Introduction:Shigella is a notifiable condition in Victoria under the Public Health and Wellbeing Act. Since 24 October 2022, the South East Public Health Unit (SEPHU) has been managing these notifications for the south east region of Melbourne. Aim:This study aimed to determine the demographics and risk factors for acquisition of shigellosis cases in the SEPHU catchment. Methods:A review was performed of all shigellosis notifications within the SEPHU catchment during the period 1 January 1 2022 - 31 March 2023. De-identified information was collated from the Public Health Event Surveillance System (PHESS) for analysis of demographics, risk factors and antimicrobial resistance. Results:A total of 127 cases were notified: 51 were confirmed with culture, with the remaining 76 identified as probable cases through polymerase chain reaction testing. The greatest numbers of cases were within the 0-4 and 5-9 years of age categories (each 19/127; 15%), followed by the 30-34 years age group (18/127; 14%). The highest case numbers were recorded in the local government area (LGA) of Casey (30/127; 24%) while the highest rate across the 15-month study period, of 20.2 per 100,000, was from the Stonnington LGA. The most prominent primary risk factor was travel overseas (62/127, 49%) followed by contact between men who have sex with men (MSM) (16/127, 13%). Of confirmed cases, 61% (31/51) met the criteria for classification as critical antibiotic resistance (CAR) shigellosis. Conclusion:This review found that the LGAs with high number and rates of cases are Casey, Greater Dandenong and Stonnington. However, the risk factors for acquisition differs in these areas, indicating a need for LGA-specific education in the diverse SEPHU catchment.

Surveillance case definitions are utilised to understand the epidemiology of communicable diseases and to inform public health actions. We report a case of hepatitis B infection that meets the case definition for newly acquired infection. However, further investigation revealed that this was most likely past resolved hepatitis B infection with subsequent reactivation secondary to immunosuppression, rather than a newly acquired infection. This case highlights the importance of thorough case and clinician interviews, in combination with detailed assessment of pathology results in collaboration with treating clinicians, to determine the most appropriate public health actions.

Local public health units offer a place-based response to disease threats impacting populations in its catchment. This place-based response can be further strengthened when local public health units (LPHUs) collaborate with local stakeholders, in particular health services, to protect the more vulnerable population. We describe the approaches taken by a newly formed LPHU in southeast metropolitan Victoria, Australia in COVID-19 outbreak management impacting residential aged care facilities (RACFs) in its catchment, throughout the different phases of the pandemic. These collaborative and flexible approaches ensured that public health actions met the demand and needs of stakeholders. Approaches included the development of prioritization and risks matrices, refining known processes such as outbreak management team membership and redefining roles of the LPHU as capacity of stakeholder evolved.

Buruli ulcer, a chronic subcutaneous infection caused by Mycobacterium ulcerans , is increasing in prevalence in southeastern Australia. Possums are a local wildlife reservoir for M. ulcerans and, although mosquitoes have been implicated in transmission, it remains unclear how humans acquire infection. We conducted extensive field survey analyses of M. ulcerans prevalence among mosquitoes in the Mornington Peninsula region of southeastern Australia. PCR screening of trapped mosquitoes revealed a significant association between M. ulcerans and Aedes notoscriptus . Spatial scanning statistics revealed overlap between clusters of M. ulcerans -positive Ae. notoscriptus , M. ulcerans -positive possum excreta and Buruli ulcer cases, and metabarcoding analyses showed individual mosquitoes had fed on humans and possums. Bacterial genomic analysis confirmed shared single-nucleotide-polymorphism profiles for M. ulcerans detected in mosquitoes, possum excreta and humans. These findings indicate Ae. notoscriptus probably transmit M. ulcerans in southeastern Australia and highlight mosquito control as a Buruli ulcer prevention measure.

Surveillance case definitions are utilised to understand the epidemiology of communicable diseases and to inform public health actions. We report a case of hepatitis B infection that meets the case definition for newly acquired infection. However, further investigation revealed that this was most likely past resolved hepatitis B infection with subsequent reactivation secondary to immunosuppression, rather than a newly acquired infection. This case highlights the importance of thorough case and clinician interviews, in combination with detailed assessment of pathology results in collaboration with treating clinicians, to determine the most appropriate public health actions.

