even more relevant now. This research builds on emerging evidence on how to strengthen public health emergency response and provides a platform to begin a global conversation to address operational issues and the role of the international epidemiology responder.
Publisher: Springer Science and Business Media LLC
Date: 29-04-2021
DOI: 10.1186/S12960-021-00603-1
Abstract: Rapid and effective emergency response to address health security relies on a competent and suitably trained local and international workforce. The COVID-19 pandemic has highlighted that the health security workforce needs to be well equipped to tackle current and future challenges. In this study, we explored whether training in applied epidemiology was meeting the current needs of the applied epidemiology workforce. We conducted a cross-sectional online survey that was available in English and French. We used purposive and snowballing s ling techniques to identify potential survey respondents. An online social media advertisement c aign was used to disseminate a REDCap survey link between October 2019 and February 2020 through field epidemiology networks. Survey questions included demographic details of participants, along with their technical background, level of formal education, topics studied during epidemiology training, and years of experience as an epidemiologist. We used Pearson Chi-squared (Chi 2 ) to test the difference between categorical variables, and content analysis to evaluate responses to open-ended questions. In total, 282 people responded to the survey. Participants had a range of formal public health and epidemiology training backgrounds. Respondents applied epidemiology experience spanned almost 30 years, across 64 countries. Overall, 74% ( n = 210) were alumni of Field Epidemiology Training Programs (FETP). Basic outbreak and surveillance training was well reported by respondents, however training in specialised techniques related to emergency response, communication, and leadership was less common. FETP graduates reported higher levels of formal training in all survey topics. It is critical for the health security workforce to be well-trained and equipped with skills needed to ensure a rapid and effective response to acute public health events. Leadership, communication, interpersonal skills, and specialist training in emergency response are lacking in current training models. Our study has demonstrated that applied epidemiology workforce training must evolve to remain relevant to current and future public health challenges.
Publisher: Wiley
Date: 07-2016
DOI: 10.1111/RISA.12444
Abstract: Salmonellosis is a significant cause of foodborne gastroenteritis in Australia, and rates of illness have increased over recent years. We adopt a Bayesian source attribution model to estimate the contribution of different animal reservoirs to illness due to Salmonella spp. in South Australia between 2000 and 2010, together with 95% credible intervals (CrI). We excluded known travel associated cases and those of rare subtypes (fewer than 20 human cases or fewer than 10 isolates from included sources over the 11-year period), and the remaining 76% of cases were classified as sporadic or outbreak associated. Source-related parameters were included to allow for different handling and consumption practices. We attributed 35% (95% CrI: 20-49) of sporadic cases to chicken meat and 37% (95% CrI: 23-53) of sporadic cases to eggs. Of outbreak-related cases, 33% (95% CrI: 20-62) were attributed to chicken meat and 59% (95% CrI: 29-75) to eggs. A comparison of alternative model assumptions indicated that biases due to possible clustering of s les from sources had relatively minor effects on these estimates. Analysis of source-related parameters showed higher risk of illness from contaminated eggs than from contaminated chicken meat, suggesting that consumption and handling practices potentially play a bigger role in illness due to eggs, considering low Salmonella prevalence on eggs. Our results strengthen the evidence that eggs and chicken meat are important vehicles for salmonellosis in South Australia.
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1111/J.1753-6405.2010.00602.X
Abstract: To examine the frequency and circumstances of reported waterborne outbreaks of gastroenteritis in Australia. Examination of data reported to OzFoodNet between 2001 and 2007. During these seven years, 6,515 gastroenteritis outbreaks were reported to OzFoodNet, most of which were classified as being transmitted person-to-person or from an unknown source. Fifty-four (0.83%) outbreaks were classified as either 'waterborne' or 'suspected waterborne', of which 78% (42/54) were attributed to recreational water and 19% (10/54) to drinking water. Of the drinking water outbreaks, implicated pathogens were found on all but one occasion and included Salmonella sp. (five outbreaks), C ylobacter jejuni (three outbreaks) and Giardia (one outbreak). There have been few waterborne outbreaks detected in Australia, and most of those reported have been associated with recreational exposure. However, there are difficulties in identifying and categorising gastroenteritis outbreaks, as well as in obtaining microbiological and epidemiological evidence, which can result in misclassification or underestimation of water-associated events. Gastroenteritis surveillance data show that, among reported water-associated gastroenteritis outbreaks in Australia, recreational exposure is currently more common than a drinking water source. However, ongoing surveillance for waterborne outbreaks is important, especially as drought conditions may necessitate replacement of conventional drinking water supplies with alternative water sources, which could incur potential for new health risks.
