AIM:To quantify the proportion of selected notified diseases in NSW attributable to overseas travel and assess the quality of data on travel-associated risk factors, to inform prevention strategies.METHODS:2010 and 2011 notification data for dengue, hepatitis A, hepatitis E, malaria, paratyphoid fever, shigellosis and typhoid fever were extracted from the NSW Notifiable Conditions Information Management System and analysed for travel-associated risk factors.RESULTS:Where place of acquisition was known, the proportion of cases for whom the disease was acquired overseas ranged from 48.7% for shigellosis to 100% for hepatitis E, malaria and typhoid. Over half of hepatitis A (53.3%), hepatitis E (74.2%), malaria (54.5%), paratyphoid (53.3%) and typhoid (65.7%) cases were associated with travel to the person's country of birth. Hepatitis A vaccination rates were significantly lower among overseas-acquired than locally-acquired cases (4.8% vs 22.2%, Χ(2)=6.58, p<0.02).CONCLUSION:A large proportion of selected enteric and vectorborne disease case notifications were associated with overseas travel. All potential travellers should be made aware of the risks and available preventive measures, such as vaccination against hepatitis A and typhoid fever, taking precautions with food and water and use of malaria chemoprophylaxis, where appropriate. Improvements in data on risk factors, reason for travel and barriers to the use of preventive measures would better inform prevention strategies.
AIMTo investigate the distribution of public and private dental practices in NSW in relation to population distribution and socioeconomic status.METHODSDental practices (public and private) were mapped and overlayed with Census data on Collection District population and Socio-Economic Indexes for Areas (SEIFA).RESULTSOverall, there was an uneven geographic distribution of public and private dental practices across NSW. When the geographic distribution was compared to population socioeconomics it was found that in rural NSW, 12% of the most disadvantaged residents lived further than 50km from a public dental practice, compared to 0% of the least disadvantaged. In Sydney, 9% of the three most disadvantaged groups lived greater than 7.5km from a public dental practice, compared to 21% of the three least disadvantaged groups.CONCLUSIONThe findings of this study can contribute to informing decisions to determine future areas for focus of dental resource development (infrastructure and workforce) and identifying subgroups in the population (who are geographically isolated from accessing care) where public health initiatives focused on amelioration of disease consequences should be a focus.
AIM:Postpartum haemorrhage rates have been increasing in NSW and internationally, and blood transfusion is required in severe cases. Using routinely collected administrative data provides a convenient method with which to monitor trends in both postpartum haemorrhage and associated transfusion use. In order for this to be feasible however, the reliability of reporting of the conditions needs to be assessed.METHODS:This study used linked data to compare the reporting of postpartum haemorrhage with transfusion as reported in the NSW Admitted Patient Data Collection (hospital data), with the same information obtained from the Perinatal Data Collection (birth data), for births in NSW from 2007 to 2010.RESULTS:The rate of postpartum haemorrhage requiring blood transfusion was 1.0% based on the hospital data and 1.1% based on the birth data, with a rate of 1.7% if identifying cases from either source. Agreement between the two sources improved from fair to moderate over the time period.CONCLUSION:Postpartum haemorrhage requiring transfusion recorded in the birth data shows only moderate agreement with hospital data, so caution is recommended when using this variable for analysis. Linkage of both datasets is recommended to identify birth information from birth data and postpartum haemorrhage with transfusion from hospital data until further validation work has been undertaken.
The birth of the Bulletin The year 1990 was a landmark for public health in New South Wales (NSW). The Public Health Division at the then NSWDepartment of Health was in its infancy, having been formed at the end of 1989, and funding for a program to enhance public health in NSW led to the establishment of a network of Public Health Units and the NSW Public HealthOfficer Training Program. TheNSWPublicHealth Bulletin was established in May 1990 to disseminate accurate and timely information among this newly formed public health network and to provide regular feedback to practitioners on notifiable conditions. It was hoped that the Bulletin would assist in ‘‘the development of a vibrant public health network in NSW’’, and ‘‘provide a useful mechanism for exchange of information and ideas on investigations, programs, and evaluations that (may) affect the health of the citizens of NSW’’.