Newly formed local public health units in Victoria have been established to support a place-based approach that tailors and delivers public health initiatives and responds to public health incidents and issues. Initially, post-establishment of these units, public health activities focused on the prevention and control of communicable diseases. In 2022, mpox emerged as a global public health threat. As case numbers rose across Australia, local public health units in Victoria were engaged by the Department of Health to support a localized response to this new threat. The South East Public Health Unit, Monash Health, developed a number of targeted initiatives to control the local spread of mpox, ranging from capacity building of health professionals to increase early diagnosis, contact tracing, facilitating vaccine delivery, and community engagement. This contributed to effective local elimination within 6 months, demonstrating how LPHUs are well placed to engage with local communities and health care providers to respond rapidly to newly emerging public health threats.

AbstractIn temperate southeastern Australia over the past two decades there has been a marked progressive increase in human cases of Buruli ulcer, an infection of subcutaneous tissue caused byMycobacterium ulcerans. Native possums are the major local environmental reservoir ofM. ulceransas they not only develop Buruli lesions but they also shedM. ulceransin their excreta. However the way humans acquireM. ulceransfrom possums has not been determined. Previous case-control studies, insect field surveys and vector competence studies have suggested a role for mosquitoes inM. ulceranstransmission between possums and humans. To explore these links we conducted an extensive, 4-month structured mosquito field survey and fourad hocfield surveys across an area of 350km2on the Mornington Peninsula, an area endemic for Buruli ulcer to the south of the major metropolitan city of Melbourne. We then compared spatial and temporal patterns ofM. ulcerans-positive mosquito occurrence withM. ulcerans-positive possums (established by previous possum excreta surveys) and human Buruli ulcer cases across the region. We used metabarcoding to assess mosquito blood-feeding host preference and to reconstructM. ulceransgenomes from positive mosquitoes to test epidemiological inferences. We collected 66,325 mosquitoes spanning 26 different species from 180 repeatedly sampled traps over a 4-month period.Culex molestusandAedes notoscriptuswere the dominant species (42% and 35% of trapped mosquitoes, respectively). PCR screening 25% of trapped mosquitoes revealed a significant association betweenM. ulceransandAe. notoscriptus(p<0.0001) with a maximum likelihood estimate (MLE) of 5.88M. ulceranspositive mosquitoes per 1,000 tested. Using spatial scanning statistics, we also observed significant overlap between clusters ofM. ulcerans-positiveAe. notoscriptus,M. ulcerans-positive possum excreta and human Buruli ulcer cases. Metabarcoding analyses of blood-fedAe. notoscriptusshowed individual mosquitoes had fed both on humans and native possums. Enrichment genome sequencing from PCR-positive mosquitoes confirmed sharedM. ulceransgenome single-nucleotide polymorphism (SNP) profiles between mosquitoes, possum excreta and clinical human isolates within the same regions. These findings indicate thatAe. notoscriptuslikely transmitM. ulceransin southeastern Australia and highlight mosquito control as a plausible means to control the Buruli ulcer epidemic in our region.

We present a case of late symptom onset of COVID-19 infection 72 days after initial diagnosis in an immunocompromised 53-year-old man. SARS-CoV-2 was cultured from his sputum sample at this time, and genomic sequencing suggested reinfection was unlikely. After receipt of convalescent plasma, SARS-CoV-2 became undetectable by PCR 111 days after diagnosis, although SARS-CoV-2 antibodies remained not detectable. This case posed difficult public health management issues in a low prevalence COVID-19 setting as the person required extended home isolation given his prolonged SARS-CoV-2 PCR detection.

