Kerri Viney

An outbreak of epidemic keratoconjunctivitis in a regional ophthalmology clinic in New South Wales

The objective of the study was to identify the extent and cause of an outbreak of epidemic keratoconjunctivitis (EKC). The study design was active case finding and a case-control study of clinic patients who developed symptoms of EKC between 31 December 2005 and 31 March 2006. The main outcome measures were clinical procedures carried out and clinicians seen during clinic visit. Significantly more cases than controls had tonometry with instillation of anaesthetic drops (OR 16.5, 95% CI 3.9-145.1, P<0.01), optical coherence tomography (OR 4.7, 95% CI 1.2-21.9, P=0.01), or instillation of dilating drops by an orthoptist (OR 2.3, 95% CI 1.1-4.7, P=0.01). Significantly more cases than controls were seen by one orthoptist (OR 21.8, 95% CI 8.2-60.0, P<0.01). Transmission of EKC within the clinic was probably due to contamination of either or both the anaesthetic drops and the tonometer head in the room used by an orthoptist. A comprehensive suite of strategies is required to prevent healthcare-associated EKC.

Tuberculosis patients' knowledge and beliefs about tuberculosis: a mixed methods study from the Pacific Island nation of Vanuatu

BackgroundThe setting for this study was the Pacific island nation of Vanuatu, an archipelago of 82 islands, located in the South Pacific Ocean. Our objective was to assess the knowledge, attitudes and practices of tuberculosis (TB) patients towards TB.MethodsThis was a descriptive study using qualitative and quantitative methods. Quantitative analysis was based on the responses provided to closed questions, and we present frequencies to describe the TB patients’ knowledge, attitudes and practice relating to TB. Qualitative analysis was based on open questions permitting fuller explanations. We used thematic analysis and developed a posteriori inductive categories to draw conclusions.ResultsThirty five TB patients were interviewed; 22 (63%) were male. They attributed TB to cigarettes, kava, alcohol, contaminated food, sharing eating utensils and “kastom” (the local term for the traditional way of life, but also for sorcery). Most (94%) did not attribute TB to a bacterial cause. However, almost all TB patients (89%) thought that TB was best treated at a hospital with antibiotics. Three quarters (74%) experienced stigma after their TB diagnosis.Seeking health care from a traditional healer was common; 54% of TB patients stated that they would first consult a traditional healer for any illness. When seeking a diagnosis for signs and symptoms of TB, 34% first consulted a traditional healer. Patients cited cost, distance and beliefs about TB causation as reasons for first consulting a traditional healer or going to the hospital. Of the TB patients who consulted a traditional healer first, there was an average of two weeks delay before they consulted the health service. In some cases, however, the delay was up to six years.ConclusionThe majority of the TB patients interviewed did not attribute TB to a bacterial cause. Consulting a traditional healer for health care, including while seeking a diagnosis for TB symptoms, was common and may have delayed diagnosis. People require better information about TB to correct commonly held misperceptions about the disease. Traditional healers could also be engaged with the national TB programme, in order to refer people with signs and symptoms of TB to the nearest health service.

A multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional NSW: model of service delivery and summary of preliminary findings

Objective: To describe a multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional New South Wales and report health problems and issues encountered during the initial period of operation.

EPIREVIEW. Pertussis in New South Wales, 1993-2005: the impact of vaccination policy on pertussis epidemiology.

OBJECTIVE To assess whether changes in vaccination policy have affected the epidemiology of pertussis in NSW between 1993 and 2005. METHODS Surveillance data from the NSW Notifiable Diseases Database was reviewed for the period. RESULTS 35,695 cases of pertussis were notified; annual incidence rates varied from 18.4 to 84.2 per 100,000 people. The highest rates of pertussis were consistently found in infants aged 0-6 months. Rates of disease in other age groups changed markedly over the study period, with high rates currently observed in adult age groups. CONCLUSIONS New strategies may be needed to control pertussis in infants and in adults who now comprise the largest proportion of cases.

The Epidemiology of Tuberculosis in Pacific Island Countries and Territories: 2000-2007

This is a descriptive study of routinely collected tuberculosis (TB) surveillance data from 19 Pacific Island countries and territories. The objectives of the study are to describe (a) the epidemiology of TB during the period 2000-2007 (with a focus on 2007), (b) progress against World Health Organization (WHO) targets, and (c) how TB control can be enhanced in the region. In 2007, there were 1544 cases of TB notified in the Pacific (excluding Papua New Guinea). The case notification rate was 52 per 100 000 population. The case detection rate for sputum smear positive cases in 2007 was 66%, slightly below the WHO target of 70%. The treatment success rate for new sputum smear positive cases in 2006 was 89%, above the WHO target of 85%. It is likely that the regional prevalence and mortality targets will be narrowly missed in 2010. There has been good progress in TB control in the Pacific region, but intensified efforts are needed to further reduce the burden of TB.

