ORCID Profile
0000-0003-1368-1039
Current Organisations
Royal Melbourne Hospital
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Monash University
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Publisher: Oxford University Press (OUP)
Date: 12-2006
DOI: 10.1510/ICVTS.2006.132191
Abstract: Serious non-fatal complications of cardiac surgery include deep sternal wound infection (DSWI) and haemorrhage. Understanding the factors associated with these complications (both pre-operatively and intra-operatively) may aid in the prevention and avoidance of such complications. The aim of the current report is to identify factors associated with DSWI and haemorrhage for all patients undergoing cardiac surgical procedures in Victorian public hospitals from July 2001 to June 2005. Multiple logistic regression analysis incorporating preoperative and intraoperative variables was used to identify risk factors for DSWI and haemorrhage. There were 153 cases of DSWI (1.3%) and 413 cases of haemorrhage (3.5%) in 11,848 patients. The risk factors differ between DSWI and haemorrhage, with pre-operative factors being more commonly associated with DSWI and intra-operative factors associated with haemorrhage. Strategies directed towards minimising modifiable pre-operative risk factors (diabetes, preoperative dialysis, respiratory disease, being overweight and angina CCS Class 3 or 4) may reduce the incidence of DSWI. Improvements in operative factors (perfusion time, ventricular assist device, intraaortic balloon pump and aortic dissection) and surgical technique, may impact on reducing the incidence of haemorrhage.
Publisher: American Society for Microbiology
Date: 10-2013
DOI: 10.1128/JCM.01501-13
Abstract: Contact precautions are recommended in hospitals to prevent the transmission of vancomycin-resistant enterococci (VRE) however, there is no clear policy for how long patients should be under contact precautions due to a lack of information on the duration of carriage of these organisms. We conducted a retrospective cohort study to understand the duration of carriage of VRE (by screening of a single stool culture) and associated factors among patients who had been identified with VRE infection and/or colonization since the year 2000 at our health facilities. Of the 345 eligible participants, 136 did not respond, 90 declined to participate, and 16 did not send in the required specimens. Of the 103 remaining participants, 13 were found to have current VRE fecal carriage. The proportion of colonized patients fell from 40% (2/5) in the first year to 23.3% (7/30) in year 4. None of the 40 patients who had VRE detected years prior were found to be colonized at the time of the study. The longest duration of detected VRE positivity was 46.5 months. Univariate analysis revealed that recent exposure to any antibiotics ( P = 0.016), multiple antibiotics ( P = 0.001), amoxicillin-clavulanic acid ( P = 0.021), piperacillin-tazobactam ( P = 0.007), glycopeptides ( P 0.001), meropenem ( P = 0.007), aminoglycosides ( P = 0.021), or fluoroquinolones ( P = 0.021), being the index case in a clinical specimen ( P = 0.016), and recent hospitalization ( P 0.001) were significantly associated with continued carriage on follow-up. In the surviving outpatients, a significant proportion appeared to clear VRE carriage. Our results suggest that in the absence of recent risk factors, such as hospitalization or antibiotic use, patients with a remote history of colonization ( years) may no longer require contact isolation precautions.
Publisher: Japan Epidemiological Association
Date: 2014
Publisher: Elsevier BV
Date: 12-2014
Abstract: This study aimed to evaluate the knowledge, attitudes and practices of healthcare providers regarding asplenic patients and to assess their satisfaction with the Victorian Spleen Registry (VSR) service. Survey forms were sent to 992 healthcare providers listed as caring for at least one patient registered on the VSR. A total of 223 completed questionnaires were returned. Healthcare providers heard about the VSR mainly from another healthcare professional or through a healthcare institution (31.7%), via online or printed resources (30.8%) or from their patients (24.4%). Most respondents valued the work of the VSR in providing information to healthcare professionals (71.4%), providing a reminder service for vaccinations (66.7%) and providing education to patients (60.5%). Most of those surveyed correctly identified high-risk infections for asplenic and hyposplenic patients with encapsulated organisms, but less than one-third identified a risk with malarial infections (32.9%). Providers always recommended influenza vaccinations, emergency standby antibiotics and an alert medallion or card in 92.8%, 63.6% and 36.4% of cases, respectively. Healthcare providers value and are satisfied with the service provided by the VSR. Patients can play a valuable role in communicating with their health providers. This survey may have been of value to healthcare providers by heightening awareness of the VSR website as well as knowledge of the registry. The results positively reflect the functioning of the VSR, although better promotion of the VSR among healthcare professionals and consideration of expansion is needed.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 04-2014
Publisher: Oxford University Press (OUP)
Date: 11-2013
DOI: 10.1111/JTM.12052
Abstract: Dengue is a leading public health problem with an expanding global burden. Dengue virus is also a significant cause of illness in international travelers with an increasing number of cases of dengue fever identified in travelers returning from dengue-endemic countries. This review focuses on the clinical illness of dengue infection in international travelers and provides a summary of the risk of infection for travelers, clinical features of infection, and an overview of dengue vaccines and their potential applicability to travelers. Four prospective studies of travelers to dengue-endemic destinations have shown that the dengue infection incidence ranges from 10.2 to 30 per 1,000 person-months. This varies according to travel destination and duration and season of travel. Dengue is also a common cause of fever in returned travelers, accounting for up to 16% of all febrile illnesses in returned travelers. Although the majority of infections are asymptomatic, a small proportion of travelers develop dengue hemorrhagic fever. The diagnosis of dengue in travelers requires a combination of serological testing for IgG and IgM together with either nucleic acid or NS1 antigen testing. Several vaccine candidates have now entered into clinical trials including ChimeriVax Dengue, which is currently in phase 3 trials, live-attenuated chimeric vaccines (DENV-DENV Chimera, Inviragen), live-attenuated viral vaccines, recombinant protein subunit vaccines, and DNA vaccines. Dengue infection in international travelers is not infrequent and may be associated with substantial morbidity. Furthermore, an accurate diagnosis of dengue in travelers requires the use of a combination of diagnostic tests. Although a vaccine is not yet available a number of promising candidates are under clinical evaluation. For now travelers should be provided with accurate advice regarding preventive measures when visiting dengue-endemic areas.
Publisher: Wiley
Date: 16-05-2011
Publisher: Cambridge University Press (CUP)
Date: 09-07-2004
DOI: 10.1017/S0950268804002365
Abstract: Cases of gastroenteritis were examined to identify if dietary intake prior to an episode and food-handling and storage practices in the home were risk factors for illness. Cases and controls completed a dietary questionnaire after an event or when well, and questionnaires concerning food-handling, storage and general food-hygiene practices. Comparing cases to themselves when well, subjects were more likely to have eaten cold sliced salami, fried rice and foods cooked elsewhere, and to have had a baby in nappies in the house (OR 1·52–6·24, P [les ]0·01). Cases compared to non-cases were more likely to have bought frozen poultry, have eaten foods cooked elsewhere and to have had a baby in nappies in the house (OR 1·44–2·05, P [les ]0·01). Although food-handling and storage practices are considered important, we were unable to detect an association in this study.
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1111/J.1753-6405.2009.00359.X
Abstract: To investigate the recruitment of 'niche' household populations, defined by their household characteristics and/or water supply type for health studies. The Australian Electoral Commission (AEC) database was used to recruit households for participation in two health-related studies, the first, a recycled water usage study and the second, an epidemiological study investigating household rainwater use. The AEC database facilitated the identification and recruitment of households using a particular water supply from among the general household population. The good utility of the AEC roll in household recruitment was associated with its coverage, accuracy and the ability to delimit the s ling frame according to the geographical area(s) and household characteristics of interest. Its use also allowed personalised contact to be made with potential survey participants by mail, contact that is not otherwise possible using existing telephone and on-line databases. The AEC database is a valuable resource for household recruitment in a ersity of health and environmental exposure surveys.
Publisher: IWA Publishing
Date: 09-2009
DOI: 10.2166/WST.2009.494
Abstract: Appropriate preservation of a range of water types prior to analysis for endotoxin was investigated, including s le storage and addition of sodium thiosulphate. Biologically active endotoxin in water s les was assayed using a chromogenic Limulus Amoebocyte Lysate (LAL) assay. Statistical analysis of measured mean endotoxin levels obtained for s les with and without sodium thiosulphate showed no significant difference in results. There was a 44% mean decline in the concentration of detectable endotoxin in water s les stored at −80°C for 4 weeks compared with s les stored at 4°C and analysed within 24 hours. Freezing of water s les at −80°C in pyrogen-free containers for 4 weeks or longer, then thawing may lead to considerable endotoxin loss however the addition of sodium thiosulphate to water s les interferes minimally with the LAL assay. These results provide methodological information that can be used to assist researchers in future water endotoxin monitoring studies. The validation and standardisation of water s le preservation protocols are necessary, given the likely increase in the quantification of endotoxin levels in a variety of water sources and the use of such results for health effect determinations.
Publisher: Cambridge University Press (CUP)
Date: 10-2013
DOI: 10.1086/673153
Abstract: Contact precautions (CPs) may lead to adverse psychological effects, delays in access to services, and compromises in the quality of care and patient safety. These need to be balanced with the benefits in preventing transmission of resistant microorganisms. In this study, we aimed to quantify the effect of CPs on reported patient safety incidents. The Alfred hospital is a tertiary referral hospital in Melbourne, Australia. Previous studies have shown that colonization with vancomycin-resistant enterococcus (VRE) is endemic in our hospital. Patients found to be colonized with VRE are placed in CPs immediately and during each subsequent admission. At our facility, modified CPs practiced during the study period include isolation in single rooms with a dedicated toilet, use of gloves when entering the room, and gloves and gown if contact with body fluids is anticipated. The hospital has a computerized risk management system where relevant patient safety incidents are reported to facilitate institutional review and response. We conducted a retrospective cohort study using these routinely collected data, comparing the incidence rate of documented adverse events in patients prior and subsequent to initiation of CPs among patients colonized or infected with VRE. Patients with incident VRE detection between January 2009 and October 2010 were included.
Publisher: Oxford University Press (OUP)
Date: 11-2006
DOI: 10.1086/507893
Abstract: Travelers returning to their country of origin to visit friends and relatives (VFRs) have increased risk of travel-related health problems. We examined GeoSentinel data to compare travel characteristics and illnesses acquired by 3 groups of travelers to low-income countries: VFRs who had originally been immigrants (immigrant VFRs), VFRs who had not originally been immigrants (traveler VFRs), and tourist travelers. Immigrant VFRs were predominantly male, had a higher mean age, and disproportionately required treatment as inpatients. Only 16% of immigrant VFRs sought pretravel medical advice. Proportionately more immigrant VFRs visited sub-Saharan Africa and traveled for >30 days, whereas tourist travelers more often traveled to Asia. Systemic febrile illnesses (including malaria), nondiarrheal intestinal parasitic infections, respiratory syndromes, tuberculosis, and sexually transmitted diseases were more commonly diagnosed among immigrant VFRs, whereas acute diarrhea was comparatively less frequent. Immigrant VFRs and traveler VFRs had different demographic characteristics and types of travel-related illnesses. A greater proportion of immigrant VFRs presented with serious, potentially preventable travel-related illnesses than did tourist travelers.
Publisher: Oxford University Press (OUP)
Date: 1999
DOI: 10.1093/JAC/43.1.113
Abstract: Since the efficacy of beta-lactams against pathogens such as methicillin-susceptible Staphylococcus aureus (MSSA) is related to the time for which serum drug concentrations exceed the MIC for the pathogen, administration of anti-staphylococcal beta-lactams by continuous infusion may provide a more suitable means of drug delivery than intermittent dosing. To assess the clinical efficacy of continuous-infusion therapy, we reviewed the outcomes for 20 consecutive patients with proven serious MSSA sepsis (three with endocarditis, ten osteomyelitis, one endocarditis plus osteomyelitis and six deep abscess) treated with continuous-infusion flucloxacillin (8-12 g/day). Patients initially receiving routine intermittent-dose flucloxacillin therapy were changed to continuous-infusion flucloxacillin (mean duration 29 days range 4-60 days) for completion of their treatment course. In the majority of cases this was given at home. Serum flucloxacillin concentrations during continuous-infusion flucloxacillin 12 g/day were 11.5->40 mg/L (ten patients) and those during continuous-infusion flucloxacillin 8 g/day were 8->40 mg/L (five patients), these concentrations being well above the expected MIC of flucloxacillin for MSSA. Continuous-infusion flucloxacillin was well tolerated by most patients, and 14/17 patients (82%) who completed their course of continuous-infusion flucloxacillin were judged clinically and microbiologically cured at long-term follow-up (mean 67 weeks range 4-152 weeks). These preliminary data suggest that, following initial intermittent-dose flucloxacillin therapy, continuous-infusion flucloxacillin is an effective treatment option for serious MSSA sepsis, and forms a feasible and possibly preferable alternative to glycopeptides when considering home-based parenteral therapy for these infections. Further studies are needed to identify whether continuous-infusion flucloxacillin can entirely replace intermittent-dose therapy for such infections.