To describe characteristics of COVID-19 outbreaks in Australia to guide policy development for mitigation of future outbreaks, we conducted a retrospective analysis of COVID-19 outbreaks affecting two or more people reported to COVID-Net—an Australian national surveillance network—from 28 January until 27 December 2020. The COVID-Net surveillance network covered all Australian states and territories, with an estimated population of 25,649,985 persons as at 31 June 2020. We reported the epidemiology of COVID-19 outbreaks in Australia, including the setting in which they occurred, size, and duration. 853 outbreaks of COVID-19 were reported; associated with 13,957 confirmed cases, of whom 2,047 were hospitalised, and 800 died. The pattern of outbreaks followed a similar trend to the epidemic in Australia, defined by two distinct peaks in mid-March and July. Victoria reported the greatest number of outbreaks across all settings aligned with the second wave of infections. Outbreaks most commonly occurred in the workplace/industry setting (22%, 190/853), followed by education (14%, 122/853), residential aged care (13%, 114/853) and hospitals (10%, 83/853). The majority (40%, 340/853) of outbreaks had 6 to 24 cases, and the median outbreak duration increased in proportion with the number of associated cases. This report summarising COVID-19 outbreaks in Australia identifies settings of highest risk. Surveillance of outbreaks informs our understanding of transmission dynamics in Australia relative to national and jurisdictional interventions. For settings that are high risk for COVID-19, it is important to prioritise planning, surveillance, and implementation of control measures.

BACKGROUND:A cornerstone of Australia's ability to control COVID-19 has been effective border control with an extensive supervised quarantine programme. However, a rapid recrudescence of COVID-19 was observed in the state of Victoria in June, 2020. We aim to describe the genomic findings that located the source of this second wave and show the role of genomic epidemiology in the successful elimination of COVID-19 for a second time in Australia. METHODS:In this observational, genomic epidemiological study, we did genomic sequencing of all laboratory-confirmed cases of COVID-19 diagnosed in Victoria, Australia between Jan 25, 2020, and Jan 31, 2021. We did phylogenetic analyses, genomic cluster discovery, and integrated results with epidemiological data (detailed information on demographics, risk factors, and exposure) collected via interview by the Victorian Government Department of Health. Genomic transmission networks were used to group multiple genomic clusters when epidemiological and genomic data suggested they arose from a single importation event and diversified within Victoria. To identify transmission of emergent lineages between Victoria and other states or territories in Australia, all publicly available SARS-CoV-2 sequences uploaded before Feb 11, 2021, were obtained from the national sequence sharing programme AusTrakka, and epidemiological data were obtained from the submitting laboratories. We did phylodynamic analyses to estimate the growth rate, doubling time, and number of days from the first local infection to the collection of the first sequenced genome for the dominant local cluster, and compared our growth estimates to previously published estimates from a similar growth phase of lineage B.1.1.7 (also known as the Alpha variant) in the UK. FINDINGS:Between Jan 25, 2020, and Jan 31, 2021, there were 20 451 laboratory-confirmed cases of COVID-19 in Victoria, Australia, of which 15 431 were submitted for sequencing, and 11 711 met all quality control metrics and were included in our analysis. We identified 595 genomic clusters, with a median of five cases per cluster (IQR 2-11). Overall, samples from 11 503 (98·2%) of 11 711 cases clustered with another sample in Victoria, either within a genomic cluster or transmission network. Genomic analysis revealed that 10 426 cases, including 10 416 (98·4%) of 10 584 locally acquired cases, diagnosed during the second wave (between June and October, 2020) were derived from a single incursion from hotel quarantine, with the outbreak lineage (transmission network G, lineage D.2) rapidly detected in other Australian states and territories. Phylodynamic analyses indicated that the epidemic growth rate of the outbreak lineage in Victoria during the initial growth phase (samples collected between June 4 and July 9, 2020; 47·4 putative transmission events, per branch, per year [1/years; 95% credible interval 26·0-85·0]), was similar to that of other reported variants, such as B.1.1.7 in the UK (mean approximately 71·5 1/years). Strict interventions were implemented, and the outbreak lineage has not been detected in Australia since Oct 29, 2020. Subsequent cases represented independent international or interstate introductions, with limited local spread. INTERPRETATION:Our study highlights how rapid escalation of clonal outbreaks can occur from a single incursion. However, strict quarantine measures and decisive public health responses to emergent cases are effective, even with high epidemic growth rates. Real-time genomic surveillance can alter the way in which public health agencies view and respond to COVID-19 outbreaks. FUNDING:The Victorian Government, the National Health and Medical Research Council Australia, and the Medical Research Future Fund.