Publisher: Elsevier BV
Date: 09-2019
Publisher: BMJ
Date: 07-2013
Publisher: Cambridge University Press (CUP)
Date: 08-10-2014
DOI: 10.1017/S0950268813002471
Abstract: We used a national survey of 7578 randomly selected respondents in 2008–2009 to identify the period prevalence of acute respiratory infection (ARI) by season and state, and to estimate the incidence of ARI in the Australian community. A case was defined as any episode of cold or flu with at least one of the following symptoms: fever, chills, sore throat, running nose, or cough in the past 4 weeks. Frequency data were weighted to the Australian population. The response rate to the survey was 49%, and 19·9% (1505/7578) of respondents reported an ARI in the previous 4 weeks, which extrapolated to 68·9 million cases [95% confidence interval (CI) 65·1–72·7] of ARI in Australia annually. The incidence was 3·2 (95% CI 3·0–3·4) cases of ARI erson per year, and was highest in young children and lowest in older people. ARI imposes a significant burden on Australian society.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.JHIN.2019.03.001
Abstract: Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhoea with peak incidence in late winter or early autumn. Although CDI is commonly associated with hospitals, community transmission is important. To explore potential drivers of CDI seasonality and the effect of community-based interventions to reduce transmission. A mechanistic compartmental model of C. difficile transmission in a hospital and surrounding community was used to determine the effect of reducing transmission or antibiotic prescriptions in these settings. The model was extended to allow for seasonal antibiotic prescriptions and seasonal transmission. Modelling antibiotic seasonality reproduced the seasonality of CDI, including approximate magnitude (13.9-15.1% above annual mean) and timing of peaks (0.7-1.0 months after peak antibiotics). Halving seasonal excess prescriptions reduced the incidence of CDI by 6-18%. Seasonal transmission produced larger seasonal peaks in the prevalence of community colonization (14.8-22.1% above mean) than seasonal antibiotic prescriptions (0.2-1.7% above mean). Reducing transmission from symptomatic or hospitalized patients had little effect on community-acquired CDI, but reducing transmission in the community by ≥7% or transmission from infants by ≥30% eliminated the pathogen. Reducing antibiotic prescription rates led to approximately proportional reductions in infections, but limited reductions in the prevalence of colonization. Seasonal variation in antibiotic prescription rates can account for the observed magnitude and timing of C. difficile seasonality. Even complete prevention of transmission from hospitalized patients or symptomatic patients cannot eliminate the pathogen, but interventions to reduce transmission from community residents or infants could have a large impact on both hospital- and community-acquired infections.
Publisher: Cambridge University Press (CUP)
Date: 12-12-2017
DOI: 10.1017/S0950268816002909
Abstract: C ylobacter sp. are a globally significant cause of gastroenteritis. Although rates of infection in Australia are among the highest in the industrialized world, studies describing c ylobacteriosis incidence in Australia are lacking. Using national disease notification data between 1998 and 2013 we examined C ylobacter infections by gender, age group, season and state and territory. Negative binomial regression was used to estimate incidence rate ratios (IRRs), including trends by age group over time, with post-estimation commands used to obtain adjusted incidence rates. The incidence rate for males was significantly higher than for females [IRR 1·20, 95% confidence interval (CI) 1·18–1·21], while a distinct seasonality was demonstrated with higher rates in both spring (IRR 1·18, 95% CI 1·16–1·20) and summer (IRR 1·17, 95% CI 1·16–1·19). Examination of trends in age-specific incidence over time showed declines in incidence in those aged years combined with contemporaneous increases in older age groups, notably those aged 70–79 years (IRR 1998–2013: 1·75, 95% CI 1·63–1·88). While crude rates continue to be highest in children, our findings suggest the age structure for c ylobacteriosis in Australia is changing, carrying significant public health implications for older Australians.