Publisher: Elsevier BV
Date: 06-2000
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 2014
Publisher: MDPI AG
Date: 19-04-2022
Abstract: Objective: the COVID-19 pandemic has incurred psychological risks for healthcare workers (HCWs). We established a Victorian HCW cohort (the Coronavirus in Victorian Healthcare and Aged-Care Workers (COVIC-HA) cohort study) to examine COVID-19 impacts on HCWs and assess organisational responses over time. Methods: mixed-methods cohort study, with baseline data collected via an online survey (7 May–18 July 2021) across four healthcare settings: ambulance, hospitals, primary care, and residential aged-care. Outcomes included self-reported symptoms of depression, anxiety, post-traumatic stress (PTS), wellbeing, burnout, and resilience, measured using validated tools. Work and home-related COVID-19 impacts and perceptions of workplace responses were also captured. Results: among 984 HCWs, symptoms of clinically significant depression, anxiety, and PTS were reported by 22.5%, 14.0%, and 20.4%, respectively, highest among paramedics and nurses. Emotional exhaustion reflecting moderate–severe burnout was reported by 65.1%. Concerns about contracting COVID-19 at work and transmitting COVID-19 were common, but 91.2% felt well-informed on workplace changes and 78.3% reported that support services were available. Conclusions: Australian HCWs employed during 2021 experienced adverse mental health outcomes, with prevalence differences observed according to occupation. Longitudinal evidence is needed to inform workplace strategies that support the physical and mental wellbeing of HCWs at organisational and state policy levels.
Publisher: Oxford University Press (OUP)
Date: 05-2015
DOI: 10.1111/JTM.12183
Abstract: An important role of pre-travel consultations is to improve travelers' understanding of travel-related diseases, but the efficacy of education provided is unknown. This study sought to assess recall and knowledge immediately following a pre-travel consultation. The study was conducted at a hospital-based pre-travel clinic in Melbourne, Australia. Travelers aged ≥16 years seen between September 2010 and March 2012 were invited to complete an anonymous self-administered questionnaire immediately following their consultation to assess knowledge of appropriate preventive measures and presumptive self-treatment strategies for common travel risks. The doctor of each participating traveler also completed a survey regarding issues discussed. A total of 300 participants were recruited (34% male, median age 31 years). Most were traveling for vacation (77%) and reported previous travel (95%). Main travel destinations were Asia (43%), Americas (21%), and Africa (17%). Doctors' and travelers' surveys showed variable levels of concordance: 94% of patients recalled discussion of malaria, 84% rabies, and 76% dengue. For malaria, 95% remembered discussions regarding insect repellents, and 92% recalled that medical advice should be sought if fever developed. For travelers with whom rabies was discussed, 94% recalled that medical advice must be urgently sought following a bite/scratch. For travelers' diarrhea (TD), 99% knew to drink only boiled/bottled water, but 13% did not recall avoiding unpeeled fruit/vegetables as a prevention strategy. There was 20% discordance between doctors and travelers regarding antibiotics for TD self-treatment, but only 4% discordance regarding prescription of malaria prophylaxis. Factors associated with improved recall were doctor discussion, previous travel, and a university education. Key travel health messages are well assimilated after pre-travel consultation. However, large amounts of information are discussed and immediate recollection of all information is not possible. This study reinforces the importance of providing supplementary information (eg, written and/or electronic resources) to accompany pre-travel consultations.
Publisher: Informa UK Limited
Date: 04-2013
DOI: 10.1586/ERV.13.16
Abstract: Illness in business travelers is associated with reduced productivity on the part of the employee as well as the employer. Immunizations offer a reliable method of preventing infectious diseases for international business travelers. The authors review the travel patterns of business travelers, available data on illnesses they encounter, their potential travel-associated risks for vaccine-preventable diseases and recommendations on immunizations for this population. Routine vaccines (e.g., measles, tetanus and influenza) should be reviewed to assure that they provide current coverage. The combined hepatitis A and hepatitis B vaccine with a rapid schedule offers options for those with time constraints. Other vaccine recommendations for business travelers need to focus on their destinations and activities and underlying health, taking into account the concept of cumulative risk for those with frequent travel, multiple trips or long stays.
Publisher: American Society of Tropical Medicine and Hygiene
Date: 04-09-2013
Publisher: Wiley
Date: 09-01-2015
DOI: 10.1111/TMI.12448
Abstract: To assess sustained siphon filter usage among a low-income population in Bangladesh and study relevant motivators and barriers. After a randomised control trial in Bangladesh during 2009, 191 households received a siphon water filter along with educational messages. Researchers revisited households after 3 and 6 months to assess filter usage and determine relevant motivators and barriers. Regular users were defined as those who reported using the filter most of the time and were observed to be using the filter at follow-up visits. Integrated behavioural model for water, sanitation and hygiene (IBM-WASH) was used to explain factors associated with regular filter use. Regular filter usage was 28% at the 3-month follow-up and 21% at the 6-month follow-up. Regular filter users had better quality water at the 6-month, but not at the 3-month visit. Positive predictors of regular filter usage explained through IBM-WASH at both times were willingness to pay >US$1 for filters, and positive attitude towards filter use (technology dimension at in idual level) reporting boiling drinking water at baseline (psychosocial dimension at habitual level) and Bengali ethnicity (contextual dimension at in idual level). Frequently reported barriers to regular filter use were as follows: considering filter use an additional task, filter breakage and time required for water filtering (technology dimension at in idual level). The technological, psychosocial and contextual dimensions of IBM-WASH contributed to understanding the factors related to sustained use of siphon filter. Given the low regular usage rate and the hardware-related problems reported, the contribution of siphon filters to improving water quality in low-income urban communities in Bangladesh is likely to be minimal.
Publisher: Oxford University Press (OUP)
Date: 15-02-2003
DOI: 10.1086/346155
Abstract: Respiratory tract infections are common in travelers, and improving our knowledge of risk factors associated with specific types of respiratory infections should enable implementation of better preventive strategies. Data collected by the GeoSentinel surveillance network were analyzed, and the most significant predictors for developing specific categories of respiratory infections while abroad were age, sex, season of travel, trip duration, and reason for travel. In particular, influenza was associated with travel to the Northern Hemisphere during the period of December through February, travel involving visits to friends or relatives, and trip duration of >30 days. Lower respiratory tract infections were associated with male sex and increasing age. Knowledge of the respiratory tract infections that occur in specific groups of travelers allows for the development of targeted pretravel preventive strategies to high-risk groups.
Publisher: IWA Publishing
Date: 03-2013
DOI: 10.2166/WS.2013.022
Abstract: Research on the potential of greywater reuse to reduce urban tap water demand has focused mainly on permanently installed greywater treatment or irrigation systems. These may be readily implemented in new housing developments, but experience in Australia shows their uptake by established households in urban areas is low. The majority of households employ simple and temporary methods for greywater collection and use, but their behaviour has not been well documented. We characterised the greywater use practices of over 1,000 Melbourne households during a 5-year period (2007 to 2011) which included 3 years of severe drought with stringent restrictions on outdoor tap water use. Greywater was most frequently collected from the laundry and bathroom, and generally used within 24 hours. Garden watering was the most common end use, and treatment of greywater to reduce microbial contamination was very rare. Volume estimates by householders suggest that on average around 10% of tap water used in the home was being collected for reuse. When drought conditions and water restrictions eased, over 40% of user households discontinued greywater use. Widespread adoption of permanent greywater collection, treatment and storage systems by households would be required to achieve a lasting effect on urban water consumption.
Publisher: IWA Publishing
Date: 05-01-2015
DOI: 10.2166/WH.2015.201
Abstract: The health-based targets of 1 in 10,000 for infection and 10−6 disability adjusted life years (DALYs) per person per year are increasingly being considered, or have already been adopted, to define microbial safety targets for water. The aim of this paper is to convey information about how these two targets compare by converting each of the target values to a common metric. The metric chosen for viral (rotavirus and norovirus) and protozoan (Cryptosporidium) reference pathogens is the estimated maximum number of annual drinking water-associated cases of acute diarrhoeal disease tolerated. For the reference bacterial pathogen C ylobacter, sequelae to acute diarrhoeal illness have also been considered in estimating the tolerable number of cases for the DALY target. Also investigated is whether non-compliance with targets would be detected as a waterborne disease outbreak by the health surveillance system in an extreme hypothetical situation whereby all tolerable cases per annum occurred as a single event. The paper highlights that verification of compliance with targets cannot be demonstrated by the absence of reported drinking water-associated outbreaks alone and concludes that introduction of a quantitative health-based outcome for drinking water in Australia would help improve water quality management by providing a common goal directly linked to health outcomes.
Publisher: American Public Health Association
Date: 05-2011
Abstract: Objectives. We examined whether drinking untreated rainwater, a practice that is on the rise in developed countries because of water shortages, contributes to community gastroenteritis incidence. Methods. We conducted a double-blinded, randomized controlled trial in Adelaide, Australia. Sham or active water treatment units were installed, and participants recorded incidences of illness in a health diary for 12 months. The primary outcome was highly credible gastroenteritis (HCG characterized by a specified number of loose stools or vomiting alone or in combination with abdominal pain or nausea in a 24-hour period), and we used generalized estimating equations to account for correlations between numbers of HCG events for in iduals in the same family. Results. Participants reported 769 episodes during the study (0.77 episodes erson/year), with an HCG incidence rate ratio (active vs sham) of 1.05 (95% confidence interval [CI] = 0.82, 1.33). Blinding of the participants was effective (index = 0.65 95% CI = 0.58, 0.72). Conclusions. Our results suggest that consumption of untreated rainwater does not contribute appreciably to community gastroenteritis. However, our findings may not be generalizable to susceptible and immunocompromised persons because these groups were specifically excluded from the study.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.WATRES.2012.05.001
Abstract: A monitoring program was undertaken to assess the microbial quality of greywater collected from 93 typical households in Melbourne, Australia. A total of 185 s les, comprising 75 washing machine wash, 74 washing machine rinse and 36 bathroom s les were analysed for the faecal indicator Escherichia coli. Of these, 104 were also analysed for genetic markers of pathogenic E coli and 111 for norovirus (genogroups GI and GII), enterovirus and rotavirus using RT-PCR. Enteric viruses were detected in 20 out of the 111 (18%) s les comprising 16 washing machine wash water and 4 bathroom s les. Eight (7%) s les were positive for enterovirus, twelve (11%) for norovirus genogroup GI, one (1%) for norovirus genogroup GII and another (1%) for rotavirus. Two washing machine s les contained more than one virus. Typical pathogenic E. coli were detected in 3 out of 104 (3%) s les and atypical enteropathogenic E. coli in 11 (11%) of s les. Levels of indicator E. coli were highly variable and the presence of E. coli was not associated with the presence of human enteric viruses in greywater. There was also little correlation between reported gastrointestinal illness in households and detection of pathogens in greywater.