Background Mosquito control interventions are widely used to reduce mosquito-borne diseases. It is unclear what combination of interventions are most effective in reducing human disease. A novel intervention study for Buruli ulcer targeting mosquito vectors was proposed for a Buruli ulcer-endemic area of Victoria, Australia. The local community expressed a preference for avoiding widespread residual spraying of pyrethroids. To inform the design of a future cluster randomised control study (cRCT) for Buruli ulcer prevention in Victoria, we conducted a systematic literature review. Aims The aim was to describe cRCT designs which investigated interventions other than non-targeted insecticide for reducing mosquito-borne disease transmission, and comment on the strengths and weaknesses of these study designs. Methods Five medical research databases were searched for eligible literature from the earliest available sources up to 5 July 2019 (Medline, Embase, Web of Science, EBM Reviews, CAB Direct). Reference lists of identified studies were hand searched. Eligible studies were cRCTs using targeted chemical or biological mosquito control interventions, or mosquito breeding source reduction, with the occurrence of mosquito-borne disease as an outcome. Results Eight eligible cRCTs, conducted between 1994–2013 were identified in a variety of settings in the Americas and Asia. Interventions to reduce dengue transmission were mass adult trapping and source reduction. Interventions to reduce malaria transmission were largescale larvicide administration and (topical and spatial) repellent use. Three studies showed the intervention was associated with statistically significant reductions in the disease of interest and entomological indicators. High community engagement with the intervention were common to all three. In two studies, large buffer zones reduced contamination between study arms. Heterogeneity was reduced through increasing study cluster numbers, cluster matching and randomisation. Conclusion High community engagement is vital for a cRCT reducing mosquito-borne disease with a mosquito control intervention. These findings support a mosquito breeding source reduction intervention for Aedes control in a future study of Buruli ulcer prevention if local communities are supportive and very engaged. Regular administration of larvicide to sites unsuited to source reduction may supplement the intervention.

Countries worldwide are experiencing a second wave of coronavirus disease 2019 (COVID-19), which is proving to be difficult to control. We describe the combination of physical distancing, mandatory mask wearing, movement restrictions, and enhanced test, trace, and isolation efforts that can be used to successfully suppress community transmission to zero.

Background: Victoria experienced the greatest burden of COVID-19 in Australia in 2020. This report describes key epidemiological characteristics and corresponding control measures between 17 January 2020 and 26 March 2021. Methods: COVID-19 notifications made to the State Government Department of Health were used in this analysis. Epidemiological features are described over 4 phases, including enhancements to testing, contact tracing and public health interventions. Demographic and clinical features of cases are described. Findings: Victoria recorded 20,483 cases of COVID-19, of which 1073 (5.2%) were acquired overseas and 19,360 (95%) were locally acquired. The initial epidemic (Phase I) was well-contained through public health interventions and was followed by relaxation of restrictions and low-level community transmission (Phase II). However, an outbreak in a hotel used to quarantine returned travellers led to wide-scale community transmission accounting for a majority (91%) of cases (Phase III). Outbreaks occurred in vulnerable settings including aged care and hospitals, contributing to high hospitalisation (12%) and case fatality rates (3.7%). Aggressive restrictions ultimately led to local elimination, and subsequent outbreaks have been swiftly managed with improved processes (Phase IV). The demographic composition of cases evolved across phases from an older, wealthier population to a less advantaged younger population, with many from culturally and linguistically diverse backgrounds. Interpretation: Over time, adaptations to the public health response have strengthened capacity to respond to new cases and outbreaks in a more effective manner. The Victorian experience underscores the importance of authentic engagement with diverse communities and balancing restrictions with livelihoods. (C) 2021 The Authors. Published by Elsevier Ltd.