Salmonella Typhimurium is the most common bacterial cause of gastrointestinal disease in NSW. Regular review of surveillance procedures ensures system objectives are met and informs improvements in system utility and efficiency. This paper assesses the timeliness and data completeness of NSW Salmonella Typhimurium surveillance after the routine introduction of multilocus variable repeat analysis (MLVA), a rapid sub-typing technique. MLVA results were available significantly earlier than alternate sub-typing techniques over the 2 years of this review. Accordingly, from a timeliness perspective, MLVA offers a favourable Salmonella Typhimurium sub-typing option in NSW. Further opportunities to improve timeliness and data completeness are identified. This paper was produced as part of a review of Salmonella Typhimurium surveillance in NSW for the period 2008-2009 by members of OzFoodNet based at Hunter New England Population Health. OzFoodNet is a national network established by the then Commonwealth Department of Health and Ageing in 2000 to enhance foodborne disease surveillance in Australia.
TheNSWPublicHealth Bulletin has achievedmuch over the past 24 years and there is a great deal to celebrate. To support an agile, contemporary, public health environment the Bulletin is about to enter a new phase in its evolution – one that builds on its proud history and strongly positions public health for the future. The Bulletin will be renamed Public Health Research & Practice and will strengthen its focus on supporting knowledge-driven policies and the provision of best practice public/population health services and programs in NSW and across Australia. This will be underpinned by original, policy-relevant research and articles on implementing and evaluating innovative NSW policies, services and programs. Editorial management and production will move to the Sax Institute and be overseen by an Editorial Board (Box 1).
Congratulations on the publication of the ‘‘Tuberculosis in NSW’’ edition (2013; 24(1)). It makes excellent reading on a disease that continues to smoulder in this country. However, there is one topic on which some authors appear unclear: the limitations of immunological tests for both tuberculosis (TB) disease and infection. I refer to the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs), in particular the QuantiFERON-Gold In Tube (QFT-Gold IT). Certainly Britton et al are correct in stating the unreliability of such tests in infants under the age of 2. Indeed, these tests have little application in diagnosing disease, but are the only diagnostic agents we have for infection. It is not good enough for authors to tell us that the TST is negative or positive since this means nothing in an investigation where we have to balance sensitivity against specificity. A TST threshold of 10mm induration might be said to achieve this balance, but the QFT-Gold IT shows that it does not. Across the world, tuberculins are produced that are of different potency, are recommended to be given in different doses (not always 10 units), and a ‘‘positive induration’’ may be less than 10mm. Therefore authors should be encouraged to tell us what dose of which tuberculin has achieved what degree of induration. Although IGRAs are reported as positive and negative, this is dependant on an arbitrary cut-off point. The criterion we use for a ‘‘positive’’ TST in Australia may be sensitive, but has poor specificity and for QFT-Gold IT, mediocre sensitivity, if good specificity. I am surprised that none of the articles dealing with TB infection mention the use of both tests being used together (except in the BCGvaccinated), a strategy thatwe inAustralia can surely afford.