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.JCV.2013.01.008
Abstract: Respiratory infections including influenza are a common cause of acute short-term morbidity in travellers and yet the risk of these infections is poorly defined. To estimate the incidence density of and risk factors for acute respiratory infections (ARIs) and influenza in Australian travellers to Asia. Travel-clinic attendees were prospectively identified and completed questionnaires (demographic data, travel itinerary, health and vaccination history) and also provided pre and post-travel serological s les for Influenza A and B (complement fixation test). Returned travellers with an ARI provided nasopharyngeal specimens for RT-PCR identification of respiratory viruses. In this cohort (n = 387) of predominantly (72%) short-term travellers, 58% were female, the median age was 37 years and 69% were tourists. ARIs occurred in 109 travellers (28%) translating to an incidence of 106.4 ARIs per 10,000 traveller days (95% confidence interval CI 88.6-126.7). The traveller type of missionary or aid worker was a risk factor for acquiring an ARI (p = 0.03) and ARIs occurred early (< 30 days) in the travel period (p = 0.001). Four travellers (1%) acquired influenza A during travel translating to an incidence density of 3.4 infections per 10,000 days of travel (95% CI 1.4-8.6). Influenza vaccination was reported in 49% of travellers with a 3.5-fold higher incidence of influenza in unvaccinated travellers compared to vaccinated travellers (p = 0.883). This is one of the largest prospective studies estimating the incidence of respiratory infections in travellers. These findings have important implications for practitioners advising prospective travellers and for public health authorities.
Publisher: Springer Science and Business Media LLC
Date: 30-05-2013
DOI: 10.1057/JPHP.2013.22
Publisher: Springer Science and Business Media LLC
Date: 31-08-2012
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-042850
Abstract: Increasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries. RISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental s ling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and ersity of gastrointestinal pathogens, abundance and ersity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination abundance and ersity of pathogens and AMR genes in environmental s les impacts on ecological bio ersity and microclimates mosquito vector abundance anthropometric assessments, nutrition markers and systemic inflammation in children caregiver-reported and self-reported health symptoms and healthcare utilisation and measures of in idual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being. Study protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University. ACTRN12618000633280 Pre-results.
Publisher: Oxford University Press (OUP)
Date: 07-2012
Publisher: IWA Publishing
Date: 08-2008
DOI: 10.2166/WST.2008.427
Abstract: The aim of this study was to elucidate whether the current withholding period of 4 hours following irrigation of public recreational areas with some classes of recycled water, as prescribed in some Australian state regulations, is valid or whether the holding time can be reduced under specified ambient conditions. A secondary objective was to evaluate laboratory simulations of ambient field conditions for microbial survival experiments. Results suggest that the currently prescribed 4 hour withholding period achieves a reduction of health risk associated with bacterial enteric pathogens that would not otherwise occur if the withholding period was reduced. However, this may not be the case for viral enteric pathogens as the survival of bacteriophages, PRD-1 and MS-2 on turf-grass did not significantly change even after 6 hours, except PRD-1 under high solar conditions. These results suggest that bacteriophages, PRD-1 and MS-2 are more conservative indicators of enteric pathogen survival on UV exposed turf-grass compared with E. coli. The simulations of field conditions in the laboratory were somewhat problematic, with the variations in natural conditions that occur temporally, sometimes for short periods, difficult to reproduce.
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.00672
Publisher: IWA Publishing
Date: 08-2008
DOI: 10.2166/WST.2008.428
Abstract: The primary objective of this preliminary study was to ascertain the concentration of endotoxin in a variety of Australian water types, including recycled water. A total of 42 s ling sites were surveyed, the majority on at least 2 separate occasions (total number of s les analysed was 76). S les were collected from a variety of locations throughout Australia including: drinking water distribution (12), drinking water reservoir (4), wastewater treatment train (11) and finished recycled water (15). Class A recycled waters, defined microbiologically in Australian regulations as having & E. coli per 100 mL, where the treatment train did not include membrane filtration, gave rise to an average measured endotoxin concentration of 2.030 Endotoxin Units (EU) per mL (N=7). For recycled Class A water s les, where membrane filtration was part of the treatment train (N=3) the average endotoxin concentration was 41 EU/mL. Measured endotoxin concentrations in drinking water varied from & to 119 EU/mL. Results of this preliminary study indicate that endotoxin concentrations in recycled water may be reduced to levels at least as low as those found in drinking water but for some recycled waters, where membrane filtration is not practiced, higher endotoxin concentrations may persist.
Publisher: Springer Science and Business Media LLC
Date: 09-1998
Abstract: We perform partial sphincterectomy during cataract surgery in cases with very small pupil (< 3 mm). We assume that the small pupil is mainly due to a fibrosis ring of the sphincter muscle. In 35 patients we performed the complete ophthalmological routine checkup. The pupil diameter was analysed by perimeter: a base value, with light, and in pharmaceutical mydriasis. Moreover 15 preparations were analysed histologically. Average pupil diameter was: base value 3.76 mm, with light 3.24 mm, in pharmaceutical mydriasis 4.84 mm. The showed pathohistological examination that in all excisions a part of the sphincter muscle was verifiable. We found fibrosis of different grades in various locations. In most cases functional pupil movement can be verified after operation. In an intended partial sphincterectomy part of the sphincter muscle can be excised. The different pupil diameter is due to the different degree of fibrosis of the sphincter muscle.
Publisher: Public Library of Science (PLoS)
Date: 30-09-2014
Publisher: Oxford University Press (OUP)
Date: 03-2023
DOI: 10.1093/JTM/TAAD029
Abstract: The recent emergence of Japanese encephalitis in south-eastern Australia highlights the changing epidemiology of this important disease and the need for integrated surveillance to inform risk-based discussions and vaccination advice for travellers and endemic populations.
Publisher: Wiley
Date: 12-10-2005
DOI: 10.1111/J.1440-1746.2005.04047.X
Abstract: Many in iduals with gastrointestinal symptoms do not seek medical attention and so there is little known about the pathogens involved in most cases of community gastroenteritis. We aimed to identify the pathogens responsible for community gastroenteritis and to examine the associated symptoms. In a prospective study of 2811 subjects over 15 months, fecal pathogens were examined following highly credible gastroenteritis (HCG) events. The population consisted of family units of at least two children (< or =15 years-old) and two adults each. Fecal s les were tested for a range of bacterial, viral and protozoal pathogens. Gastroenteric episode duration and symptoms such as vomiting, nausea and diarrhea were measured. One or more pathogens were identified in 198 of a total 791 specimens collected. Pathogens detected most often were Norovirus virus (10.7%), pathogenic E. coli (6.7%), C ylobacter spp. (3.0%) and Giardia sp. (2.5%). Children were more prone than adults to all the pathogens tested, except E. coli. Children infected with C ylobacter were 8.3 times more likely (95% CI: 2.7-25.4) to have a longer duration of diarrhea than children with Norovirus (P < 0.001). Similarly, children infected with E. coli had increased persistence of diarrhea compared to Norovirus (OR = 3.5 95% CI: 1.3-9.5 P = 0.02). Infection with Norovirus in children meant greater persistence of vomiting symptoms than infection with C ylobacter (P = 0.005), E. coli (P = 0.03), or if no pathogen was identified (P = 0.004). Adults usually vomited for fewer days than children while duration of diarrhea was similar to children. Many of the pathogens responsible for cases of gastroenteritis in the Australian community are likely to go undetected by current surveillance systems and routine clinical practice.
Publisher: Oxford University Press (OUP)
Date: 07-2011
Publisher: Oxford University Press (OUP)
Date: 05-2006
DOI: 10.1111/J.1708-8305.2006.00033.X
Abstract: Data comparing returned travelers and immigrants/refugees managed in a hospital setting is lacking. We prospectively collected data on 1,106 patients with an illness likely acquired overseas who presented to two hospital-based Australian infectious diseases units over a 6-year period. Eighty-three percent of patients were travelers and 17% immigrants/refugees. In travelers, malaria (19%), gastroenteritis/diarrhea (15%), and upper respiratory tract infection (URTI) (7%) were the most common diagnoses. When compared with immigrants/refugees, travelers were significantly more likely to be diagnosed with gastroenteritis/diarrhea [odds ratio (OR) 8], malaria (OR 7), pneumonia (OR 6), URTI (OR 3), skin infection, dengue fever, typhoid aratyphoid fever, influenza, and rickettsial disease. They were significantly less likely to be diagnosed with leprosy (OR 0.03), chronic hepatitis (OR 0.04), tuberculosis (OR 0.05), schistosomiasis (OR 0.3), and helminthic infection (OR 0.3). In addition, travelers were more likely to present within 1 month of entry into Australia (OR 96), and have fever (OR 8), skin (OR 6), gastrointestinal (OR 5), or neurological symptoms (OR 5) but were less likely to be asymptomatic (OR 0.1) or have anaemia (OR 0.4) or eosinophilia (OR 0.3). Diseases in travelers were more likely to have been acquired via a vector (OR 13) or food and water (OR 4), and less likely to have been acquired via the respiratory (OR 0.2) or skin (OR 0.6) routes. We also found that travel destination and classification of traveler can significantly influence the likelihood of a specific diagnosis in travelers. Six percent of travelers developed a potentially vaccine-preventable disease, with failure to vaccinate occurring in 31% of these cases in the pretravel medical consultation. There are important differences in the spectrum of illness, clinical features, and mode of disease transmission between returned travelers and immigrants/refugees presenting to hospital-based Australian infectious diseases units with an illness acquired overseas.
Publisher: Oxford University Press (OUP)
Date: 03-2007
DOI: 10.1086/511690
Publisher: Oxford University Press (OUP)
Date: 15-10-2004
DOI: 10.1086/424510
Abstract: Malaria is a common and important infection in travelers. We have examined data reported to the GeoSentinel surveillance network to highlight characteristics of malaria in travelers. A total of 1140 malaria cases were reported (60% of cases were due to Plasmodium falciparum, 24% were due to Plasmodium vivax). Male subjects constituted 69% of the study population. The median duration of travel was 34 days however, 37% of subjects had a travel duration of < or =4 weeks. The majority of travellers did not have a pretravel encounter with a health care provider. Most cases occurred in travelers (39%) or immigrants/refugees (38%). The most common reasons for travel were to visit friends/relatives (35%) or for tourism (26%). Three-quarters of infections were acquired in sub-Saharan Africa. Severe and/or complicated malaria occurred in 33 cases, with 3 deaths. Compared with others in the GeoSentinel database, patients with malaria had traveled to sub-Saharan Africa more often, were more commonly visiting friends/relatives, had traveled for longer periods, presented sooner after return, were more likely to have a fever at presentation, and were less likely to have had a pretravel encounter. In contrast to immigrants and visitors of friends or relatives, a higher proportion (73%) of the missionary/volunteer group who developed malaria had a pretravel encounter with a health care provider. Travel to sub-Saharan Africa and Oceania was associated with the greatest relative risk of acquiring malaria. We have used a global database to identify patient and travel characteristics associated with malaria acquisition and characterized differences in patient type, destinations visited, travel duration, and malaria species acquired.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1111/J.1469-0691.2010.03271.X
Abstract: Since 2008, when the outbreak of rabies in Bali began, 45 patients have attended GeoSentinel or EuroTravNet sites for rabies post-exposure prophylaxis (PEP), representing 12.6% of all travellers seen for PEP in all network clinics during the same time period. This suggests that Bali is emerging as a commonly visited destination among travellers presenting for rabies PEP. The data demonstrate that the majority of animal-related injuries in travellers returning from Bali are associated with exposure to monkeys, and not dog bites/scratches. The clinical implications of this are discussed.
Publisher: American College of Physicians
Date: 18-06-2013
Publisher: Springer Science and Business Media LLC
Date: 09-11-2009
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.IJID.2014.08.006
Abstract: To estimate and compare disease burden attributable to six gastrointestinal pathogens (norovirus, rotavirus, C ylobacter, non-typhoidal Salmonella, Giardia, and Cryptosporidium) in Australia, 2010. We estimated the number of acute gastroenteritis (AGE) cases and deaths, disability-adjusted life years (DALYs), and DALY/case for each pathogen. We included AGE cases that did not require medical care. Sequelae were included for C ylobacter (Guillain-Barré syndrome, reactive arthritis (ReA), irritable bowel syndrome (IBS)) and Salmonella (ReA, IBS). We estimated 16626069 AGE cases in Australia in 2010 (population 22 million). Of the pathogens studied, most AGE cases were attributed to norovirus (2180145), C ylobacter (774003), and Giardia (614740). Salmonella caused the fewest AGE cases (71255) but the most AGE deaths (90). The DALY burden was greatest for C ylobacter (18222 DALYs) and Salmonella (3856 DALYs), followed by the viral and protozoal pathogens. The average DALY/case was greatest for Salmonella (54.1 DALY/1000 cases), followed by C ylobacter (23.5 DALY/1000 cases). The pathogen causing the greatest disease burden varied according to the metric used, however DALYs are considered most useful given the incorporation of morbidity, mortality, and sequelae. These results can be used to prioritize public health interventions toward Salmonella and C ylobacter infections and to measure the impact of these interventions.