Medical Journal of AustraliaVolume 216, Issue 4 p. 199-201 Research lettersOpen Access Second SARS-CoV-2 infections twelve months after initial infections in Australia, confirmed by genomic analysis The Victorian SARS-CoV-2 Reinfection Study Group, The Victorian SARS-CoV-2 Reinfection Study GroupCorinna Minko, Filimon Haile, Jessica Gu, Daniel Kidd, Michael Cross, Mohana Baptista (Victorian Department of Health, Melbourne, VIC); Simon Crouch, Anna B Pierce, Rhonda L Stuart (South East Public Health Unit, Monash Health, Melbourne, VIC); Courtney R Lane, Sandra Johnson, Norelle L Sherry, Michelle Sait, Kristy Horan, Susan A Ballard, Mathilda Wilmot, Anne Watt, Christina Crachi, Torsten Seemann, Benjamin P Howden (Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC).Search for more papers by this author The Victorian SARS-CoV-2 Reinfection Study Group, The Victorian SARS-CoV-2 Reinfection Study GroupCorinna Minko, Filimon Haile, Jessica Gu, Daniel Kidd, Michael Cross, Mohana Baptista (Victorian Department of Health, Melbourne, VIC); Simon Crouch, Anna B Pierce, Rhonda L Stuart (South East Public Health Unit, Monash Health, Melbourne, VIC); Courtney R Lane, Sandra Johnson, Norelle L Sherry, Michelle Sait, Kristy Horan, Susan A Ballard, Mathilda Wilmot, Anne Watt, Christina Crachi, Torsten Seemann, Benjamin P Howden (Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC).Search for more papers by this author First published: 22 November 2021 https://doi.org/10.5694/mja2.51352Citations: 1 AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Second infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are thought to affect fewer than 1% of people with resolved coronavirus disease 2019 (COVID-19).1 Reinfections as soon as 26 days after the initial diagnosis have been reported, in some cases with increased disease severity.1, 2 No confirmed cases of second SARS-CoV-2 infections have been reported in Australia, but public awareness of the possibility is needed to encourage continued testing and vaccination. In late July 2021, three people in one Melbourne household were diagnosed with COVID-19. There had been a large COVID-19 outbreak at the workplace of patients 1 and 2, and patient 1 had worked during their acquisition period (ie, the 14 days prior to symptom onset) while infectious co-workers were present. All three patients had also been diagnosed with COVID-19 in July 2020, during a period of high community transmission in Victoria; the source of these earlier infections was unknown. Polymerase chain reaction (PCR) cycle threshold (CT) values were consistent with recent infections in both 2020 and 2021 (Box 1). Box 1. Demographic, sample, and clinical details for three people with second SARS-CoV-2 infections, Victoria, 2021 Patient 2020 infections 2021 infections Number Sex Age group (years)* Symptom onset Sample collection date (CT) Reported symptoms Pangolin lineage Symptom onset Sample collection date (CT) Reported symptoms Pangolin lineage 1 F 20‒29 13 July 21 July (19.67) Mild† D.2 16 July 19 July (27.87) Mild† B.1.617.2 (Delta) 2 M 20‒29 — 21 July (24.00) None D.2 20 July 22 July (18.24) Mild† B.1.617.2 (Delta) 3 M 20‒29 18 July 22 July (NA) Mild† NA 16 July 20 July (29.71) Mild† B.1.617.2 (Delta) CT = polymerase chain reaction cycle threshold (E-gene target, in-house assay); NA = not available; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2. * Age group at initial infection. † Cough, runny nose, sore throat, fatigue, headache. It is required that all Victorian SARS-CoV-2-positive samples be referred to the Microbiological Diagnostic Unit Public Health Laboratory in Melbourne for whole genome sequencing and phylogenetic analysis.3 Sequences were available for the three 2021 infections, and for the 2020 infections of patients 1 and 2 (Supporting Information, table 1). The 2021 sequences were genetically distinct from the 2020 sequences, and were closely related to sequences associated with the workplace of patients 1 and 2 and with other recent sequences (since June 2021) from Victoria and New South Wales in the Communicable Diseases Genomics Network AusTrakka database (https://www.cdgn.org.au/austrakka) (Box 2; Supporting Information, table 2). Box 2. Maximum likelihood phylogenetic tree of SARS-CoV-2 sequences from Australia and New Zealand and for three people with second SARS-CoV-2 infections, Victoria, 2021* SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2. *The phylogenetic tree, prepared using