Publisher: Elsevier BV
Date: 11-2017
Publisher: Cambridge University Press (CUP)
Date: 25-01-2006
DOI: 10.1017/S0950268805005777
Abstract: In order to identify subtyping methods able to contribute to the surveillance or investigation of Australian C ylobacter infection, six genotypic and three phenotypic subtyping methods were evaluated on a collection of 84 clinical isolates collected over a 30-month period from one region in Australia. The aim was to compare the logistics of various subtyping methods and examine their ability to assist in finding outbreaks or common sources of sporadic infection. The genotypic subtyping methods used were sequencing of the short variable region of the flaA gene, two methods using restriction fragment length polymorphism (RFLP) of the flaA gene using either Dde I or Eco RI with Pst I, automated ribotyping, pulsed field gel electrophoresis and multilocus sequence typing. The phenotypic methods employed included Laboratory of Enteric Pathogens serotyping, Lior biotyping and antibiotic resistotyping. The level of agreement between subtyping results was determined. Phenotypic methods showed little agreement whereas genotypic typing methods showed a high level of agreement. Using the premise that five of the six genotypic typing methods were in agreement 15 genotypic groupings were identified. Sequencing of the short variable region of the flaA gene, RFLP of the flaA gene or automated ribotyping in conjunction with multilocus sequence typing best identified genotypic groupings. An alternative combination of RFLP of the flaA gene followed by ribotyping was equally satisfactory. RFLP of the flaA gene appeared to be suitable as a preliminary typing method based on ease of operation, equipment availability and cost.
Publisher: Public Library of Science (PLoS)
Date: 20-12-2016
Publisher: Public Library of Science (PLoS)
Date: 12-10-2016
Publisher: Public Library of Science (PLoS)
Date: 03-12-2015
Publisher: Oxford University Press (OUP)
Date: 09-2005
DOI: 10.1086/432064
Abstract: The burden of foodborne disease is not well defined in many countries or regions or on a global level. The World Health Organization (WHO), in conjunction with other national public health agencies, is coordinating a number of international activities designed to assist countries in the strengthening of disease surveillance and to determine the burden of acute gastroenteritis. These data can then be used to estimate the following situations: (1) the burden associated with acute gastroenteritis of foodborne origin, (2) the burden caused by specific pathogens commonly transmitted by food, and (3) the burden caused by specific foods or food groups. Many of the scientists collaborating with the WHO on these activities have been involved in quantifying the burden of acute gastroenteritis on a national basis. This article reviews these key national studies and the international efforts that are providing the necessary information and technical resources to derive national, regional, and global burden of disease estimates.
Publisher: Public Library of Science (PLoS)
Date: 23-12-2015
Publisher: Mary Ann Liebert Inc
Date: 07-2016
Abstract: Salmonellosis is a significant public health problem, with eggs frequently identified as a food vehicle during outbreak investigations. Salmonella enterica serovar Typhimurium and Salmonella enterica serovar Enteritidis are the two most frequently identified causes of egg-associated disease in industrialized countries. In Australia, a comprehensive review of egg-associated outbreaks has not been previously undertaken. Using a national register of foodborne outbreaks, we undertook a descriptive review of egg-associated outbreaks between 2001 and 2011. Included in our review was additional detail from the findings of trace back investigations conducted to the farm level. Evidence classifications were developed and applied to each outbreak based on descriptive and analytical epidemiology, food safety investigations, and microbiological testing of clinical, food, and trace back-derived s les. Over the study period, the proportion of foodborne Salmonella outbreaks linked to eggs increased significantly (p < 0.001). In total, 166 outbreaks were identified, with 90% caused by Salmonella Typhimurium. The majority of outbreaks were linked to commercial food providers, with raw egg use the major contributing factor. These events resulted in more than 3200 cases, more than 650 hospitalizations, and at least 4 deaths. Fifty-four percent of investigations used analytical epidemiology, food microbiology, and trace back microbiology to demonstrate links between human illness and eggs. Trace back investigations identified S. enterica indistinguishable from outbreak-associated clinical or food s les on 50% of s led egg farms. Effective control of egg-associated salmonellosis remains a challenge in Australia, with Salmonella Typhimurium dominating as the causative serotype in outbreak events. Although outbreaks predominantly occur in the settings of restaurants, the high recovery rate of indistinguishable Salmonella on epidemiologically implicated egg farms suggests that further efforts to minimize infection pressure at the primary production level are needed in Australia.