Publisher: American College of Physicians
Date: 07-2023
DOI: 10.7326/M23-0721
Publisher: Oxford University Press (OUP)
Date: 11-2010
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/AH14124
Abstract: Objective To demonstrate the suitability of accessing interpreters via videoconference for medical consultations and to assess doctor and patient perceptions of this compared with either on-site or telephone interpreting. Methods We assessed the suitability and acceptability of accessing interpreters via videoconference during out-patient clinical consultations in two situations: (i) when the doctor and patient were in a consulting room at a central hospital and the interpreter sat remotely and (ii) when the doctor, patient and interpreter were each at separate sites (during a telehealth consultation). The main outcome measures were patient and doctor satisfaction, number of problems recorded and acceptability compared with other methods for accessing an interpreter. Results Ninety-eight per cent of patients were satisfied overall with the use of an interpreter by video. When comparing videoconference interpreting with telephone interpreting, 82% of patients thought having an interpreter via video was better or much better, 15% thought it was the same and 3% considered it worse. Compared with on-site interpreting, 16% found videoconferencing better or much better, 58% considered it the same and 24% considered it worse or much worse. Conclusions The present study has demonstrated that accessing an interpreter via videoconference is well accepted and preferred to telephone interpreting by both doctors and patients. What is known about the topic? Many immigrants and refugees settle in rural Australia. Access to professional on-site interpreters is difficult, particularly in rural Australia. What does this study add? Interpreters can be successfully accessed by videoconference. Patients and doctors prefer an interpreter accessed by videoconference rather than a telephone interpreter. What are the implications for practitioners? Doctors can utilise videoconferencing to access interpreters if this is available, confident that this is well accepted by patients and preferred to telephone interpreting.
Publisher: Oxford University Press (OUP)
Date: 28-02-2014
DOI: 10.1093/CID/CIU122
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.TMAID.2013.08.002
Abstract: International students in Victoria, Australia, originate from over 140 different countries. They are over-represented in disease notifications for tuberculosis and travel-associated infections, including enteric fever, hepatitis A, and malaria. We describe a public health initiative aimed to increase awareness of these illnesses among international students and their support staff. We identified key agencies including student support advisors, medical practitioners, health insurers, and government and professional organisations. We developed health education materials targeting international students regarding tuberculosis and travel-related infections to be disseminated via a number of different media, including electronic and printed materials. We sought informal feedback from personnel in all interested agencies regarding the materials developed, their willingness to deliver these materials to international students, and their preferred media for disseminating these materials. Education institutions with dedicated international student support staff and on-c us health clinics were more easily engaged to provide feedback and disseminate the health education materials than institutions without such dedicated personnel. Response to contacting off-c us medical practices was poor. Delivery of educational materials via electronic and social media was preferred over face-to-face education. It is feasible to provide health education messages targeting international students for dissemination via appropriately-staffed educational institutions. This initiative could be expanded in terms of age-group, geographic range, and health issues to be targeted.
Publisher: IWA Publishing
Date: 15-11-2014
DOI: 10.2166/WH.2014.242
Abstract: The last century has been marked by major advances in the understanding of microbial disease risks from water supplies and significant changes in expectations of drinking water safety. The focus of drinking water quality regulation has moved progressively from simple prevention of detectable waterborne outbreaks towards adoption of health-based targets that aim to reduce infection and disease to a level well below detection limits at the community level. This review outlines the changes in understanding of community disease and waterborne risks that prompted development of these targets, and also describes their underlying assumptions and current context. Issues regarding the appropriateness of selected target values, and how continuing changes in knowledge and practice may influence their evolution, are also discussed.
Publisher: Informa UK Limited
Date: 09-2020
Publisher: Oxford University Press (OUP)
Date: 02-2008
DOI: 10.1086/525268
Abstract: Among African immigrants in Melbourne, Victoria, Australia, we demonstrated lower geometric mean vitamin D levels in immigrants with latent tuberculosis infection than in those with no Mycobacterium tuberculosis infection (P=.007) such levels were also lower in immigrants with tuberculosis or past tuberculosis than in those with latent tuberculosis infection (P=.001). Higher vitamin D levels were associated with lower probability of any M. tuberculosis infection (P=.001) and lower probability of tuberculosis or past tuberculosis (compared with latent tuberculosis infection P=.001).
Publisher: Springer Science and Business Media LLC
Date: 29-08-2013
Abstract: Isoniazid treatment of latent tuberculosis infection (LTBI) is commonly prescribed in refugees and immigrants. We aimed to assess understanding of information provided about LTBI, its treatment and potential side effects. A questionnaire was administered in clinics at a tertiary hospital. Total Knowledge (TKS) and Total Side Effect Scores (TSES) were derived. Logistic regression analyses were employed to correlate socio-demographic factors with knowledge. Fifty-two participants were recruited, 20 at isoniazid commencement and 32 already on isoniazid. The average TKS were 5.04/9 and 6.23/9 respectively and were significantly associated with interpreter use. Approximately half did not know how tuberculosis was transmitted. The average TSES were 5.0/7 and 3.5/7 respectively, but were not influenced by socio-demographic factors. There was suboptimal knowledge about LTBI. Improvements in health messages delivered via interpreters and additional methods of distributing information need to be developed for this patient population.
Publisher: Elsevier BV
Date: 10-2022
Publisher: Public Library of Science (PLoS)
Date: 03-10-2017
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 11-2009
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.WATRES.2012.12.012
Abstract: The reuse of domestic greywater has become common in Australia, especially during periods of extreme drought. Greywater is typically used in a raw, untreated form, primarily for landscape irrigation, but more than a quarter of greywater users irrigate vegetable gardens with the water, despite government advice against this practice. Greywater can be contaminated with enteric pathogens and may therefore pose a health risk if irrigated produce is consumed raw. A quantitative microbial risk assessment (QMRA) model was constructed to estimate the norovirus disease burden associated with consumption of greywater-irrigated lettuce. The annual disease burdens (95th percentile DALYs per person) attributed to greywater irrigation ranged from 2 × 10(-8) to 5 × 10(-4), depending on the source of greywater and the existence of produce washing within households. Accounting for the prevalence of produce-washing behaviours across Melbourne, the model predicted annual disease burdens ranging from 4 × 10(-9) for bathroom water use only to 3 × 10(-6) for laundry water use only, and accounting for the proportionate use of each greywater type, the annual disease burden was 2 × 10(-6). We recommend the preferential use of bathroom water over laundry water where possible as this would reduce the annual burden of disease to align with the current Australian recycled water guidelines, which recommend a threshold of 10(-6) DALYs per person. It is also important to consider other exposure pathways, particularly considering the high secondary attack rate of norovirus, as it is highly likely that the estimated norovirus disease burden associated with greywater irrigation of vegetables is negligible relative to household contact with an infected in idual.
Publisher: Elsevier BV
Date: 11-2013
Publisher: American College of Physicians
Date: 19-03-2013
Publisher: Oxford University Press (OUP)
Date: 12-2002
DOI: 10.1086/344271
Abstract: Hepatitis B vaccine is a key tool for the prevention of hepatitis B infection. Age-associated changes in immune function may contribute to decreased vaccine efficacy in older in iduals, although research related to this topic has yielded contradictory findings. We performed a meta-analysis of 24 published trials and studies that evaluated the association of age with response to hepatitis B vaccine, using a random-effects model. Pooling of study results suggested a significantly increased risk of nonresponse to hepatitis B vaccine among older in iduals (relative risk [RR], 1.76 95% confidence interval [CI], 1.48-2.10). An elevated risk of nonresponse persisted even after exclusion of poor-quality studies (RR, 1.63 95% CI, 1.23-2.15) and adjustment for publication bias (RR, 1.52 95% CI, 1.26-1.83), and it was present even when "older" in iduals were defined as being as young as 30 years. These findings have important implications for in iduals at risk for hepatitis B infection, including health care workers and travelers.
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.TMAID.2013.06.008
Abstract: Dengue is a frequent cause of fever in travellers. The true extent is unknown as many infections are asymptomatic or undiagnosed. We used paired sera, with pre- and post-travel specimens from Swiss travellers to tropical destinations, to evaluate the seroepidemiology of travel-related dengue. Post-travel specimens were tested for the presence of IgG and IgM antibodies to dengue antigen serotypes (1, 2, 3 and 4) using an indirect enzyme-linked immunosorbent assay (ELISA). All post-travel sera that screened as positive for dengue IgG or IgM antibodies were re-tested with the corresponding pre-travel sera as paired assays in order to detect seroconversion. There were 285 travellers with specimens available for analysis. Two hundred and fifty seven of the 285 in iduals (90.2%) had negative dengue serology post-travel. Of the remaining 28 cases, 25 were dengue IgG positive and 3 had equivocal results. This corresponds to IgG seropositivity in 8.9%. Eighteen of these 25 in iduals had a pre-travel specimen available for testing, of which 15 were positive for IgG consistent with possible past exposure. Three of the 18 had negative serology pre-travel, indicating possible recent infection. This corresponds to an attack rate of possible dengue of 1.1% and an incidence rate of 6.7 per 1000 person-months (95% CI 0-60.0). Two of these three in iduals had received yellow fever vaccine for their trip, raising the potential of cross-reactivity. The confirmed dengue attack rate therefore was 0.23% with a corresponding incidence rate of 2.2 per 1000 person-months (95% CI-0-33.1). Seroepidemiology provides additional evidence of an appreciable risk of acute dengue infection among travellers to tropical destinations.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2014
Publisher: Wiley
Date: 15-03-2021
DOI: 10.1002/HPJA.472
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.VACCINE.2011.12.133
Abstract: Vaccine recommendations for travellers are based on in idual risk assessments of multiple factors, most importantly the destination and duration of the impending trip. Many people undertake frequent trips, but existing WHO, CDC and national advisory board recommendations do not explicitly consider cumulative travel-associated risks. Given the period of protection provided by many vaccines, in particular rabies, hepatitis A, hepatitis B and yellow fever vaccines, an aggregate multi-trip risk assessment which views vaccines as an investment for future travel health may be more appropriate than separately evaluating the risks for each trip.
Publisher: Oxford University Press (OUP)
Date: 2018
DOI: 10.1093/JTM/TAY053
Abstract: Estimates of travel-related illness have focused predominantly on populations from highly developed countries visiting low- or middle-income countries, yet travel to and within high-income countries is very frequent. Despite being a top international tourist destination, few sources describe the spectrum of infectious diseases acquired among travellers to the USA. We performed a descriptive analysis summarizing demographic and travel characteristics, and clinical diagnoses among non-US-resident international travellers seen during or after travel to the USA at a GeoSentinel clinic from 1 January 1997 through 31 December 2016. There were 1222 ill non-US-resident travellers with 1393 diagnoses recorded during the 20-year analysis period. Median age was 40 (range 0–86 years) 52% were female. Patients visited from 63 countries and territories, most commonly Canada (31%), Germany (14%), France (9%) and Japan (7%). Travellers presented with a range of illnesses skin and soft tissue infections of unspecified aetiology were the most frequently reported during travel (29 diagnoses, 14% of during-travel diagnoses) arthropod bite/sting was the most frequently reported after travel (173 diagnoses, 15% after-travel diagnoses). Lyme disease was the most frequently reported arthropod-borne disease after travel (42, 4%). Nonspecific respiratory, gastrointestinal and systemic infections were also among the most frequently reported diagnoses overall. Low-frequency illnesses (& % of cases) made up over half of diagnoses during travel and 41% of diagnoses after travel, including 13 cases of coccidioidomycosis and mosquito-borne infections like West Nile, dengue and Zika virus diseases. International travellers to the USA acquired a erse array of mostly cosmopolitan infectious diseases, including nonspecific respiratory, gastrointestinal, dermatologic and systemic infections comparable to what has been reported among travellers to low- and middle-income countries. Clinicians should consider the specific health risks when preparing visitors to the USA and when evaluating and treating those who become ill.
