Leena Gupta

Factors associated with low immunity to rubella infection on antenatal screening

Background:  Rubella infection during the first trimester results in congenital rubella syndrome. There has been little recent published evidence identifying those at‐risk of infection in the first trimester of pregnancy. This study examined the level of rubella immunity in pregnant women in a part of Sydney and risk factors for non‐immunity.

Educational and health service needs of Australian general practitioners in managing hepatitis C

Background:  There has been interest in recent years in the role of primary care practitioners in managing hepatitis C, but there has been minimal research to identify educational and health service needs. A national survey of Australian general practitioners (GPs) was therefore conducted to assess their needs and identify areas for service development.

Socioeconomic, remoteness and sex differences in life expectancy in New South Wales, Australia, 2001–2012: a population-based study

Objectives Despite being one of the healthiest countries in the world, Australia displays substantial mortality differentials by socioeconomic disadvantage, remoteness and sex. In this study, we examined how these mortality differentials translated to differences in life expectancy between 2001 and 2012. Design and setting Population-based study using mortality and estimated residential population data from Australias largest state, New South Wales (NSW), between 2001 and 2012. Age-group-specific death rates by socioeconomic disadvantage quintile, remoteness (major cities vs regional and remote areas), sex and year were estimated via Poisson regression, and inputted into life table calculations to estimate life expectancy. Results Life expectancy decreased with increasing socioeconomic disadvantage in males and females. The disparity between the most and least socioeconomically deprived quintiles was 3.77 years in males and 2.39 years in females in 2012. Differences in life expectancy by socioeconomic disadvantage were mostly stable over time. Gender gaps in life expectancy ranged from 3.50 to 4.93 years (in 2012), increased with increasing socioeconomic disadvantage and decreased by ∼1 year for all quintiles between 2001 and 2012. Overall, life expectancy varied little by remoteness, but was 1.8 years higher in major cities compared to regional/remote areas in the most socioeconomically deprived regions in 2012. Conclusions Socioeconomic disadvantage and sex were strongly associated with life expectancy. The disparity in life expectancy across the socioeconomic spectrum was larger in males and was stable over time. In contrast, gender gaps reduced for all quintiles between 2001 and 2012, and a remoteness effect was evident in 2012, but only for those living in the most deprived areas.

Use of a prohibition order after a large outbreak of gastroenteritis caused by norovirus among function attendees

INTRODUCTION In May 2011, an outbreak of acute gastroenteritis occurred among guests attending two functions (Function A and B) at a local function centre in Sydney, Australia. The Sydney South West Public Health Unit and the New South Wales (NSW) Food Authority sought to determine the cause of the outbreak and implement control measures. METHODS A retrospective cohort study was planned. A complete guest list was unavailable, so guests who could be contacted were asked to provide details of other guests. Attendee demographics, symptom profile and food histories were obtained using a standard response questionnaire. Stool samples were requested from symptomatic guests. The NSW Food Authority conducted a site inspection. RESULTS Of those interviewed, 73% of Function A guests and 62% of Function B guests were ill, with mean incubation times of 27 and 23 hours respectively. Diarrhoea was the most common symptom. Three stool samples and four environmental swabs were positive for norovirus. One food handler reported feeling ill before and during the functions. A prohibition order was used to stop food handlers implicated in the outbreak from preparing food. DISCUSSION This outbreak strongly suggests transmission of norovirus, possibly caused by an infected food handler. Regulatory measures such as prohibition orders can be effective in enforcing infection control standards and minimising ongoing public health risk.

Enhanced surveillance of hepatitis B infection in inner-western Sydney

OBJECTIVES We developed an enhanced surveillance system for hepatitis B to improve the detection of newly acquired cases and to collect epidemiological data. METHODS The study was undertaken from February to June (inclusive) 2005 at the Sydney South West Area Health Service Eastern Zone Public Health Unit. A letter was sent to treating doctors on receipt of a notification, requesting additional information on cases. Cases identified by the treating doctors as newly acquired were followed up by telephone. RESULTS There were 295 notifications of hepatitis B in the period, of which three were newly acquired infections. Only one of these three cases was identified through enhanced surveillance. Information on ethnicity was obtained. CONCLUSIONS This enhanced surveillance system is of limited value as an ongoing process. We recommend that it be undertaken periodically to monitor the epidemiology of the disease.