Publisher: WHO Press
Date: 18-01-2019
Publisher: Mary Ann Liebert Inc
Date: 12-2014
Abstract: Estimates of the incidence of foodborne illness are increasingly used at national and international levels to quantify the burden of disease and advocate for improvements in food safety. The calculation of such estimates involves multiple datasets and several disease multipliers, applied to dozens of pathogens. Unsurprisingly, this process often produces wide interval estimates. Using a model of foodborne gastroenteritis in Australia, we calculate the contribution of both data and multipliers to the width of the interval. We then compare pathogen-specific estimates of the proportion of gastroenteritis that is foodborne from national-level studies conducted in Canada, Greece, France, the Netherlands, New Zealand, the United Kingdom, and the United States. Overall, we estimate that 74% (range 63-92%) of the interval width for foodborne gastroenteritis in Australia is a result of uncertainty in the proportion of gastroenteritis that is due to contaminated food. Across national studies, we find considerable variability in point estimates and the width of interval estimates for the foodborne proportion for relatively common pathogens such as Salmonella spp., C ylobacter spp., and norovirus. While some uncertainty in estimates of gastroenteritis incidence is inevitable, an understanding of the drivers of this uncertainty can help to focus further research. In particular, this work highlights the value of studies quantifying the routes of transmission for common pathogens.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
Publisher: Public Library of Science (PLoS)
Date: 13-12-2017
Publisher: The Royal Society
Date: 05-2012
DOI: 10.1098/RSOB.120061
Abstract: Accurate identification of sparse heterozygous single-nucleotide variants (SNVs) is a critical challenge for identifying the causative mutations in mouse genetic screens, human genetic diseases and cancer. When seeking to identify causal DNA variants that occur at such low rates, they are overwhelmed by false-positive calls that arise from a range of technical and biological sources. We describe a strategy using whole-exome capture, massively parallel DNA sequencing and computational analysis, which identifies with a low false-positive rate the majority of heterozygous and homozygous SNVs arising de novo with a frequency of one nucleotide substitution per megabase in progeny of N -ethyl- N -nitrosourea (ENU)-mutated C57BL/6j mice. We found that by applying a strategy of filtering raw SNV calls against known and platform-specific variants we could call true SNVs with a false-positive rate of 19.4 per cent and an estimated false-negative rate of 21.3 per cent. These error rates are small enough to enable calling a causative mutation from both homozygous and heterozygous candidate mutation lists with little or no further experimental validation. The efficacy of this approach is demonstrated by identifying the causative mutation in the Ptprc gene in a lymphocyte-deficient strain and in 11 other strains with immune disorders or obesity, without the need for meiotic mapping. Exome sequencing of first-generation mutant mice revealed hundreds of unphenotyped protein-changing mutations, 52 per cent of which are predicted to be deleterious, which now become available for breeding and experimental analysis. We show that exome sequencing data alone are sufficient to identify induced mutations. This approach transforms genetic screens in mice, establishes a general strategy for analysing rare DNA variants and opens up a large new source for experimental models of human disease.
Publisher: Cambridge University Press (CUP)
Date: 12-10-2015
DOI: 10.1017/S0950268815002435
Abstract: Estimates of the proportion of illness transmitted by food for different enteric pathogens are essential for foodborne burden-of-disease studies. Owing to insufficient scientific data, a formal synthesis of expert opinion, an expert elicitation, is commonly used to produce such estimates. Eleven experts participated in an elicitation to estimate the proportion of illnesses due to food in Australia for nine pathogens over three rounds: first, based on their own knowledge alone second, after being provided with systematic reviews of the literature and Australian data and finally, at a workshop where experts reflected on the evidence. Estimates changed significantly across the three rounds ( P = 0·002) as measured by analysis of variance. Following the workshop in round 3, estimates showed smoother distributions with significantly less variation for several pathogens. When estimates were combined to provide combined distributions for each pathogen, the width of these combined distributions reflected experts’ perceptions of the availability of evidence, with narrower intervals for pathogens for which evidence was judged to be strongest. Our findings show that the choice of expert elicitation process can significantly influence final estimates. Our structured process – and the workshop in particular – produced robust estimates and distributions appropriate for inclusion in burden-of-disease studies.
Publisher: Cambridge University Press (CUP)
Date: 22-07-2006
DOI: 10.1017/S0950268805004656
Abstract: To estimate the frequency of infectious gastroenteritis across Australia, and to identify risk factors, we conducted a national telephone survey of 6087 randomly selected respondents in 2001–2002. The case definition was three or more loose stools and/or two or more vomits in a 24-hour period in the last 4 weeks, with adjustment to exclude non-infectious causes and symptoms secondary to a respiratory infection. Frequency data were weighted to the Australian population. Multivariate logistic regression was used to assess potential risk factors including season, region, demographic and socioeconomic status. Among contacted in iduals, 67% responded. The case definition applied to 7% of respondents (450/6087) which extrapolates to 17·2 million (95% CI 14·5–19·9 million) cases of gastroenteritis in Australia in one year, or 0·92 (95% CI 0·77–1·06) cases erson per year. In the multivariate model, the odds of having gastroenteritis were increased in summer and in the warmest state, in young children, females, those with higher socioeconomic status and those without health insurance.