Publisher: Oxford University Press (OUP)
Date: 2015
DOI: 10.1111/JTM.12170
Abstract: It has been recommended that numerical risk data should be provided during the pre-travel consultation in order for travelers to make informed decisions regarding uptake of preventive interventions. In this article, we review the definitions of the various risk measures, particularly as they relate to travel health, and discuss the study designs and methodological details required to obtain each measure. Risk measures can be broadly ided into absolute risk measures (including incidence rate, attack rate, and incidence density) and risk factor measures (including relative risk, risk ratio, and odds ratio). Although there are limitations inherent to each measure, absolute risk measures estimate the baseline risk for an "average" traveler, and risk factor measures help determine whether the risks for an in idual traveler are likely to be higher or lower than this average, which is determined by specific traveler and itinerary characteristics. Incremental risk considerations add additional complexity, and risk communication plus risk perception/risk tolerance have additional impact on the in idual traveler's interpretation of risk measures. Travel health practitioners should be aware of the complexities, limitations, and difficulties in understanding numerical risk data, as these factors are important in travelers' acceptance or rejection of interventions offered.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 07-2013
Publisher: Oxford University Press (OUP)
Date: 2015
DOI: 10.1111/JTM.12171
Abstract: Existing travel health guidelines are based on a variety of data with underpinning evidence ranging from high-quality randomized controlled trials to best estimates from expert opinion. For strategic guidance and to set overall priorities, data about average risk are useful. The World Health Organization (WHO) plans to base future editions of "International Travel and Health" on its new "Handbook for Guideline Development." Based on a systematic search in PubMed, the existing evidence and quality of data on vaccine-preventable disease (VPD) risks in travelers was examined and essentials of vaccine efficacy were briefly reviewed. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to evaluate the quality of the data. Moderate-quality data to determine the risk of VPD exist on those that are frequently imported, whereas in most others the level of confidence with existing data is low or very low. In order for the WHO to produce graded risk statements in the updated version of "International Travel and Health," major investment of time plus additional high-quality, generalizable risk data are needed.
Publisher: Oxford University Press (OUP)
Date: 05-2012
DOI: 10.1111/J.1708-8305.2012.00613.X
Abstract: Older in iduals represent a substantial proportion of international travelers. Because of physiological changes and the increased probability of underlying medical conditions, older travelers might be at higher risk for at least some travel-associated diseases. With the aim of describing the epidemiology of travel-associated diseases in older adults, medical data were prospectively collected on ill international travelers presenting to GeoSentinel sites from 1997 to 2009. Seven thousand thirty-four patients aged 60 years and over were identified as older travelers and were compared to 56,042 patients aged 18-45 years, who were used as the young adult reference population. The proportionate morbidity of several etiological diagnoses was higher in older ill travelers compared to younger ill, including notably lower respiratory tract infections, high-altitude pulmonary edema, phlebitis and pulmonary embolism, arthropod bites, severe malaria, rickettsiosis, gastritis, peptic ulcers, esophagitis and gastroesophageal reflux disease, trauma and injuries, urinary tract infections, heart disease, and death. In contrast, acute diarrhea, upper respiratory tract infections, flu and flu-like illnesses, malaria, dengue, genital infections, sexually transmitted diseases, and schistosomiasis proportionate morbidities were lower among the older group. Older ill travelers are more likely to suffer from certain life-threatening diseases and would benefit from reinforcement of specific preventive measures including use of anti-thrombosis compression stockings and sufficient hydration and exercises during long-distance flights, hand hygiene, use of disposable handkerchiefs, consideration of face-masks in crowded conditions, influenza and pneumococcal vaccines, progressive acclimatization to altitude, consideration of acetazolamide, and use of repellents and mosquito nets. Antibiotics for the presumptive treatment of respiratory and urinary tract infections may be considered, as well as antacid medications. At-risk patients should be referred to a specialist for medical evaluation before departing, and optimal control of co-morbidities such as cardiovascular and chronic obstructive pulmonary diseases should be achieved, particularly for high-altitude travel.
Publisher: Wiley
Date: 06-2009
Publisher: Wiley
Date: 06-2009
Publisher: Oxford University Press (OUP)
Date: 17-09-2009
DOI: 10.1093/AJE/KWP238
Abstract: Multisymptom illness is more prevalent in 1991 Gulf War veterans than in military comparison groups less is known about comorbidities. The authors compared physical, psychological, and functional comorbidities in Australian male Gulf War I veterans with those in actively (non-Gulf) deployed and nondeployed military personnel by using a questionnaire and medical assessment in 2000-2002. Multisymptom illness was more common in male Gulf War veterans than in the comparison group (odds ratio (OR) = 1.80, 95% confidence interval (CI): 1.48, 2.19). Stratifying by deployment status in the comparison group made little difference in this association. Gulf War veterans with multisymptom illness had increased psychiatric disorders, including major depression (OR = 6.31, 95% CI: 4.19, 9.52) and posttraumatic stress disorder (OR = 9.77, 95% CI: 5.39, 18.59) increased unexplained chronic fatigue (OR = 13.32, 95% CI: 7.70, 23.05) and more reported functional impairment and poorer quality of life, but objective physical and laboratory outcomes were similar to those for veterans without multisymptom illness. Similar patterns were found in the comparison groups differences across the 3 groups were statistically significant for only hospitalization, obstructive liver disease, and Epstein-Barr virus exposure. Multisymptom illness is more prevalent in Gulf War I veterans, but the pattern of comorbidities is similar for actively deployed and nondeployed military personnel.
Publisher: Oxford University Press (OUP)
Date: 17-02-2018
DOI: 10.1093/CID/CIY141
Abstract: Overwhelming post-splenectomy infection (OPSI) is a serious complication of asplenia. Clinical guidelines recommend numerous measures to reduce the risk of OPSI, but awareness and adherence to preventative measures are generally poor. We aimed to determine whether a registry for asplenic/hyposplenic patients was associated with a reduction in the incidence of infection with encapsulated bacteria. We performed a retrospective cohort study of asplenic/hyposplenic patients in the state of Victoria, Australia, who registered with Spleen Australia from 2003 through 2014. Spleen Australia provides education, clinical guidance, and annual vaccination reminders to registrants and their healthcare providers. We compared the incidence of infection with Streptococcus pneumoniae, Haemophilus influenzae type B (Hib), and Neisseria meningitidis before and after registration. Registry data were linked with Victorian notifiable disease data on invasive pneumococcal disease (IPD), invasive meningococcal disease (IMD), and Hib between 2000 and 2014. Twenty-seven cases of IPD and 1 of IMD occurred among 3221 registrants. No cases of Hib were reported. The rate of IPD/IMD was 150 per 100000 patient-years prior to registration and 36 per 100000 patient-years after registration registration was associated with a 69% reduction in the risk of infection (incidence rate ratio, 0.31 95% confidence interval, 0.12 to 0.83 P = .019). Based on the absolute reduction in incidence, we estimate that Spleen Australia prevents 5-6 invasive infections with encapsulated organisms annually among registrants. Systematic, long-term approaches to post-splenectomy care can significantly reduce the risk of infection with encapsulated organisms among in iduals with asplenia/hyposplenism.
Publisher: Wiley
Date: 2005
Publisher: Oxford University Press (OUP)
Date: 07-2008
DOI: 10.1111/J.1708-8305.2008.00203.X
Abstract: Data on relative rates of acquisition of gastrointestinal infections by travelers are incomplete. The objective of this study was to analyze infections associated with oral ingestion of pathogens in international travelers in relation to place of exposure. We performed a multicenter, retrospective observational analysis of 6,086 travelers ill enough with any gastrointestinal infection to seek medical care at a GeoSentinel clinic after completion of travel during 2000 to 2005. We determined regional and country-specific reporting rate ratios (RRRs) in comparison to risk in northern and western Europe. Travel to sub-Saharan Africa (RRR = 282), South America (RRR = 203), and South Asia (RRR = 890) was associated with the greatest rate of gastrointestinal infections. RRRs were moderate (25-142) for travel to Oceania, the Middle East, North Africa, Central America, the Caribbean, and Southeast Asia. RRRs were least (<28) following travel to southern, central, and eastern Europe North America Northeast Asia and Australasia. Income level of the country visited was inversely proportional to the RRR for gastrointestinal infection. For bacterial and parasitic infections examined separately, the regions group in the same way. RRRs could be estimated for 28 in idual countries and together with regional data were used to derive a global RRR map for travel-related gastrointestinal infection. This analysis of morbidity associated with oral ingestion of pathogens abroad determines which parts of the world currently are high-risk destinations.
Publisher: Oxford University Press (OUP)
Date: 05-2013
DOI: 10.1111/JTM.12019
Abstract: The risk of Japanese encephalitis (JE) in travelers is unknown. In this prospective study, we investigated the incidence of JE in 387 short-term Australian travelers visiting Asia over a 32-month period from August 2007 to February 2010 by performing pre- and post-travel antibody testing. No travelers were infected with JE virus during travel, indicating a low risk of infection for short-term travelers.
Publisher: Oxford University Press (OUP)
Date: 03-09-2010
DOI: 10.1093/IJE/DYQ152
Abstract: Households in dual reticulation developments are supplied with recycled water from sewage effluent for some non-potable purposes, and conventional tap water for other uses. Adverse health effects from recycled water exposure are considered unlikely however, no epidemiological studies have been undertaken to assess the public health impact of such exposures. We compared the health status of residents of a dual reticulation housing development with residents of an adjacent conventional water supply area by assessing consultation rates with primary-care physicians for three conditions considered plausibly related to recycled water exposure (gastroenteritis, respiratory complaints and dermal complaints), and two conditions considered unrelated to water exposures (urinary tract infections and musculoskeletal complaints). We found little difference in the overall number of medical consultations per person, or in consultation rates for specific disease conditions between residents of the two water supply areas, after adjustment for demographic differences. Slight elevations in odds ratios (ORs) for dermal and respiratory consultations were observed, but seasonal patterns were not consistent with recycled water exposures. This retrospective assessment of medical records indicates that residents of the dual reticulation water supply area are not likely to be experiencing elevated rates of adverse health outcomes as a result of their exposure to recycled water. This finding provides added assurance that appropriately operated and managed dual reticulation residential developments are a safe option for future urban water supplies.
Publisher: Springer Science and Business Media LLC
Date: 24-12-2008
Publisher: Springer Science and Business Media LLC
Date: 02-11-2009
DOI: 10.1038/NRMICRO2238
Publisher: IWA Publishing
Date: 12-2009
DOI: 10.2166/WST.2009.722
Abstract: The aim of this study was to address existing data gaps and to determine the size distribution of aerosols associated with water-efficient devices during typical domestic activities. This information is important to assist in understanding infection spread during water-using activities and in designing water regulations. Three water-using scenarios were evaluated: i) showering using a water-efficient showerhead ii) use of a high pressure spray unit for cleaning cars and iii) toilet flushing using a dual flush low volume flush device. For each scenario a control condition (conventional lower efficiency device) was selected for benchmarking purposes. Shower module results highlighted the complexity of particle generation and removal processes and showed that more than 90% of total particle mass in the breathing zone was attributed to particle diameters greater than 6 μm. Conversely, results for car washing experiments showed that particle diameters up to 6 μm constituted the major part of the total mass generated by both water-efficient and conventional devices. Even under worse case scenario conditions for toilet flushing, particle measurements were at or below the level of detection of the measuring instrumentation. The data provide information that assists in health risk assessment and in determining future research directions, including methodological aspects.