Aim: To describe the epidemiology of tuberculosis in NSW between 2009 and 2011 and compare with previous years.Methods: Data from all cases of tuberculosis notified in NSW during this period were extracted from the Notifiable Conditions Information Management System.Descriptive analyses of notification data were undertaken.Incidence rates were calculated per 100 000 population.Results: Between 2009 and 2011, there were 1548 cases of tuberculosis notified in NSW, translating to an average annual notification rate of 7.2 per 100 000 population for this period.A total of 89% (n ¼ 1371) of notified cases were overseas-born, and 1.6% (n ¼ 24) of cases were recorded as Aboriginal persons.The most common site of infection was the lung (60% of cases).Of notified cases, 68% were reported as having been tested for HIV, of which 3% (n ¼ 28) of cases had HIV/tuberculosis co-infection.There were 20 cases of multidrug-resistant tuberculosis, including one case of extensively drug-resistant tuberculosis.Conclusion: The notification rate of tuberculosis in NSW has remained relatively stable over the past two decades, though small incremental increases since 2003 are evident.Endemic transmission of tuberculosis within subgroups of the NSW population, as well as the ongoing high endemnicity for tuberculosis in neighbouring countries, highlight the importance of tuberculosis control as a continued strategic priority for disease control in NSW.Tuberculosis (TB) remains a disease of global public health significance.The World Health Organization (WHO) estimates that in 2011 there were 8.7 million incident cases of TB and 1.4 million TB-related deaths, as well as an additional 430 000 deaths as a result of TB and human immunodeficiency virus (HIV) co-infection. 1 In Australia the incidence of TB is low: in 2010 it was reported by WHO to be 6.1 cases per 100 000 population.Mortality from TB, excluding HIV-positive cases, was less than one TB-related death per 100 000 population in Australia in 2010.
Aim: An analysis of general practice data for rural communities in close proximity to coal mining and coal-fired power generation in the Hunter Valley region of NSW was conducted to identify unusual patterns of illness.Methods: Bettering the Evaluation and Care of Health general practice consultation data from the Hunter Valley region for 1998-2010 were compared with data from all other rural NSW residents.Results: There were no significantly higher rates of problems managed or medications prescribed for Hunter Valley region residents compared with the rest of rural NSW.Rates of respiratory problem management in the Hunter Valley region did not change significantly over time, while for all other rural NSW areas these rates significantly decreased. Conclusion:There was no evidence of significantly elevated health issues for residents in the Hunter Valley region of NSW.The diverging trend for respiratory problem management over time is worthy of further exploration.Coal mining has the potential to impact on the health of nearby residents but there are limited Australian data available. 1,2 The rural communities of Singleton, Muswellbrook and Denman are situated in close proximity to extensive and expanding coal mining and coal-fired power generation activities in the Hunter Valley region of New South Wales (NSW).Raw coal production from open cut coal mines in NSW increased by 81% over the period 1999-2011, with the Hunter Valley region accounting for 76% of all open-cut coal production in NSW in 2011 (unpublished data, Coal Services Pty Ltd, 2012).In response to health concerns raised by the community, NSW Health reviewed existing health data for the region.Patterns of NSW emergency department presentations and hospital admissions, as well as mortality, cancer incidence and self-reported health survey data for these areas were compared with other parts of NSW and an analysis published in May 2010. 3 Some regions with exposure to open-cut coal mining and power generation were shown to have higher rates of emergency department attendance for asthma and respiratory disease, and higher rates of hospital admission for asthma, respiratory conditions and cardiovascular disease.There was ongoing community concern that hospital data only represented severe disease.A complementary analysis of general practice data was conducted to determine whether there were any indications of excessive or unusual patterns of illness in these communities which may not have been detected by the May 2010 study.
Twenty-one percent of the world's tuberculosis cases are found in the Western Pacific Region. The region has demonstrated a lower rate of decline in incidence than the regions of Africa, the Americas and Europe. Issues around drug resistance, human immunodeficiency virus and diabetes impact on the burden of tuberculosis disease in the Western Pacific Region. Australia has exhibited a low and relatively stable tuberculosis incidence rate but has not progressed toward the desired international goal for tuberculosis elimination (<1 case per million population). The pathogenesis and transmission of tuberculosis make it difficult to achieve elimination within a geographically defined area. These aspects of disease control are amplified by globalisation and Australia's increasing economic and strategic engagement within the Western Pacific Region and South-East Asia. Promoting and supporting tuberculosis control within the Western Pacific Region provides an opportunity for Australia to maintain its low tuberculosis incidence rate and progress toward elimination.