the ggtree package (version 2.4.1) in R 4.0.4, Includes all available sequences from Victoria and all publicly available sequences from other Australian states and New Zealand, to 6 August 2021. Sequences with less than 95% genome coverage are excluded. Highlighted areas indicate sequences identified as variant of concern Delta (red) or D.2 (green) pangolin lineages. Branches containing sequences from patients 1, 2 or 3 are expanded in the insets, and the tree tips are coloured by sequence source. Median pairwise genetic distances are provided in the Supporting Information, table 3. This figure is available in high-resolution at https://github.com/MDU-PHL/COVID19-paper/blob/master/reinfection/Box2_HighResolution.pdf The 2021 sequences were identified as belonging to the SARS-CoV-2 variant of concern Delta (pangolin lineage B.1.617.2), first detected overseas in July 2020 and in Australia in February 2021.4 The 2020 sequences were from the pangolin lineage D.2 (not a variant of concern); they were closely related to other 2020 Victorian sequences in the genomic clade dominant during the Victorian "second wave" of June–October 2020, introduced into Victoria following a hotel quarantine breach in May 2020.3 The phylogenetic data, together with the link with a known COVID-19 outbreak, indicate that the 2021 COVID-19 diagnoses reflected new infections rather than prolonged viral shedding. Serological data were available only for patients 1 and 3 in 2021; both were seropositive for SARS-CoV-2 (Supporting Information, table 2). The three patients had no known immunocompromising conditions and were not eligible for COVID-19 vaccination at the time of either of their infections. Illness severity was similar during both infections; neither respiratory support nor hospitalisation were required. People who have recovered from COVID-19 may be less likely to seek vaccination.5 The occurrence of second infections in Australia, where the incidence of COVID-19 has been relatively low, indicates that doctors should encourage recovered patients to be vaccinated, and that public awareness of the possibility of reinfection should be promoted to encourage vaccination, testing, and protective behaviours. Acknowledgements This investigation was funded by the Victorian Government, and by the National Health and Medical Research Council through the Medical Research Future Fund (MRF9200006). We acknowledge and thank Australian SARS-CoV-2 diagnostic and sequencing laboratories for their contributions to this research. Ethics approval The reported data were collected in accordance with the Victorian Public Health and Wellbeing Act 2008, and the University of Melbourne Human Research Ethics Committee approved the study (study number 1954615.4). The three patients provided written consent for the use of their data in this publication. Data sharing All SARS-CoV-2 sequence data have been uploaded to the Global Initiative on Sharing All Influenza Data (GISAID; https://www.gisaid.org); the sequence numbers are included in the Supporting Information, table 1. Competing interests No relevant disclosures. Supporting Information Filename Description mja251352-sup-0001-Supinfo.pdfPDF document, 471.4 KB Supplementary material mja251352-sup-0002-Supinfo.xlsxapplication/excel, 1.2 MB GISAID accession and associated data for sequences included in phylogenetic analysis Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. References 1Hansen CH, Michlmayr D, Gubbels SM, et al. Assessment of protection against reinfection with SARS-CoV-2 among 4 million PCR-tested individuals in Denmark in 2020: a population-level observational study. Lancet 2021; 397: 1204– 1212. 2Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS-CoV-2: a case study. Lancet Infect Dis 2021; 21: 52– 58. 3Lane CR, Sherry NL, Porter AF, et al. Genomics-informed responses in the elimination of COVID-19 in Victoria, Australia: an observational, genomic epidemiological study. Lancet Public Health 2021; 6: e547– e556. 4Andersson P, Sherry NL, Howden BP. Surveillance for SARS-CoV-2 variants of concern in the Australian context. Medical Journal of Australia 2021; 214: 500– 502.e1. https://www.mja.com.au/journal/2021/214/11/surveillance-sars-cov-2-variants-concern-australian-context 5Hall VJ, Foulkes S, Saei A, et al; SIREN Study Group. COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Lancet 2021; 397: 1725- 1735. Citing Literature Volume216, Issue4March 2022Pages 199-201 ReferencesRelatedInformation