Publisher: Oxford University Press (OUP)
Date: 09-2014
DOI: 10.1111/JTM.12134
Abstract: According to WHO, 1.5 million cases of malaria are reported annually in Pakistan. Malaria distribution in Pakistan is heterogeneous, and some areas, including Punjab, are considered at low risk for malaria. The aim of this study is to describe the trend of imported malaria cases from Pakistan reported to the international surveillance systems from 2005 to 2012. Clinics reporting malaria cases acquired after a stay in Pakistan between January 1, 2005, and December 31, 2012, were identified from the GeoSentinel (www.geosentinel.org) and EuroTravNet (www.Eurotravnet.eu) networks. Demographic and travel-related information was retrieved from the database and further information such as areas of destination within Pakistan was obtained directly from the reporting sites. Standard linear regression models were used to assess the statistical significance of the time trend. From January 2005 to December 2012, a total of 63 cases of malaria acquired in Pakistan were retrieved in six countries over three continents. A statistically significant increasing trend in imported Plasmodium vivax malaria cases acquired in Pakistan, particularly for those exposed in Punjab, was observed over time (p = 0.006). Our observation may herald a variation in malaria incidence in the Punjab province of Pakistan. This is in contrast with the previously described decreasing incidence of malaria in travelers to the Indian subcontinent, and with reports that describe Punjab as a low risk area for malaria. Nevertheless, this event is considered plausible by international organizations. This has potential implications for changes in chemoprophylaxis options and reinforces the need for increased surveillance, also considering the risk of introduction of autochthonous P. vivax malaria in areas where competent vectors are present, such as Europe.
Publisher: Springer Science and Business Media LLC
Date: 16-07-2009
Abstract: Community-based recruitment is challenging particularly if the s ling frame is not easily defined as in the case of people who drink rainwater. Strategies for contacting participants must be carefully considered to maximise generalisability and minimise bias of the results. This paper assesses the recruitment strategies for a 1-year double-blinded randomised trial on drinking untreated rainwater. The effectiveness of the recruitment strategies and associated costs are described. Community recruitment of households from Adelaide, Australia occurred from February to July 2007 using four methods: electoral roll mail-out, approaches to schools and community groups, newspaper advertising, and other media involvement. Word of mouth communication was also assessed. A total of 810 callers were screened, with 53.5% eligible. Of those who were eligible and sent further information, 76.7% were willing to participate in the study and 75.1% were enrolled. The target for recruitment was 300 households, and this was achieved. The mail-out was the most effective method with respect to number of households randomised, while recruitment via schools had the highest yield (57.3%) and was the most cost effective when considering cost per household randomised (AUD$147.20). Yield and cost effectiveness were lowest for media advertising. The use of electoral roll mail-out and advertising via schools were effective in reaching households using untreated rainwater for drinking. Employing multiple strategies enabled success in achieving the recruitment target. In countries where electoral roll extracts are available to researchers, this method is likely to have a high yield for recruitment into community-based epidemiological studies.
Publisher: Oxford University Press (OUP)
Date: 20-06-2011
DOI: 10.1093/CID/CIR352
Publisher: Wiley
Date: 04-08-2015
DOI: 10.1111/IRV.12331
Publisher: Wiley
Date: 2015
DOI: 10.1111/IMJ.12638
Abstract: Leprosy remains an important global health concern, but little has been published about its diagnosis and management in developed settings. It has been postulated that delay in diagnosis is common in developed settings. We reviewed all the cases of leprosy seen at a major tertiary referral centre between 1999 and 2013 and demonstrated that delay in diagnosis is common, especially when patients present with symptoms of leprosy reactions rather than classical symptoms, such as hypo-pigmented hypo-aesthetic skin lesions and neuropathy.
Publisher: Oxford University Press (OUP)
Date: 13-01-2023
DOI: 10.1093/JTM/TAAD002
Abstract: International travellers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists. Data were collected on travellers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analysed, including the reason and nature of healthcare sought, characteristics of the treatment provided and outcomes. Travellers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis. From May 2017 through June 2020, after excluding travellers obtaining rabies post-exposure prophylaxis (n= 415), 1093 travellers reported care for a medical or dental issue that was an unanticipated part of the travellers’ planned itinerary (unplanned healthcare). Travellers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhoea, dengue, falciparum malaria and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition a third (n = 405 37%) had a pre-travel health encounter. Forty-one travellers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n = 9 19%), expertise abroad (n = 9 19%), lower cost (n = 8 17%) and convenience (n = 7 15%) a third (n = 13 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travellers, respectively. Four travellers (10%) had a pre-travel health encounter. International travellers encounter health problems during travel that often could be prevented by pre-travel consultation. Travellers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.
Publisher: Oxford University Press (OUP)
Date: 05-2013
DOI: 10.1111/JTM.12026
Abstract: Hepatitis B and C virus (HBV and HCV) cause significant morbidity and mortality worldwide. With the rise in international travel over the last three decades, many travelers are at risk of HBV and HCV infection. This review focuses on the epidemiology of HBV and HCV in international travelers, the modes of transmission, and the prevention of infection in travelers. The risk of HBV and HCV infection varies widely and depends on the prevalence of the destination country, the duration of travel, and the activities undertaken while abroad. Travelers commonly undertake high-risk activities that place them at risk of both HBV and HCV infection. Poor uptake of preventative health measures and poor adherence to health recommendations are also common. The monthly incidence of HBV infection for long-term travelers to endemic countries ranges from 25 to 420 per 100,000 travelers. HBV infection can be prevented through timely vaccination of travelers. HBV vaccination is safe and efficacious with protective levels of antibodies achieved in >90% of recipients. Information regarding the risk of HCV acquisition is scarce and until recently was limited to case reports following medical interventions. This review demonstrates international travelers are at risk of HBV and HCV infection and provides evidence-based information enabling health practitioners to provide more appropriate pre-travel advice. HBV vaccination should be considered in all travelers to countries with a moderate to high HBV prevalence (HBsAg ≥ 2%) and the risk and benefits discussed with the in iduals in consultation with the health practitioner. There is no duration of travel without risk of HBV infection. However, it is apparent that those travelers with a longer duration of travel are at greatest risk of HBV infection (ie, expatriates). Travelers should also receive advice regarding the modes of transmission and the activities that place them at risk of both HBV and HCV infection.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 11-2009
Publisher: Oxford University Press (OUP)
Date: 05-2013
DOI: 10.1111/JTM.12029
Abstract: We analyzed paired pre- and post-travel sera in a cohort of Australian travelers to Asia and demonstrated the acquisition of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection. The incidence density in nonimmune travelers for HCV infection was calculated as 1.8 infections per 10,000 traveler-days and for HBV infection 2.19 per 10,000 traveler-days.
Publisher: Oxford University Press (OUP)
Date: 07-2008
Publisher: Cambridge University Press (CUP)
Date: 26-06-2013
DOI: 10.1017/S0950268813001416
Abstract: The generalizability of a prediction model from North America for incident nosocomial pneumonia following coronary artery bypass graft surgery was assessed for 23247 patients on the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registry. The performance of the North American model was evaluated using measures of calibration and discrimination. The model had reasonable discrimination (area under the receiver-operating characteristic curve, AUC = 0·69), but unsatisfactory calibration (Hosmer–Lemeshow test, P 0·001) in the ANZSCTS patients. An update of the model coefficients yielded a model with AUC = 0·71 and good calibration ( P = 0·46).
Publisher: Wiley
Date: 05-2010
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: 09-2011
DOI: 10.1016/J.TMAID.2011.09.002
Abstract: This report describes novel initiatives to inform ethnic groups contributing high numbers of VFRs about potential travel risks. Multilingual and culturally appropriate information was distributed to the media (newspaper, radio, web-based, and television), via printed materials (posters, tear sheets and z-cards) and at community festivals to convey simple travel health messages.
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.ARTH.2009.08.011
Abstract: Although deep surgical site infection (SSI) is a major complication of primary total hip arthroplasty (THA), there are conflicting data regarding the incidence of deep SSI, and no comprehensive evaluation of the associated risk factors has been undertaken. We performed a systematic review of the literature undertaking computer-aided searches of electronic databases, assessment of methodological quality, and a best-evidence synthesis. The incidence of SSI ranged from 0.2% before discharge to 1.1% for the period up to and including 5 years post surgery. Greater severity of a pre-existing illness and a longer duration of surgery were found to be independent risk factors for deep SSI. There is a need for high-quality, prospective studies to further identify modifiable risk factors for deep SSI after THA.
Publisher: Informa UK Limited
Date: 1998
DOI: 10.1080/00365549850160594
Abstract: Microsporidiosis is recognized as an increasingly important infection, particularly in patients with human immunodeficiency virus (HIV) infection. In this retrospective study we have reviewed the clinical features, laboratory findings and management of 42 HIV positive patients co-infected with microsporidia. All patients had spores identified in faeces stained with a modified trichome blue stain. Patients were all markedly immunosuppressed (median CD4 20 cells/microl). Common symptoms included weight loss, diarrhoea, abdominal pain, anorexia and nausea. 29 patients were diagnosed with Enterocytozoon bieneusi infection 13 were infected with Encephalitozoon intestinalis, and disseminated disease was confirmed in 8. Albendazole therapy in patients with E. intestinalis (but not E. bieneusi) resulted in good clinical response.
Publisher: Wiley
Date: 06-02-2014
DOI: 10.1111/ANAE.12563
Abstract: In the presence of single-use airway filters, we quantified anaesthetic circuit aerobic microbial contamination rates when changed every 24 h, 48 h and 7 days. Microbiological s les were taken from the interior of 305 anaesthetic breathing circuits over a 15-month period (3197 operations). There was no significant difference in the proportion of contaminated circuits when changed every 24 h (57/105 (54%, 95% CI 45-64%)) compared with 48 h (43/100 (43%, 95% CI 33-53%, p = 0.12)) and up to 7 days (46/100 (46%, 95% CI 36-56%, p = 0.26)). Median bacterial counts were not increased at 48 h or 7 days provided circuits were routinely emptied of condensate. Annual savings for one hospital (six operating theatres) were $AU 5219 (£3079, €3654, $US 4846) and a 57% decrease in anaesthesia circuit steriliser loads associated with a yearly saving of 2760 kWh of electricity and 48 000 l of water. Our findings suggest that extended circuit use from 24 h up to 7 days does not significantly increase bacterial contamination, and is associated with labour, energy, water and financial savings.
Publisher: Elsevier
Date: 2009
Publisher: Elsevier BV
Date: 10-2021
Publisher: Oxford University Press (OUP)
Date: 05-2010
DOI: 10.1111/J.1708-8305.2010.00399.X
Abstract: Travelers visiting friends and relatives (VFR) have low rates of pre-travel health encounters. In 2006 in the Bronx, New York, a convenience s le of 129 families originating in malaria-endemic countries and presenting for a routine pediatric outpatient evaluation completed a standardized questionnaire regarding future travel plans to their country of origin. Pro-active screening for intended travel activities can identify future VFR travelers and ascertain potentially high-risk itineraries, thereby enabling education regarding the importance of accessing competent pre-travel medicine services.
Publisher: Cambridge University Press (CUP)
Date: 06-2009
DOI: 10.1017/S0950268809990124
Abstract: Surveillance for gastroenteritis rarely detects small, intra-familial outbreaks. This study examined intra-household transmission of gastroenteritis using prospectively collected data from 2811 participants (600 households) in a community-based study. There were 258 household clusters of gastroenteritis during the 15 months of observation involving 774 residents (28% of total). Age years and attendance at a day care/kindergarten were associated with increased likelihood of inclusion in a cluster. The reach of illness into the household was extensive, with 63% of household members affected by symptoms during clusters. Simultaneous and secondary transmission of gastroenteritis appeared equally common. In only 20% of clusters did more than one member submit a faecal specimen. Of clusters where two or more specimens were submitted, concordance in laboratory confirmation of pathogens was 18·8%. Our results show that clustering of gastrointestinal symptoms within households occurs commonly, but reliance on pathogen notification data will substantially underestimate the true frequency of gastroenteritis clusters.