Childcare services provide ideal settings to promote good oral health and help reduce tooth decay in young children.This paper reports the results of an evaluation of the dental information session component of the NSW Little Smiles Program provided by public oral health service professionals to childcare educators in NSW in 2010-2011.The evaluation sought to determine if a face-to-face information session provided to childcare educators by oral health professionals: (i) can improve the confidence of childcare educators to reach national quality standards that relate to oral health; and (ii) is an appropriate model to use.In 2010-2011, 163 dental information sessions were provided to 1716 participants from over 526 childcare centres across NSW.Results showed that a dental information session can improve the confidence of childcare educators to assist their service to reach the required national quality standards for oral hygiene and diet-related oral health issues.Further evaluation is required to determine if oral health can be embedded in the daily practice of childcare services and other options need to be explored to deliver the sessions in a more cost-effective way.
A recently conducted study on tuberculosis contact investigations in six Sydney tuberculosis clinics - that together managed 59% of all tuberculosis cases in NSW from January 2000 to December 2009 - found that the prevalence of tuberculosis among contacts was comparable to other low-incidence settings. However, only 9% of contacts with latent tuberculosis infection received treatment. This paper explores the results of the study, evaluating potential missed opportunities to prevent tuberculosis among contacts, and discussing the mechanisms in decision making about treatment of latent tuberculosis infection. In particular, the paper focuses on the challenges of tuberculin skin test interpretation among contacts who have received Bacille Calmette-Guérin vaccination and who were born in countries where tuberculosis is endemic.
Enteric infections Outbreaks of suspected foodborne disease Six outbreaks of gastrointestinal disease thought to be due to consumption of contaminated food were reported in November and December 2011. These outbreaks occurred in restaurants or cafes (5) and in a private residence (1); 63 people were affected. Four outbreaks were identified through complaints to the NSWFood Authority (NSWFA) and two outbreaks were identified through emergency department reports to public health units. Stool samples were tested in two outbreaks, and the pathogens identified were Salmonella Typhimurium, and Campylobacter. Due to limited ability to recall the food eaten (in two outbreaks) or lack of an association between eating a particular food and gastrointestinal illness in cases who were interviewed and controls (in three outbreaks), there was not enough evidence to identify the food vehicle in five of the outbreaks.
AIM:This study explores knowledge and beliefs about longer-term health risks related to alcohol consumption among Australian adults.METHODS:Data were drawn from the 2009 Cancer Institute NSW Lifestyle and Cancer Survey, a telephone survey of adults in NSW. Participants (n=1255) were asked about their alcohol consumption, knowledge of the Australian guidelines (revised in 2009), and personal perceptions and beliefs about longer-term health risks from alcohol consumption.RESULTS:Seventy-eight percent of the sample drank alcohol either occasionally or weekly, with 37% of drinkers drinking above the current Australian guidelines (two standard drinks on any day). Two-thirds (67%) correctly nominated the maximum number of standard drinks per day that met the current Australian guidelines, and a similar proportion (64%) agreed that regular moderate alcohol consumption can have serious health consequences in the longer term. Knowledge of the guidelines and longer-term health consequences was lower for drinkers, especially those drinking above the guidelines. Less than half (48%) of the participants were aware that drinking alcohol could cause cancer and 51% were aware that limiting alcohol intake helps prevent cancer.CONCLUSION:The current Australian guidelines, the longer-term health risks and the link with cancer are not well understood, especially by those who drink frequently and above the guidelines.
The links between tobacco smoking, and periodontal disease and oral cancer make the inclusion of smoking cessation interventions at dental visits an important prevention strategy in oral health services. The 5As (Ask, Advise, Assess, Assist, Arrange), which utilises a stages of change model, is the most commonly recognised framework for the provision of smoking cessation brief interventions and is advocated widely. While the popularity of the 5As continues, increasingly evidence suggests that staged-based interventions in smoking cessation may not be the best approach. Lack of time and expertise are also cited by health professionals as barriers to undertaking brief interventions and thus abbreviated forms of the 5As have been advocated. In 2009, NSW Health introduced a mandatory policy for public dental services in NSW to conduct smoking cessation brief interventions at the chairside based on a three-step approach, which is currently being evaluated. Given the debate and the pending evaluation results, this paper reviews models of smoking cessation brief interventions, to contribute to achieving a best practice model for public oral health in NSW.
