Mark J. Ferson

The Association of Respiratory Viruses, Temperature, and Other Climatic Parameters with the Incidence of Invasive Pneumococcal Disease in Sydney, Australia

BACKGROUND Increases in incidence of invasive pneumococcal disease (IPD) during the colder months of the year in temperate regions are well recognized, but few detailed studies of possible interactions are available. We examined the relationship between virus activity, climatic parameters, and IPD during a winter in which there were separate peak incidences of influenza and respiratory syncytial virus (RSV) infection. METHODS We performed an ecological study that correlated population-based data on IPD and respiratory virus activity in the year 2000 in metropolitan New South Wales, Australia, with climatic parameters, including weekly mean maximum and minimum temperature, relative humidity, rainfall, and wind speed. RESULTS In children, RSV activity was significantly positively correlated with IPD activity (r = 0.578; P = .002) but not with influenza virus activity. There was a weak inverse relationship between parainfluenza virus activity and IPD activity (r = -0.401; P = .043) and a stronger inverse relationship between weekly mean maximum temperature (r = -0.458; P = .001), weekly mean minimum temperature (r = -0.437; P = .001), and IPD activity. In adults, there was no significant correlation between RSV or influenza virus activity alone and IPD, but the combination of RSV and influenza was significantly correlated with IPD (r = 0.481; P = .013). CONCLUSIONS This study suggests that RSV infection and influenza contribute to IPD incidence peaks differently for children than for adults. Data from other geographic areas and more rigorous study designs are required to confirm these findings.

Varicella‐zoster virus infection in Australia

Objective: To determine the epidemiology of varicella‐zoster virus (VZV) infection in Australia using currently available data sources.

Designated “no smoking” areas provide from partial to no protection from environmental tobacco smoke

Objective: To determine the efficacy of designated “no smoking” areas in the hospitality industry as a means of providing protection from environmental tobacco smoke (ETS), and whether certain design features assist in achieving this end. Methodology: In the greater metropolitan region of Sydney, a representative group of 17 social and gaming clubs, licensed to serve alcoholic beverages and in which, apart from designated areas, smoking occurs, agreed to participate. In each establishment, simultaneous single measurements of atmospheric nicotine, particulate matter (10 μm; PM10) and carbon dioxide (CO2) levels were measured in a general use area and in a designated “no smoking” area during times of normal operation, together with the levels in outdoor air (PM10 and CO2 only). Analyses were made of these data to assess the extent to which persons using the “no smoking” areas were protected from exposure to ETS. Results: By comparison with levels in general use areas, nicotine and particulate matter levels were significantly less in the “no smoking” areas, but were still readily detectable at higher than ambient levels. For nicotine, mean (SD) levels were 100.5 (45.3) μg/m3 in the areas where smoking occurred and 41.3 (16.1) μg/m3 in the “no smoking” areas. Corresponding PM10 levels were 460 (196) μg/m3 and 210 (210) μg/m3, while outdoor levels were 61 (23) μg/m3. The reduction in pollutants achieved through a separate room being designated “no smoking” was only marginally better than the reduction achieved when a “no smoking” area was contiguous with a smoking area. CO2 levels were relatively uninformative. Conclusion: Provision of designated “no smoking” areas in licensed (gaming) clubs in New South Wales, Australia, provides, at best, partial protection from ETS—typically about a 50% reduction in exposure. The protection afforded is less than users might reasonably have understood and is not comparable with protection afforded by prohibiting smoking on the premises.

Impact of influenza on morbidity in children with cystic fibrosis

Abstract  Recommendations concerning annual influenza vaccination in children suffering from cystic fibrosis (CF) are not uniform. Previous studies have shown that influenza causes a small proportion of episodes of episodes of acute respiratory deterioration in CF patients. During the 1989 Australian winter, we studied the association between serologically proven influenza infection and acute respiratory morbidity in 20 children with CF. Six children were shown to have influenza infection, four with type A and two with type B. Four of five children requiring hospital admission were shown to have influenza, but only 2 of 15 did not need admission (P≤0.025). As well, influenza was diagnosed in 6 of 12 children who suffered acute respiratory illness leading to school absenteeism (including hospitalization), but diagnosed in no children without this degree of illness (P≤0.25). Influenza significantly increases the incidence of hospitalization and of less serious respiratory illness in children with CF, a finding which suggests that influenza vaccine efficacy studies are necessary in this group.

Outbreak of hepatitis A among homosexual men in Sydney.

OBJECTIVES This study examined an outbreak of hepatitis A in eastern Sydney during 1991-1992. METHODS Data were based on cases of hepatitis A in eastern Sydney residents reported from January 1991 to October 1992. RESULTS Five hundred seventy cases of hepatitis A were reported. Of these, 515 (90%) occurred in male patients, of whom 330 were reported to be homosexual or bisexual. The highest attack rate (71/10,000) occurred in men aged 20 to 29 years of age. CONCLUSIONS This outbreak affected large numbers of young homosexual men living in the inner eastern suburbs of Sydney. Hepatitis A vaccination should be considered for all susceptible homosexual men. Further research into the use of hepatitis A vaccine as an outbreak control measure is also recommended.

Determination and importance of varicella immune status of nursing staff in a children's hospital

A survey of nurses at the Prince of Wales Childrens Hospital was conducted to determine the prevalence of immunity to varicella-zoster virus (VZ) as defined by enzyme immunoassay (EIA), and to establish the value of history as a predictor of immunity. Of the 209 nurses surveyed, 51% could recall suffering VZ infection, and with a single exception, all of this group were immune. However, despite a 95% prevalence of immunity among all nurses, 46% of those found to be immune by EIA could not recollect having VZ infection. In the event of a hospital VZ outbreak, the latter group, without serological testing, would thus need to be regarded as susceptible, and this would create a major logistical problem in staffing the affected areas. We suggest, to minimize this cause of disruption to services, that all paediatric staff with patient contact should be asked at the time of recruitment if they recall suffering VZ infection. Those who give a positive response may be considered immune, but all other staff should have their immune status assessed by EIA at the earliest opportunity.

Sexually transmissible infection testing guidelines for men who have sex with men.

Since 2002, biennial production of sexually transmissible infection testing guidelines for men who have sex with men has supported sexually transmitted infection control efforts in inner Sydney, Australia.

Changing epidemiology of hepatitis A in the 1990s in Sydney, Australia.

Surveillance of hepatitis A in residents of Eastern Sydney Health Area identified substantial epidemics in homosexual males in 1991-2 with a peak rate of 520 per 100,000 recorded in males aged 25-29 years, and again in 1995-6, with a peak rate of 405 per 100,000 per year in males aged 30-34 years. During 1994-5 an epidemic was detected among disadvantaged youth associated with injecting drug use; peak rates of 200 per 100,000 per year were reported in males aged 25-29 years and of 64 per 100,000 per year among females aged 20-24 years. The epidemiology of hepatitis A in these inner suburbs of Sydney is characterized by very few childhood cases and recurrent epidemics among homosexual men. Identified risk groups need to be targeted with appropriate messages regarding the importance of hygiene and vaccination in preventing hepatitis A. However, poor access to health services among disadvantaged youth and a constant influx of young homosexual males into these inner suburbs present major challenges to hepatitis A control.

Longitudinal study of rotavirus infection in child-care centres

To describe the epidemiology of symptomatic and asymptomatic rotavirus infection among young children attending Sydney child‐care centres during the 1994 rotavirus season.

Parechovirus Genotype 3 Outbreak among Infants, New South Wales, Australia, 2013-2014

Syndromic surveillance was useful for outbreak monitoring, and public health response helped reduce hospitalization times.