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.IJFOODMICRO.2006.04.048
Abstract: Information systems are concerned with data capture, storage, analysis and retrieval. In the context of food safety management they are vital to assist decision making in a short time frame, potentially allowing decisions to be made and practices to be actioned in real time. Databases with information on microorganisms pertinent to the identification of foodborne pathogens, response of microbial populations to the environment and characteristics of foods and processing conditions are the cornerstone of food safety management systems. Such databases find application in: Identifying pathogens in food at the genus or species level using applied systematics in automated ways. Identifying pathogens below the species level by molecular subtyping, an approach successfully applied in epidemiological investigations of foodborne disease and the basis for national surveillance programs. Predictive modelling software, such as the Pathogen Modeling Program and Growth Predictor (that took over the main functions of Food Micromodel) the raw data of which were combined as the genesis of an international web based searchable database (ComBase). Expert systems combining databases on microbial characteristics, food composition and processing information with the resulting "pattern match" indicating problems that may arise from changes in product formulation or processing conditions. Computer software packages to aid the practical application of HACCP and risk assessment and decision trees to bring logical sequences to establishing and modifying food safety management practices. In addition there are many other uses of information systems that benefit food safety more globally, including: Rapid dissemination of information on foodborne disease outbreaks via websites or list servers carrying commentary from many sources, including the press and interest groups, on the reasons for and consequences of foodborne disease incidents. Active surveillance networks allowing rapid dissemination of molecular subtyping information between public health agencies to detect foodborne outbreaks and limit the spread of human disease. Traceability of in idual animals or crops from (or before) conception or germination to the consumer as an integral part of food supply chain management. Provision of high quality, online educational packages to food industry personnel otherwise precluded from access to such courses.
Publisher: Cambridge University Press (CUP)
Date: 2019
DOI: 10.1017/S0950268819000384
Abstract: Clostridium difficile infections (CDIs) affect patients in hospitals and in the community, but the relative importance of transmission in each setting is unknown. We developed a mathematical model of C. difficile transmission in a hospital and surrounding community that included infants, adults and transmission from animal reservoirs. We assessed the role of these transmission routes in maintaining disease and evaluated the recommended classification system for hospital- and community-acquired CDIs. The reproduction number in the hospital was (range: 0.16–0.46) for all scenarios. Outside the hospital, the reproduction number was for nearly all scenarios without transmission from animal reservoirs (range: 1.0–1.34). However, the reproduction number for the human population was if a minority ( .5–26.0%) of human exposures originated from animal reservoirs. Symptomatic adults accounted for % transmission in the community. Under conservative assumptions, infants accounted for 17% of community transmission. An estimated 33–40% of community-acquired cases were reported but 28–39% of these reported cases were misclassified as hospital-acquired by recommended definitions. Transmission could be plausibly sustained by asymptomatically colonised adults and infants in the community or exposure to animal reservoirs, but not hospital transmission alone. Under-reporting of community-onset cases and systematic misclassification underplays the role of community transmission.
Publisher: Public Library of Science (PLoS)
Date: 03-12-2015
Publisher: Oxford University Press (OUP)
Date: 15-03-2010
DOI: 10.1086/650733
Abstract: To estimate the global burden of nontyphoidal Salmonella gastroenteritis, we synthesized existing data from laboratory-based surveillance and special studies, with a hierarchical preference to (1) prospective population-based studies, (2) "multiplier studies," (3) disease notifications, (4) returning traveler data, and (5) extrapolation. We applied incidence estimates to population projections for the 21 Global Burden of Disease regions to calculate regional numbers of cases, which were summed to provide a global number of cases. Uncertainty calculations were performed using Monte Carlo simulation. We estimated that 93.8 million cases (5th to 95th percentile, 61.8-131.6 million) of gastroenteritis due to Salmonella species occur globally each year, with 155,000 deaths (5th to 95th percentile, 39,000-303,000 deaths). Of these, we estimated 80.3 million cases were foodborne. Salmonella infection represents a considerable burden in both developing and developed countries. Efforts to reduce transmission of salmonellae by food and other routes must be implemented on a global scale.