In western NSW in 2006, a group of Aboriginal Community Controlled Health Organisations identified oral health as a priority need in their regions, considering the lack of regular dental services, poor access to oral health information, and high dental disease rates. A regional oral health promotion program was developed and implemented under the guidance of a regional coordinator who supports local staff in oral health promotion activities such as school-based toothbrushing and the provision of oral health information to targeted groups (e.g. young mothers and carers) and staff of chronic disease programs. The program's strength in its planning and continuity is due to many factors, one of the main being the active involvement of local Aboriginal Community Controlled Health Organisation staff in its genesis, planning and implementation. Combined with strong management support, local partnerships and regional coordination, the program continues to provide collaborative approaches to community-based oral health promotion programs.
AIMTo review the epidemiology of invasive meningococcal disease in NSW for the period 1991-2011, in particular since the introduction of the meningococcal C vaccination program in 2003.METHODSWe undertook a descriptive analysis of NSW notifications of invasive meningococcal disease for the period 2003-2011, and explored long-term changes in the epidemiology of invasive meningococcal disease over the period 1991-2011.RESULTSIn the period 2003-2011, there were 1009 notifications of invasive meningococcal disease in NSW, an average annual rate of 1.6 per 100000 population. Notification rates were highest in the 0-4 and 15-19-year age groups (8.5 and 3.6 per 100000 population respectively). In the period 1991-2011, invasive meningococcal disease notifications increased between 1991 and 2000, peaking at 3.8 notifications per 100000 population in 2000. Notifications have decreased since that time to 1.0 per 100000 population in 2011, most markedly for serogroup C disease since the introduction of the meningococcal C vaccination program in 2003. Meningococcal C notifications reduced from 54 in 2002 (0.8 per 100000 population) to two in 2011 (0.03 per 100000 population). Meningococcal C deaths have also decreased, from nine in 2002 to zero in 2011. The greatest reduction in meningococcal C notifications has been in those aged 1-19 years, the target group for the vaccination program. Meningococcal B notifications have also decreased over the study period, however serogroup B remains the predominant serogroup for invasive meningococcal disease in NSW.CONCLUSIONNotification rates of invasive meningococcal disease have decreased in NSW since 2000. Rates of serogroup C disease have decreased since the introduction of the meningococcal C vaccination program in 2003. Most of the burden of invasive meningococcal disease in NSW is now due to serogroup B disease.
Health protection involves the prevention and control of threats to health from communicable diseases and the environment.In New South Wales (NSW) in 2012 these functions were carried out by a range of groups, among them Health Protection NSW's Communicable Diseases and Environmental Health Branches, the NSW Ministry of Health's Population and Public Health Division, Public Health Units, clinicians, Local Health District services, local government, other government agencies, and communities.In this report we highlight the major health outcomes and achievements related to Health Protection NSW's activities in 2012, including some examples of health protection projects done in the field (Boxes 1-6).The health outcomes described in this report are measured mainly through routine surveillance data that are derived from notifications of selected diseases provided by doctors, hospitals and laboratories to Public Health Units under the NSW Public Health Act 2010.Tables 123456show disease-specific data on notifiable conditions reported by: year of onset of illness; month of onset of illness; Local Health District; and age group and sex.Note that the degree to which notification data reflect the true incidence of disease varies and is subject to a range of caveats. 1 Surveillance Vaccine-preventable diseasesIn 2012 there were: • no haemophilus influenzae type b notifications in children aged less than 5 years for the first time since 1993 • 5824 pertussis notifications (including one death in a 7-week old infant), a marked decrease from the record numbers in 2011 (.13 000)