Tuberculosis and diabetes mellitus in the Republic of Kiribati: a case–control study

To better inform local management of TB–diabetes collaborative activities, we aimed to determine the prevalence of diabetes among persons with and without TB and to determine the association between TB and diabetes in Kiribati, a Pacific Island nation.

An outbreak of psittacosis at a veterinary school demonstrating a novel source of infection

In November 2014, New South Wales Health was notified of a cluster of respiratory illness in a veterinary school. Active case finding identified another case at a local equine stud. All cases had exposure to the equine fetal membranes of Mare A. This tissue subsequently tested positive for Chlamydia psittaci using quantitative real-time polymerase chain reaction. We conducted a cohort study of the university and stud farm staff to determine risk factors for disease. Nine people were exposed to the fetal membranes of Mare A. Of these, five cases of psittacosis were identified. Two required hospital admission. Contact with birds was not associated with illness (RR = 0.5, 95% CI = 0.09–2.73). People who had direct contact with the abnormal fetal membranes were more likely to develop disease (RR = 11.77, 95% CI = 1.02–∞). The emergence of an association between horse exposure and C. psittaci infection has important implications for the prevention and control of psittacosis. Article summary line: Investigation of an outbreak of psittacosis in a rural veterinary school demonstrates novel source of infection for psittacosis through exposure to abnormal equine fetal membranes.

A Descriptive Study of Nosocomial Infections in an Adult Intensive Care Unit in Fiji: 2011-12

Nosocomial infections in an intensive care unit (ICU) are common and associated with a high mortality but there are no published data from the Oceania region. A retrospective study in Fijis largest ICU (2011-12) reported that 114 of a total 663 adult ICU admissions had bacteriological culture-confirmed nosocomial infection. The commonest sites of infection were respiratory and bloodstream. Gram negative bacteria were the commonest pathogens isolated, especially Klebsiella pneumoniae (extended-spectrum β-Lactamase-producing), Acinetobacter, and Pseudomonas species. Mortality for those with a known outcome was 33%. Improved surveillance and implementation of effective preventive interventions are needed.

Traditional healers and the potential for collaboration with the national tuberculosis programme in Vanuatu: results from a mixed methods study

BackgroundThis study was conducted in the Pacific island nation of Vanuatu. Our objective was to assess knowledge, attitudes and practice of traditional healers who treat lung diseases and tuberculosis (TB), including their willingness to collaborate with the national TB programme.MethodsThis was a descriptive study using both qualitative and quantitative methods. Quantitative analysis was based on the responses provided to closed-ended questions, and we used descriptive analysis (frequencies) to describe the knowledge, attitudes and practice of the traditional healers towards TB. Qualitative analysis was based on open-ended questions permitting fuller explanations. We used thematic analysis and developed a posteriori inductive categories to draw original and unbiased conclusions.ResultsNineteen traditional healers were interviewed; 18 were male. Fifteen of the healers reported treating short wind (a local term to describe lung, chest or breathing illnesses) which they attributed to food, alcohol, smoking or pollution from contact with menstrual blood, and a range of other physical and spiritual causes. Ten said that they would treat TB with leaf medicine. Four traditional healers said that they would not treat TB. Twelve of the healers had referred someone to a hospital for a strong wet-cough and just over half of the healers (9) reported a previous collaboration with the Government health care system. Eighteen of the traditional healers would be willing to collaborate with the national TB programme, with or without compensation.ConclusionsTraditional healers in Vanuatu treat lung diseases including TB. Many have previously collaborated with the Government funded health care system, and almost all of them indicated a willingness to collaborate with the national TB programme. The engagement of traditional healers in TB management should be considered, using an evidence based and culturally sensitive approach.

Evaluation of three population health capacity building projects delivered by videoconferencing in NSW

UNLABELLED Three population health projects in falls prevention, smoking cessation and refugee health secured funding through the NSW Telehealth Initiative. All were capacity building projects delivered through live videoconferencing sessions between April and August 2007. Videoconferencing as a mode of delivery was evaluated from the perspective of those who delivered the projects. METHOD Qualitative semi-structured interviews with 12 key informants explored for each project: the organisation and delivery of the education sessions; the utility of videoconferencing for delivering training programs; and the perceived potential to apply videoconferencing to other functions. RESULTS The projects were all delivered successfully through live videoconferencing. The main benefits observed were: the ability to deliver training to large numbers of people across multiple locations within a relatively short time and for reasonable costs; and the ability to improve access to high quality professional development for rural and remote workers. Technical difficulties were minor. The support required for these kinds of e-learning projects to succeed were identified. CONCLUSION The evaluation confirmed the value of videoconferencing as a vehicle through which equity of access to learning opportunities for population health workers across NSW can be achieved.