A tuberculosis contact investigation involving two private nursing homes in inner western Sydney in 2004

Australia has one of the lowest incidence rates of tuberculosis (TB) in the world, approximately five per 100,000 per year 1, although in some parts of the country the incidence is considerably higher. In the former Central Sydney Area Health Service the incidence rate in 2003 was 14 per 100,000 per year. The incidence is also higher in those aged 65 years and over, a population that has declining immunocompetence due to a variety of factors. Furthermore, the subpopulation of this group (and, indeed, of people of any age) living in residential institutions such as nursing homes and hostels are at even greater risk of TB infection and disease due to their chronic ill health and multiple medical problems. Despite this, there are no guidelines in NSW regarding TB screening of the elderly, either in response to potential exposure or with regard to screening at entry to a residential facility. There are also very few reports in the literature of TB contact investigations in residential facilities. Those that have been published come from the United States and are concerned with TB in hospitals or correctional facilities. There has been one report of TB transmission in a school setting in Sydney, but there is a paucity of Australian literature that clarifies what is required for contact investigations in the local residential care setting.

Listeriosis cluster in Sydney linked to hospital food.

Between 4 and 12 April 2013, a public health unit in Sydney was notified of three patients in different tertiary hospitals in two local health districts (LHDs) who had tested positive for listeriosis. This unusual occurrence prompted concern that the cases might be linked through contaminated hospital meals because hospitals in these LHDs source food from the same suppliers. The public health unit led a public health investigation, which included representatives from the New South Wales Food Authority, OzFoodNet, two NSW reference laboratories, food services, dietetics services and hospital infection control staff, to determine whether there was a link between the cases.

Age and cause‐of‐death contributions to area socioeconomic, sex and remoteness differences in life expectancy in New South Wales, 2010–2012

Objectives: To determine age group‐ and cause‐of‐death‐specific contributions to area socioeconomic status (SES), sex and remoteness life expectancy inequalities.

A survey of Sydney general practitioners’ management of patients with chronic hepatitis B

Objective: To examine the chronic hepatitis B (CHB) assessment and management practices of general practitioners in the Sydney and South Western Sydney Local Health Districts, areas with a high prevalence of CHB, and to obtain their views on alternative models of care.

Characteristics of gonorrhoea cases notified in inner and south-western Sydney, Australia: results of population-based enhanced surveillance.

Background: Gonorrhoea disproportionately affects young people and men who have sex with men (MSM). In Australia, the highest notification rates in urban areas occur in MSM, although characteristics of those infected are poorly described. Enhanced surveillance can provide population-based data to inform service delivery and health promotion activities. Methods: An enhanced surveillance and data collection form was sent to the ordering doctor for residents of Sydney and South Western Sydney Local Health Districts with positive gonorrhoea results notified between 1 August 2013 and 28 February 2014. Results: Questionnaires were sent for 777 notifications and 698 (89.8%) were returned. Eighty-five per cent (n = 594) were male. The majority (55.1%) resided in inner city Sydney. Of these, 91.9% were male, and 70.8% of these identified as MSM. Among females, regular partners were the most likely source of infection (44.1%), while MSM and heterosexual men identified casual partners as the likely source of infection (75.4% and 61.1% respectively). General practitioners diagnosed 60.5% of cases. MSM were more commonly diagnosed by sexual health clinics. Females were most commonly tested for contact tracing (35.6%), heterosexual males because of symptoms (86.3%), and MSM as part of sexually transmissible infection screening (40.6%). Conclusions: Our population-based analysis identified differing risk factors and testing characteristics between MSM, heterosexual males and females. Increasing rates of gonorrhoea and concerns over antibiotic resistance highlight the importance of obtaining accurate sexual histories to ensure appropriate testing. Intermittent enhanced surveillance can monitor trends in specific populations and help determine the impact of health promotion strategies.