Publisher: World Health Organization, Western Pacific Regional Office
Date: 16-05-2014
Publisher: Elsevier BV
Date: 08-2018
Publisher: Canadian Center of Science and Education
Date: 14-05-2016
DOI: 10.5539/GJHS.V8N1P21
Abstract: strong BACKGROUND: /strong This qualitative study employed the Knowledge-Attitude-Behaviour (KAB) model and Health Belief Model (HBM) to investigate factors influencing Thai consumer decision making about use of nutrition labels. Labels include both Nutrition Information Panels (1998-) and Guideline Daily Amounts labels (2011-). strong METHOD: /strong In-depth interviews were conducted with 34 participants representing two socio-demographic extremes in Thailand – “urban Bangkok” (university educated consumers) and “provincial Ranong” (non-university educated consumers). An integrated KAB-HBM model was used to devise in-depth interviews for a qualitative study using 20 open-ended questions and s les of food package labels. Additional questions arose from the interviews and they lasted 30-45 minutes and were video recorded. The analysis identified recurring themes using Atlas.ti software. strong RESULTS: /strong Most participants (n=25) were aware of nutrition labels but a much smaller number (n=10) used and derived any benefit from them. Nutrition label users were classified into 4 groups: A) competent user B) confused user C) aware non-user D) unaware non-user. Better educated participants were better at understanding nutrition labels but not more likely to use labels. Belief that nutrition influences health increased likelihood of using nutrition labels to make decisions about food. Being well-educated and motivated by health concerns increased likelihood of attention to nutrition labels. strong CONCLUSION: /strong Results are discussed with a view to increasing the use of nutrition labels by Thai consumers. Our findings, drawing on a combination of the KAB and HBM models, can contribute to strategies motivating consumers to use nutrition labels and can provide useful insights for developing promotional strategies.
Publisher: AMPCo
Date: 09-2011
DOI: 10.5694/MJA11.10816
Publisher: Cambridge University Press (CUP)
Date: 26-10-2017
DOI: 10.1017/S0950268816002260
Abstract: Clostridium difficile is the principal cause of infectious diarrhoea in hospitalized patients. We investigated the incidence and risk factors for hospitalization due to C. difficile infection (CDI) in older Australians. We linked data from a population-based prospective cohort study (the 45 and Up Study) of 266 922 adults aged ⩾45 years recruited in New South Wales, Australia to hospitalization and death records for 2006–2012. We estimated the incidence of CDI hospitalization and calculated days in hospital and costs per hospitalization. We also estimated hazard ratios (HR) for CDI hospitalization using Cox regression with age as the underlying time variable. Over a total follow-up of 1 126 708 person-years, 187 adults had an incident CDI hospitalization. The crude incidence of CDI hospitalization was 16·6/100 000 person-years, with a median hospital stay of 6 days, and a median cost of AUD 6102 per admission. Incidence increased with age and year of follow-up, with a threefold increase for 2009–2012. After adjustment, CDI hospitalization rates were significantly lower in males than females (adjusted HR 0·6, 95% confidence interval 0·4–0·7). CDI hospitalization rates increased significantly over 2009–2012. There is a need to better understand the increasing risk of CDI hospitalization in women.
Publisher: The Sax Institute
Date: 09-2016
DOI: 10.17061/PHRP2641646
Abstract: Inhalation of asbestos fibres is the predominant cause of malignant mesothelioma. Domestic exposure to asbestos is a major community concern in the Australian Capital Territory (ACT) because of loose-fill asbestos home insulation. Little is known about how trends in mesothelioma rates in the ACT compare with those elsewhere. The objective of this study was to describe trends in mesothelioma rates in the ACT and compare them with those for the rest of Australia. We used de-identified data from the ACT Cancer Registry (1982- 2014), and the Western Australia (WA) Cancer Registry and the Australian Cancer Database (1982-2011). We calculated crude mesothelioma rates, by 3-year periods, for the ACT and for the rest of Australia (excluding WA). We used Poisson regression to analyse mesothelioma trends from 1994 to 2011 (complete reporting period) using an indirect standardisation approach to adjust for age and sex. There were 140 