Jeffrey N. Hanna

Multiple outbreaks of dengue serotype 2 in north Queensland, 2003/04

Objectives: To describe the various investigations and responses to multiple outbreaks of dengue serotype 2 that occurred in north Queensland in 2003/04.

The timeliness of notification of clinically suspected cases of dengue imported into north Queensland.

Objective: Evaluate the timeliness of notifications by medical practitioners of clinically suspected dengue importations into north Queensland (NQ). Describe the features the disease and determine the likely duration of viraemia prior to implementating public health measures.

The initial coverage and impact of the pneumococcal and influenza vaccination program for at-risk Indigenous adults in Far North Queensland

Objectives: To describe the initial coverage and impact of a pneumococcal and influenza vaccination program for at‐risk Indigenous adults in Far North Queensland that formally commenced in 1996.

The epidemiology of acute rheumatic fever in Indigenous people in north Queensland

Objective: To describe the epidemiology and features of acute rheumatic fever (ARF) in Indigenous people in north Queensland from mid‐1999 to mid‐2004.

An assessment of the interval between booster doses of Japanese encephalitis vaccine in the Torres Strait

Objective:

The vaccination status of Aboriginal and Torres Strait Island children in far North Queensland

A survey was undertaken to ascertain the vaccination status of all 773 Aboriginal and Torres Strait Island children who were born and remained in Far North Queensland during the 1993‐94 financial year. Only 42% had received all 15 vaccines scheduled in the first two years of life by their second birthday. More who resided in remote communities were fully vaccinated (64%) by then than those who lived in rural towns (32%) or an urban setting (21%) (p<0.01). The 445 children who were not fully vaccinated required a median of three vaccines to have been fully vaccinated by the second birthday. Of these, 146 (33%) required only one vaccine, nearly 60% of whom would have been fully vaccinated if they had had the fourth (18‐month) dose of diphtheria‐tetanus‐pertussis (DTP) vaccine. Of the 445, 143 (32%) required five or more vaccines to have been fully vaccinated. Only 26% and 36% of the children received all the vaccines scheduled at six and 12 months of age, respectively, on the same day. However, the eventual uptakes of the three vaccines scheduled at six months of age were very similar (‐80%) and simultaneous vaccination with the two vaccines scheduled at 12 months of age would have made a very limited (‐4 percentage points) impact on the overall percentage of fully vaccinated children. Considerably more than simple and apparently logical strategies will be required to ensure that Indigenous children in Far North Queensland are adequately vaccinated. A systematic approach, with a careful understanding of the barriers to routine vaccination and a means of prospectively tracking the vaccination status of each child, will be needed if state and national vaccination goals are to be met.

Pneumococcal vaccination: an important strategy to prevent pneumonia in Aboriginal and Torres Strait Island adults

Abstract: The objective of the study was to examine the appropriateness of the National Health and Medical Research Council (NHMRC) recommendations concerning pneumococcal vaccination for Aboriginal and Torres Strait Island adults. Laboratory surveillance of invasive pneumococcal disease identified 95 cases acquired by adults 15 years of age and over in Far North Queensland from 1992 to 1995. The most common diagnosis was pneumonia (77 per cent). Sixty–one cases (64 per cent) occurred in Aboriginal and Torres Strait Island adults, who acquired the disease at a younger age (mean 40 years) than did other adults (mean 50 years). Most (93 per cent) of the Aboriginal and Torres Strait Island adults had at least one of the pre–existing medical conditions in the NMHRC criteria for pneumococcal vaccination. The most common was ‘alcohol abuse’ (62 per cent). Fifty–three (93 per cent) of the pneumococcal isolates from the Aboriginal and Torres Strait Island adults who had pre–existing conditions were serotyped. Fifty (94 per cent) belonged to types included in the currently available pneumococcal vaccine. We conclude that the NHMRC recommendations for pneumococcal vaccination are appropriate, considering the pattern of invasive pneumococcal disease that occurs in Aboriginal and Torres Strait Island adults in Far North Queensland. Because pneumococcal vaccination can reduce the pneumonia–associated morbidity and premature mortality experienced by Aboriginal and Torres Strait Island adults, the vaccine should be offered routinely to those considered to be at risk, particularly young men who have recently begun to consume hazardous amounts of alcohol, and recently diagnosed diabetics.

The investigation of a 'cluster' of hepatitis B in teenagers from an indigenous community in North Queensland.

Background: In early 1999, five teenagers from the same Indigenous community were notified as having hepatitis B. Hepatitis B vaccine should have been offered to thiscohort of teenagers in a ‘catch–up’ program during the late 1980s when they were of preschool age.

Malaria and its implications for public health in Far North Queensland: a prospective study.

This prospective studys objectives were to describe the features of all episodes of malaria diagnosed in Far North Queensland (excluding the Torres Strait) and to assess how much of a threat they posed to the areas public health.

Recognising and responding to outbreaks of hepatitis A associated with child day-care centres.

Objectives: To assess the appropriateness of a protocol for recognising and responding to outbreaks of hepatitis A in child day‐care centres and to determine if measles‐mumps‐rubella (MMR) vaccine was given too soon following the administration of normal human immunoglobulin (NIGH) to young children to control the outbreaks.