Publisher: Oxford University Press (OUP)
Date: 11-11-2009
DOI: 10.1093/AJE/KWP297
Abstract: The relation between sporadic gastroenteritis and recreational swimming was examined in a cohort of 2,811 people in Melbourne, Australia, over a 15-month period (September 1997-February 1999). Data from a prospective community-based study of gastroenteritis were used for a Poisson analysis of temporality between reported swimming (in public or private pools/spas and in marine or freshwater settings) and a highly credible gastroenteritis (HCG) event. Overall, HCG events were more likely in participants who had swum in a public pool/spa (incidence rate ratio (IRR) = 1.25, 95% confidence interval (CI): 1.10, 1.42 P = 0.001) or river/lake/dam (IRR = 1.77, 95% CI: 1.13, 2.79 P = 0.014) during the previous week or had swum in a public pool/spa (IRR = 1.29, 95% CI: 1.13, 1.46 P < 0.001) during the previous 2 weeks. Subanalysis by age showed that HCG episodes were also more likely in adults who had swum in a private pool/spa (IRR = 1.56, 95% CI: 1.02, 2.39 P = 0.042) during the previous week or swum at an ocean/beach (IRR = 1.78, 95% CI: 1.12, 2.81 P = 0.014) during the previous 2 weeks, demonstrating significant associations between all swimming locations and gastrointestinal symptoms. This study showed that although the incremental risk of recreational swimming is significant, it is relatively small.
Publisher: Oxford University Press (OUP)
Date: 07-2010
DOI: 10.1111/J.1708-8305.2010.00417.X
Abstract: Two cases of Old World cutaneous leishmaniasis (OWCL) acquired by travelers to Morocco are described. In Australia, OWCL is more frequently seen in migrants rather than returned travelers. The patients were treated with sodium stibogluconate and fluconazole. Optimal treatment is not established, particularly in returned travelers, but identification of Leishmania species can help with the selection of appropriate therapy.
Publisher: Oxford University Press (OUP)
Date: 03-2000
DOI: 10.1086/313735
Publisher: AMPCo
Date: 05-2014
DOI: 10.5694/MJA13.10630
Abstract: To assess self-reported adherence to measures for preventing infection in patients registered in the Victorian Spleen Registry (VSR). Cross-sectional survey in May 2010 of all patients who had been registered on the VSR for at least 5 months, were able to speak English, and were not living in an institution. Rates of prophylactic antibiotic use, having an emergency supply of antibiotics available, receipt of any recommended booster vaccination (in patients at > 5 years since splenectomy) and receipt of 2009 influenza vaccination. 1175 patients were sent questionnaires, of whom 889 (75.7%) responded. Self-reported adherence to taking prophylactic antibiotics was lower with time since splenectomy (82.9% for < 2 years since splenectomy, 27.4% for ≥ 30 years), as was having an emergency supply of antibiotics available (74.4% for 5 years since splenectomy) was high. Of patients registered for more than 12 months, 37.0% reported an infection requiring additional antibiotics within the prior year, and 26.1% of these required hospitalisation (including one with a case of overwhelming postsplenectomy infection [OPSI]). Use of prophylactic antibiotics was inversely associated with the rate of infections requiring additional antibiotic therapy (odds ratio, 0.75 95% CI, 0.57-0.98 P = 0.036). The proportion of VSR registrants adhering to current postsplenectomy guidelines was higher than rates reported elsewhere, and over a third reported infections requiring a course of antibiotics within the prior 12 months. However, only one OPSI occurred. These results support the view that a spleen registry can promote health maintenance behaviour in asplenic patients, which is likely to help prevent serious infections.
Publisher: AMPCo
Date: 04-2013
DOI: 10.5694/MJA12.11679
Publisher: Oxford University Press (OUP)
Date: 15-03-2010
DOI: 10.1086/650575
Abstract: No systematic studies exist on sex and gender differences across a broad range of travel-associated diseases. Travel and tropical medicine GeoSentinel clinics worldwide contributed prospective, standardized data on 58,908 patients with travel-associated illness to a central database from 1 March 1997 through 31 October 2007. We evaluated sex and gender differences in health outcomes and in demographic characteristics. Statistical significance for crude analysis of dichotomous variables was determined using chi2 tests with calculation of odds ratios (ORs) and 95% confidence intervals (CIs). The main outcome measure was proportionate morbidity of specific diagnoses in men and women. The analyses were adjusted for age, travel duration, pretravel encounter, reason for travel, and geographical region visited. We found statistically significant (P < .001) differences in morbidity by sex. Women are proportionately more likely than men to present with acute diarrhea (OR, 1.13 95% CI, 1.09-1.38), chronic diarrhea (OR, 1.28 95% CI, 1.19-1.37), irritable bowel syndrome (OR, 1.39 95% CI, 1.24-1.57), upper respiratory tract infection (OR, 1.23 95% CI, 1.14-1.33) urinary tract infection (OR, 4.01 95% CI, 3.34-4.71), psychological stressors (OR, 1.3 95% CI, 1.14-1.48), oral and dental conditions, or adverse reactions to medication. Women are proportionately less likely to have febrile illnesses (OR, 0.15 95% CI, 0.10-0.21) vector-borne diseases, such as malaria (OR, 0.46 95% CI, 0.41-0.51), leishmaniasis, or rickettsioses (OR, 0.57 95% CI, 0.43-0.74) sexually transmitted infections (OR, 0.68 95% CI 0.58-0.81) viral hepatitis (OR, 0.34 95% CI, 0.21-0.54) or noninfectious problems, including cardiovascular disease, acute mountain sickness, and frostbite. Women are statistically significantly more likely to obtain pretravel advice (OR, 1.28 95% CI, 1.23-1.32), and ill female travelers are less likely than ill male travelers to be hospitalized (OR, 0.45 95% CI, 0.42-0.49). Men and women present with different profiles of travel-related morbidity. Preventive travel medicine and future travel medicine research need to address gender-specific intervention strategies and differential susceptibility to disease.
Publisher: Wiley
Date: 11-2009
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.VACCINE.2008.05.032
Abstract: Vaccinations, and multiple vaccinations in particular, have been associated with adverse health effects in veterans of the 1990/1991 Gulf War. However, exposure assessment has usually been based on self-report and recall bias may have influenced the results. We investigated agreement between self-reported and recorded vaccinations and the relationship with health status in Australian Gulf War veterans. Agreement between self-reported and recorded vaccinations was highest for plague (kappa=0.80), and kappa coefficients were greater than 0.60 for polio and 'other unlisted' vaccines, between 0.41 and 0.60 for hepatitis B, hepatitis A, typhoid and pertussis, and less than 0.40 for the other listed vaccines. The associations of increasing number of self-reported vaccinations in dose response relationships with total number of symptoms, functional impairment, and poorer physical health were not observed when based on recorded vaccination data, although the actual difference in estimates was small and statistically significant only for total number of symptoms. Vaccinations were not associated with adverse health effects when exposure assessment was based on recorded vaccinations. It would be prudent that future research studies should be based on recorded vaccination data.
Publisher: Oxford University Press (OUP)
Date: 11-2001
DOI: 10.1086/322968
Abstract: Aging is associated with alterations in immune responses and may lead to clinically significant changes in the safety, immunogenicity, and protective efficacy of certain vaccines. This review summarizes published data regarding the effects of age on responses after immunization with vaccines generally administered before travel. The specific vaccines discussed in detail include hepatitis A, typhoid, yellow fever, Japanese encephalitis, and rabies vaccines. There is some evidence of diminished serological responses to hepatitis A and rabies vaccines in older in iduals. In addition, increased toxic effects following yellow fever vaccination in elderly recipients have recently been reported. However, many travel-related vaccines have never been studied specifically in elderly populations. Consideration of potential age-related differences in responses to travel vaccines is becoming increasingly important as elderly persons more frequently venture to exotic destinations.
Publisher: American Society for Microbiology
Date: 03-2009
DOI: 10.1128/AEM.01923-08
Abstract: Approximately 15% of overall Australian household water usage is in the laundry hence, a significant reduction in household drinking water demand could be achieved if potable-quality water used for clothes washing is replaced with recycled water. To investigate the microbiological safety of using recycled water in washing machines, bacteriophages MS-2 and PRD-1, Escherichia coli , and Cryptosporidium parvum oocysts were used in a series of experiments to investigate the transfer efficiency of enteric microorganisms from washing machine water to objects including hands, environmental surfaces, air, and fabric swatches. By determining the transference efficiency, it is possible to estimate the numbers of microorganisms that the user will be exposed to if recycled water with various levels of residual microorganisms is used in washing machines. Results, expressed as transfer rates to a given surface area per object, showed that the mean transfer efficiency of E. coli , bacteriophages MS-2 and PRD-1, and C. parvum oocysts from seeded water to fabric swatches ranged from 0.001% to 0.090%. Greatest exposure to microorganisms occurred through direct contact of hands with seeded water and via hand contact with contaminated fabric swatches. No microorganisms were detected in the air s les during the washing machine spin cycle, and transfer rates of bacteriophages from water to environmental surfaces were 100-fold less than from water directly to hands. Findings from this study provide relevant information that can be used to refine regulations governing recycled water and to allay public concerns about the use of recycled water.
Publisher: Springer Science and Business Media LLC
Date: 23-07-2012
Abstract: Gastrointestinal (GI), respiratory and dermal symptoms are common and cause substantial morbidity, although the information on their exact incidence and comparative burden is limited. The aim of this study was to describe the epidemiology and rate these three major symptom complexes in order to improve our understanding of the health burden imposed by these symptoms. We used data from a community based randomised control trial conducted from June 2007 to August 2008 among 277 South Australian families consuming rainwater. Using weekly health diaries, we prospectively collected information on GI (diarrhoea or vomiting), respiratory (sore throat, runny nose or cough) and dermal (rash, generalised itch or dermal infection) symptoms, as well as on relevant GP visits, time off work and/or hospitalisation due to these symptoms. Data were analysed using generalized estimating equations approach taking into account the variable number of weeks of follow-up of each in idual and within-family clustering of responses. Over one year, at least one episode of GI symptoms was reported by 54% of participants (95% CI 50%-58%), at least one respiratory episode by 91% (95% CI 88%-93%) and at least one episode of dermal symptoms by 27% (95% CI 24%-30%). The average number of weeks per year during which respiratory symptoms occurred was four times greater than for GI or dermal symptoms (4.9, 1.2 and 1.2 weeks, respectively, p .001), with an average number of GP visits per person per year being twice as frequent (0.48, 0.26, 0.19 respectively, p .001). However, on a per episode basis, a higher proportion of people saw a GP or were hospitalised for GI symptoms. This first comparative study of three different symptom complexes showed that although respiratory symptoms are most common, GI symptoms cause a greater per episode burden on healthcare resources. Measuring and comparing the community based burden of these symptom complexes will assist evidence-based allocation of resources.
Publisher: Oxford University Press (OUP)
Date: 11-2015
DOI: 10.1111/JTM.12240
Publisher: Oxford University Press (OUP)
Date: 07-12-2012
DOI: 10.1093/CID/CIS1016
Abstract: Increasing international migration may challenge healthcare providers unfamiliar with acute and long latency infections and diseases common in this population. This study defines health conditions encountered in a large heterogenous group of migrants. Migrants seen at GeoSentinel clinics for any reason, other than those seen at clinics only providing comprehensive protocol-based health screening soon after arrival, were included. Proportionate morbidity for syndromes and diagnoses by country or region of origin were determined and compared. A total of 7629 migrants from 153 countries were seen at 41 GeoSentinel clinics in 19 countries. Most (59%) were adults aged 19-39 years 11% were children. Most (58%) were seen >1 year after arrival 27% were seen after >5 years. The most common diagnoses were latent tuberculosis (22%), viral hepatitis (17%), active tuberculosis (10%), human immunodeficiency virus (HIV)/AIDS (7%), malaria (7%), schistosomiasis (6%), and strongyloidiasis (5%) 5% were reported healthy. Twenty percent were hospitalized (24% for active tuberculosis and 21% for febrile illness [83% due to malaria]), and 13 died. Tuberculosis diagnoses and HIV/AIDS were reported from all regions, strongyloidiasis from most regions, and chronic hepatitis B virus (HBV) particularly in Asian immigrants. Regional diagnoses included schistosomiasis (Africa) and Chagas disease (Americas). Eliciting a migration history is important at every encounter migrant patients may have acute illness or chronic conditions related to exposure in their country of origin. Early detection and treatment, particularly for diagnoses related to tuberculosis, HBV, Strongyloides, and schistosomiasis, may improve outcomes. Policy makers should consider expansion of refugee screening programs to include all migrants.