mesothelioma cases reported to the ACT Cancer Registry between 1982 and 2014 - 81% male and 19% female. Between 1994 and 2011, age- and sex-adjusted mesothelioma rates in the ACT increased over time, on average by 12% per 3-year period (relative risk [RR] 1.12 95% confidence interval [CI] 0.99, 1.26). Compared with the rest of Australia (excluding WA), ACT rates were, on average, lower (RR 0.84 95% CI 0.69, 1.02), but they increased at a higher rate (RR 1.12 per 3-year period 95% CI 0.99, 1.27). These results are strongly influenced by the higher rate of mesothelioma observed in the ACT in 2009-2011, when ACT rates became similar to those for the rest of Australia (excluding WA). Although mesothelioma rates may have increased more in the ACT than the rest of Australia (excluding WA) during the past two decades, there is considerable uncertainty in the trends. More information is needed regarding the health risks associated with living in a house with loose-fill asbestos insulation. This is the subject of further studies within the ACT Asbestos Health Study.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 05-2009
Publisher: Public Library of Science (PLoS)
Date: 16-07-2018
Publisher: Public Library of Science (PLoS)
Date: 03-12-2015
Publisher: Cambridge University Press (CUP)
Date: 14-08-2018
DOI: 10.1017/S0950268818002224
Abstract: Salmonellosis is a leading cause of hospitalisation due to gastroenteritis in Australia. A previous source attribution analysis for a temperate state in Australia attributed most infections to chicken meat or eggs. Queensland is in northern Australia and includes subtropical and tropical climate zones. We analysed Queensland notifications for salmonellosis and conducted source attribution to compare reservoir sources with those in southern Australia. In contrast to temperate Australia, most infections were due to non-Typhimurium serotypes, with particularly high incidence in children under 5 years and strong seasonality, peaking in summer. We attributed 65.3% (95% credible interval (CrI) 60.6–73.2) of cases to either chicken meat or eggs and 15.5% (95% CrI 7.0–19.5) to nuts. The subtypes with the strongest associations with nuts were Salmonella Aberdeen, S. Birkenhead, S. Hvittingfoss, S. Potsdam and S. Waycross. All five subtypes had high rates of illness in children under 5 years (ranging from 4/100 000 to 23/100 000), suggesting that nuts may be serving as a proxy for environmental transmission in the model. Australia's climatic range allows us to conduct source attribution in different climate zones with similar food consumption patterns. This attribution provides evidence for environment-mediated transmission of salmonellosis in sub-tropical regions.
Publisher: Elsevier BV
Date: 02-2016
Publisher: Springer Science and Business Media LLC
Date: 12-2009
Publisher: BMJ
Date: 2013
Publisher: Elsevier
Date: 2003
Publisher: Mary Ann Liebert Inc
Date: 2011
Abstract: Abstract Food- or waterborne diseases in long-term care facilities (LTCF) can result in serious outcomes, including deaths, and they are potentially preventable. We analyzed data collected by OzFoodNet on food- and waterborne disease outbreaks occurring in LTCF in Australia from 2001 to 2008. We compared outbreaks by the number of persons affected, etiology, and implicated vehicle. During 8 years of surveillance, 5.9% (55/936) of all food- and waterborne outbreaks in Australia occurred in LTCF. These LTCF outbreaks affected a total of 909 people, with 66 hospitalized and 23 deaths. The annual incidence of food- or waterborne outbreaks was 1.9 (95% confidence intervals 1.0-3.7) per 1000 facilities. Salmonella caused 17 outbreaks, Clostridium perfringens 14 outbreaks, C ylobacter 8 outbreaks, and norovirus 1 outbreak. Residents were at higher risk of death during outbreaks of salmonellosis than for all other outbreaks combined (relative risk 7.8, 95% confidence intervals 1.8-33.8). Of 15 outbreaks of unknown etiology, 11 were suspected to be due to C. perfringens intoxication. Food vehicles were only identified in 27% (14/52) of outbreaks, with six outbreak investigations implicating pureed foods. Dishes containing raw eggs were implicated as the cause of four outbreaks. Three outbreaks of suspected waterborne disease were attributed to rainwater collected from facility roofs. To prevent disease outbreaks, facilities need to improve handling of pureed foods, avoid feeding residents raw or undercooked eggs, and ensure that rainwater tanks have a scheduled maintenance and disinfection program.