Introduction: While annual influenza vaccination of healthcare workers (HCWs) is recommended, uptake is often suboptimal. We sought to evaluate influenza vaccination uptake by HCWs in Victorian public healthcare facilities, where non-mandatory programs are used. Methods: All participating facilities completed an annual survey (2014-2019) recording HCW influenza vaccination status. Uptake in high-risk departments (emergency and intensive care units) was evaluated for the 2019 season. Results: The proportion of vaccinated HCWs increased annually, from 72.2% (2014) to 87.7% (2019), with pre-set targets generally achieved. In 2019, 110,324 HCWs in 107 facilities were vaccinated (87.7%). Of those without documented vaccination, 7591 (6.0%) declined and 7906 (6.3%) had unknown status. Uptake was higher in high-risk departments (91.4%). Conclusion: Increasing annual influenza vaccination uptake by HCWs in Victorian public healthcare facilities has been achieved in the context of performance monitoring targets. Small proportions declined or had unknown status. Future policies should focus on these HCWs. (C) 2020 Elsevier Ltd. All rights reserved.

Laboratory-confirmed infection with Mycobacterium ulcerans is currently notifiable to health departments in several jurisdictions. Accurate surveillance is imperative to understanding current and emerging areas of endemicity and to facilitate research into a neglected tropical disease with poorly-understood transmission dynamics. The state of Victoria currently reports some of the highest numbers of M. ulcerans cases in the world each year, with 340 cases notified in 2018 (an incidence of 5.5 per 100,000 population). In May 2019, a group of clinical, laboratory and public health experts met to discuss a new case definition for the surveillance of M. ulcerans disease in Victoria, incorporating clinical and epidemiological elements. The new case definition supports important public health messaging and actions for residents and visitors to popular tourist areas in Victoria.

Buruli ulcer (BU) is a destructive soft-tissue infection caused by the environmental pathogen Mycobacterium ulcerans. In response to rising BU notifications in the state of Victoria, Australia, we reviewed all cases that occurred during 2011-2016 to precisely map the time and likely place of M. ulcerans acquisition. We found that 600 cases of BU had been notified; just over half were in residents and the remainder in visitors to defined BU-endemic areas. During the study period, notifications increased almost 3-fold, from 66 in 2013 to 182 in 2016. We identified 4 BU-endemic areas: Bellarine Peninsula, Mornington Peninsula, Frankston region, and the southeastern Bayside suburbs of Melbourne. We observed a decline in cases on the Bellarine Peninsula but a progressive increase elsewhere. Acquisitions peaked in late summer. The appearance of new BU-endemic areas and the decline in established areas probably correlate with changes in the level of local environmental contamination with M. ulcerans.

A previously healthy woman, 22 years of age, presented to her general practitioner (GP) with a small, painless ulcer of 1 cm in diameter on her right ankle, which had developed after she expressed a small pustule at that site a few weeks earlier. She could not recall any preceding trauma or insect bite. She travelled extensively throughout Australia for work, but remained exclusively in urban areas of major cities. Her only other travel of note in the previous year was an overnight holiday on the Mornington peninsula in Victoria four months prior to presentation.

Measurable aspects of child health and wellbeing for children in same-sex parented families show that these children develop well, overall. Increasingly however, it is understood that stigma can have a negative impact on their health within a same sex family context. The aim of this study is to understand how child health in same-sex parented families is constructed by same-sex attracted parents and what this teaches us about the impact of stigma on child health in this context. Families from across Australia were sampled from a larger study of child health and wellbeing. We used family interviews, which took place between January and August 2013. Thematic analysis was used to identify themes. We report on the data from 11 parents with 10 children. Families presented stories of heteronormative conflict that arose from their position in society. Through family constructs, gender assumptions, discrimination and challenging interactions with institutions this heteronormative conflict had a significant influence on child health, sometimes through the generation of broader familial stress. Resilience building was used by parents to construct a positive environment for child health by combating the lack of understanding and discrimination seen at a societal level. Resilience that is developed to combat stigma provides significant benefits, particularly in a heteronormative world where traditional assumptions about families dominate. The anticipation of stigma, and heteronormative pressures, can stimulate same-sex attracted parents to prepare their children for potential negativity. This should be supported through appropriate school programs and considered political leadership.