Publisher: American Society of Tropical Medicine and Hygiene
Date: 06-02-2013
Publisher: Springer Science and Business Media LLC
Date: 09-10-2012
DOI: 10.1007/S10096-011-1429-1
Abstract: The purpose of this study was to estimate the incidence density and prevalence of dengue virus infection in Australian travellers to Asia. We conducted a multi-centre prospective cohort study of Australian travellers over a 32-month period. We recruited 467 travellers (≥ 16 years of age) from three travel clinics who intended to travel Asia, and 387 (82.9%) of those travellers completed questionnaires and provide s les pre- and post-travel for serological testing for dengue virus infection. Demographic data, destination countries and history of vaccinations and flavivirus infections were obtained. Serological testing for dengue IgG and IgM by enzyme-linked immunosorbent assay (ELISA) (PanBio assay) was performed. Acute seroconversion for dengue infection was demonstrated in 1.0% of travellers, representing an incidence of 3.4 infections per 10,000 days of travel (95% confidence interval [CI]: 0.9-8.7). The seroprevalence of dengue infection was 4.4% and a greater number of prior trips to Asia was a predictor for dengue seroprevalence (p = 0.019). All travellers experienced subclinical dengue infections and had travelled to India (n = 3) and China (n = 1). This significant attack rate of dengue infection can be used to advise prospective travellers to dengue-endemic countries.
Publisher: Wiley
Date: 06-11-2014
DOI: 10.1111/RISA.12142
Abstract: Quantitative microbial risk assessment (QMRA) is a valuable tool that can be used to predict the risk associated with human exposure to specific microbial contaminants in water sources. The transparency inherent in the QMRA process benefits discussions between multidisciplinary teams because members of such teams have different expertise and their confidence in the risk assessment output will depend upon whether they regard the selected input data and assumptions as being suitable and/or plausible. Selection of input data requires knowledge of the availability of appropriate data sets, the limitations of using a particular data set, and the logic of using alternative approaches. In performing QMRA modeling and in the absence of directly relevant data, compromises must be made. One such compromise made is to use available Escherichia coli data and apply a ratio of enteric viruses to indicator E. coli in wastewater obtained from prior studies to estimate the concentration of enteric viruses in other wastewater types/sources. In this article, we have provided an argument for why we do not recommend the use of a pathogen to E. coli ratio to estimate virus concentrations in single household graywater and additionally suggested circumstances in which use of such a ratio may be justified.
Publisher: Oxford University Press (OUP)
Date: 07-2014
DOI: 10.1111/JTM.12122
Abstract: There can be considerable overlap in the clinical presentation and laboratory features of dengue, malaria, and enteric fever, three important causes of fever in returned travelers. Routine laboratory tests including full blood examination (FBE), liver function tests (LFTs), and C-reactive protein (CRP) are frequently ordered on febrile patients, and may help differentiate between these possible diagnoses. Adult travelers returning to Australia who presented to the Royal Melbourne Hospital with confirmed diagnosis of dengue, malaria, or enteric fever between January 1, 2000 and March 1, 2013 were included in this retrospective study. Laboratory results for routine initial investigations performed within the first 2 days were extracted and analyzed. There were 304 presentations including 58 with dengue fever, 187 with malaria, and 59 with enteric fever, comprising 56% of all returned travelers with a febrile systemic illness during the study period. Significant findings included 9-fold and 21-fold odds of a normal CRP in dengue compared with malaria and enteric fever, respectively. The odds of an abnormally low white cell count (WCC) were also significantly greater in dengue versus malaria or enteric fever. Approximately one third of dengue presentations and almost half of the malaria presentations had platelet counts <100 × 10(9) /L. A normal CRP with leukopenia and/or thrombocytopenia occurred in 21% to 30% of dengue presentations, but not in malaria or enteric fever presentations. There is a wide differential diagnosis for imported fever, but the non-specific findings of a normal CRP with a low WCC and/or low platelet count may provide useful information in addition to clinical clues to suggest dengue over malaria or enteric fever. Further systematic prospective studies among travelers could help define the potential clinical utility of these results in assisting the clinician when deciding for or against commencement of empiric antimicrobial therapy while awaiting confirmatory tests.
Publisher: Oxford University Press (OUP)
Date: 11-2010
DOI: 10.1111/J.1708-8305.2010.00466.X
Abstract: Travel medicine is the medical subspecialty which promotes healthy and safe travel. Numerous studies have been published that provide evidence for the practice of travel medicine, but gaps exist. The Research Committee of the International Society of Travel Medicine (ISTM) established a Writing Group which reviewed the existing evidence base and identified an initial list of research priorities through an interactive process that included e-mails, phone calls, and smaller meetings. The list was presented to a broader group of travel medicine experts, then was presented and discussed at the Annual ISTM Meeting, and further revised by the Writing Group. Each research question was then subject to literature search to ensure that adequate research had not already been conducted. Twenty-five research priorities were identified and categorized as intended to inform pre-travel encounters, safety during travel, and post-travel management. We have described the research priorities that will help to expand the evidence base in travel medicine. This discussion of research priorities serves to highlight the commitment that the ISTM has in promoting quality travel-related research.
Publisher: Springer Science and Business Media LLC
Date: 03-11-2008
Publisher: IWA Publishing
Date: 03-2010
DOI: 10.2166/WST.2010.055
Abstract: Households resident in metropolitan Adelaide and surrounding areas in South Australia were recruited into a randomised controlled trial. A total of 630 rainwater tanks with a total tank capacity of 14.5 ML were installed at the 325 households surveyed. The majority of the tanks were plumbed into the kitchen (64.6%), over 10 years in age (45.5%), over 15,000 L in capacity (42.5%) and composed of galvanised steel (36.9%). Over 90% of the households undertook one or more prevention and maintenance strategies for reducing contamination of collected rainwater. The use of first flush erters was reported by 30.8% households, the presence of leaf control devices on the tank by 57.2%, and the presence of leaf control screens on gutters by 25.5% households. Most households reported that the rainwater tank was cleaned at some time, with 50.4% of these households stating that tank cleaning occurred 1 to 5 years previously, and 31.9% more than 5 years prior to enrolment Rainwater from the main drinking tank was s led from a subset of households for turbidity and metals (Al, Ca, Cu, Fe, Mg, Pb, Zn). This information regarding tank characteristics and degree of adherence to recommended maintenance procedures may assist understanding of variability in rainwater quality data and may help determine whether untreated rainwater can be considered a safe water supply for household purposes including drinking.
Publisher: Oxford University Press (OUP)
Date: 03-2010
DOI: 10.1111/J.1708-8305.2009.00379.X
Abstract: We undertook an observational follow-up study of schistosomiasis serology in both travelers and immigrants in a nonendemic country to determine the natural history of schistosomiasis antibody titer post-adequate treatment in those who have not been reexposed. Longitudinal study of all adult travelers and immigrants presenting to the Royal Melbourne Hospital, Australia with positive schistosomiasis serology (titer >1: 64) between July 1995 and December 2005. All patients were treated with praziquantel and followed up clinically and serologically for a period up to 30 months. A total of 58 patients were included in the study including 26 travelers and 32 immigrants. Antibody titers often increased in the first 6 to 12 months post-treatment, especially in immigrants. After 30 months of post-treatment, 68% of travelers and 35% of immigrants (p < 0.01) achieved a fourfold antibody decline. Schistosomiasis antibody titers varied after adequate treatment. Therefore an increase in titer in the first 6 to 12 months or a failure to reduce after 3 years should not automatically justify re-treatment.
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.JPSYCHORES.2006.04.002
Abstract: The aim of this study was to evaluate fatigue in Australian Gulf War veterans and a military comparison group according to the 1994 chronic fatigue syndrome (CFS) definition and investigate the relation with exposures. Comprehensive medical, psychological and reported exposure assessments of 1,456 veterans and 1,588 comparison group in a cross-sectional study. More Gulf War veterans had fatigue at all levels than did the military comparison group. The findings may be at least partly explained as an "active-deployment effect." The odds ratios increased with increasing clinical evaluation of the nature of the fatigue, even after adjustment for current psychiatric disorders in addition to other possible confounding factors. Medically unexplained chronic fatigue was more common, but not more disabling, in veterans than in the comparison group, but veterans with unexplained chronic fatigue had poorer health than veterans without. Within both populations, CFS is uncommon and at a similar level to the general community.
Publisher: Cambridge University Press (CUP)
Date: 09-10-2016
DOI: 10.1017/S0950268815002307
Abstract: To identify hospital-level factors associated with post-cardiac surgical pneumonia for assessing their impact on standardized infection rates (SIRs), we studied 43 691 patients in a cardiac surgery registry (2001–2011) in 16 hospitals. In a logistic regression model for pneumonia following cardiac surgery, associations with hospital characteristics were quantified with adjustment for patient characteristics while allowing for clustering of patients by hospital. Pneumonia rates varied from 0·7% to 12·4% across hospitals. Seventy percent of variability in the pneumonia rate was attributable to differences in hospitals in their long-term rates with the remainder attributable to within-hospital differences in rates over time. After adjusting for patient characteristics, the pneumonia rate was found to be higher in hospitals with more registered nurses (RNs)/100 intensive-care unit (ICU) admissions [adjusted odds ratio (aOR) 1·2, P = 0·006] and more RNs/available ICU beds (aOR 1·4, P 0·001). Other hospital characteristics had no significant association with pneumonia. SIRs calculated on the basis of patient characteristics alone differed substantially from the same rates calculated on the basis of patient characteristics and the hospital characteristic of RNs/100 ICU admissions. Since SIRs using patient case-mix information are important for comparing rates between hospitals, the additional allowance for hospital characteristics can impact significantly on how hospitals compare.
Publisher: Wiley
Date: 10-08-2005
DOI: 10.1111/J.1440-1746.2005.03868.X
Abstract: Abstract Background and Aim: Previous reports regarding the clinical significance and pathogenicity of Blastocystis hominis have been contradictory. The aim of this study was to examine the association between Blastocystis and gastrointestinal symptoms in immunocompetent in iduals. We monitored over 2800 healthy people for a period of 15 months, and took stool specimens during both asymptomatic periods and during periods of gastrointestinal symptoms. After exclusion of in iduals who had simultaneous identification of other fecal pathogens, we compared the proportions of asymptomatic versus symptomatic in iduals positive for Blastocystis and found no significant difference (P = 0.5). Symptom status did not correlate with parasite abundance. We found that some in iduals were likely to have Blastocystis detected during both asymptomatic and symptomatic periods, possibly suggesting carriage of the organism. In conclusion, we found no correlation between clinical symptoms and the presence or absence of Blastocystis among this healthy cohort.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 04-2015
Publisher: Cambridge University Press (CUP)
Date: 18-05-2011
DOI: 10.1017/S0950268810001159
Abstract: This nested case-control study investigated the risk factors for gastroenteritis in a cohort using rainwater as their primary domestic water source. Consumption of beef [odds ratio (OR) 2·74, 95% confidence interval (CI) 1·56–4·80], handling of raw fresh chicken in the household (OR 1·52, 95% CI 1·02–2·29) and animal contact (OR 1·83, 95% CI 1·20–2·83) were found to be significant risk factors ( P ·05). Significant protective effects were observed with raw salad prepared at home (OR 0·33, 95% CI 0·18–0·58), consumption of salami (OR 0·60, 95% CI 0·36–0·98), and shellfish (OR 0·31, 95% CI 0·14–0·67). This study provides novel insight into community-based endemic gastroenteritis showing that consumption of beef was associated with increased odds of illness and with a population attributable fraction (PAF) of 57·6%. Detecting such a high PAF for beef in a non-outbreak setting was unexpected.
Location: United States of America
No related grants have been discovered for Karin Leder.