Publisher: WHO Press
Date: 25-11-2017
Publisher: Springer Science and Business Media LLC
Date: 24-02-2017
Publisher: Mary Ann Liebert Inc
Date: 07-2018
Abstract: Salmonella is a leading cause of foodborne enterocolitis worldwide. Antimicrobial use in food animals is the driving force for antimicrobial resistance among Salmonella particularly in high-income countries. Nontyphoidal Salmonella (NTS) infections that are multidrug resistant (MDR) (nonsusceptible to ≥1 agent in ≥3 antimicrobial categories) may result in more severe health outcomes, although these effects have not been systematically examined. We conducted a systematic review and meta-analysis to examine impacts of MDR NTS on disease outcomes in high-income settings. We systematically reviewed the literature from scientific databases, including PubMed, Scopus, and grey literature sources, using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We included peer-reviewed publications of case-control and cohort studies, outbreak investigations, and published theses, imposing no language restriction. We included publications from January 1, 1990 through September 15, 2016 from high-income countries as classified by the World Bank, and extracted data on duration of illness, hospitalization, morbidity and mortality of MDR, and pan-susceptible NTS infections. After removing duplicates, the initial search revealed 4258 articles. After further screening, 16 eligible studies were identified for the systematic review, but, only 9 of these were included in the meta-analysis. NTS serotypes differed among the reported studies, but serotypes Typhimurium, Enteritidis, Newport, and Heidelberg were the most often reported MDR pathogens. Salmonella infections that were MDR were associated with excess bloodstream infections (odds ratio [OR] 1.73 95% confidence interval [CI] 1.32-2.27), more frequent hospitalizations (OR 2.51 95% CI 1.38-4.58), and higher mortality (OR 3.54 95% CI 1.10-11.40) when compared with pan-susceptible isolates. Our study suggests that MDR NTS infections have more serious health outcomes compared with pan-susceptible strains. With the emergence of MDR Salmonella strains in high-income countries, it is crucial to reduce the use of antimicrobials in animals and humans, and intervene to prevent foodborne infections.
Publisher: Oxford University Press (OUP)
Date: 02-2010
DOI: 10.1086/649878
Abstract: Elderly people in long-term care facilities (LTCFs) may be more vulnerable to infectious gastroenteritis and food-borne disease and more likely to experience serious outcomes. We review the epidemiology of gastroenteritis and food-borne diseases in elderly residents of LTCFs to inform measures aimed at preventing sporadic disease and outbreaks. Gastroenteritis in elderly people is primarily acquired from other infected persons and contaminated foods, although infections may also be acquired when residents have poor personal hygiene, have contaminated living environments or water, or have contact with infected pets. Early recognition of outbreaks and implementation of control measures is critical to reduce the effects on LTCF residents and staff members. Although outbreaks among LTCF residents are common, they are challenging to investigate, and there are still major gaps in our knowledge, particularly in regards to controlling noroviruses, the incidence and causes of specific infections, and sources of food-borne disease.
Publisher: Mary Ann Liebert Inc
Date: 12-2009
Abstract: The objective of this study was to examine the frequency of C ylobacter outbreaks in Australia and determine common transmission routes and vehicles. Summary and unit data on C ylobacter outbreaks that occurred between January 2001 and December 2006 were systematically collected and analyzed. Data from C ylobacter mandatory notifications for the same period were used for comparison. During the study period there were 33 C ylobacter outbreaks reported, affecting 457 persons. Of these, 147 (32%) had laboratory-confirmed infections, constituting 0.1% of notified C ylobacter cases. C ylobacter outbreaks most commonly occurred during the Australian Spring (September to November n = 14, 45%), when notifications generally peaked. Transmission was predominantly foodborne or suspected foodborne (n = 27, 82%), commercial settings (n = 15, 55%) being most commonly involved. There were eight foodborne outbreaks (30%) attributed to food prepared or eaten at institutions four (15%) at aged care facilities and three (11%) at school c s. A vehicle or suspected vehicle was determined for 16 (59%) foodborne outbreaks poultry (chicken or duck) was associated with 11 (41%) of these, unpasteurized milk and salad were associated with two outbreaks each. Three potential waterborne outbreaks were detected, and one was due to person-to-person transmission. C ylobacter outbreaks were more commonly detected during this study period compared to a previous 6-year period (n = 9) when prospective recording of information was not undertaken. However, outbreak cases continue to constitute a very small proportion of notifications. Improved recognition through subtyping is required to enhance outbreak detection and investigation so as to aid policy formulation for prevention of infection. In addition to detection of chicken as a common source of outbreaks, these data highlight the importance of directing policy at commercial premises, aged care facilities, and school c s to reduce C ylobacter disease burden.
Location: Italy
Location: Italy
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 03-2012
End Date: 02-2014
Amount: $251,373.00
Funder: Australian Research Council
View Funded ActivityStart Date: 12-2021
End Date: 03-2023
Amount: $881,758.00
Funder: Australian Research Council
View Funded ActivityStart Date: 06-2018
End Date: 12-2021
Amount: $266,912.00
Funder: Australian Research Council
View Funded Activity