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Morrow RL, Binka M, Li J, Irvine M, Bartlett SR, Wong S, Jeong D, Makuza JD, Wong J, Yu A, Krajden M, Janjua NZ. Impact of the COVID-19 Pandemic on Hepatitis C Treatment Initiation in British Columbia, Canada: An Interrupted Time Series Study. Viruses 2024; 16:655. [PMID: 38793537 PMCID: PMC11125629 DOI: 10.3390/v16050655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024] Open
Abstract
We investigated the impacts of the COVID-19 pandemic on hepatitis C (HCV) treatment initiation, including by birth cohort and injection drug use status, in British Columbia (BC), Canada. Using population data from the BC COVID-19 Cohort, we conducted interrupted time series analyses, estimating changes in HCV treatment initiation following the introduction of pandemic-related policies in March 2020. The study included a pre-policy period (April 2018 to March 2020) and three follow-up periods (April to December 2020, January to December 2021, and January to December 2022). The level of HCV treatment initiation decreased by 26% in April 2020 (rate ratio 0.74, 95% confidence interval [CI] 0.60 to 0.91). Overall, no statistically significant difference in HCV treatment initiation occurred over the 2020 and 2021 post-policy periods, and an increase of 34.4% (95% CI 0.6 to 75.8) occurred in 2022 (equating to 321 additional people initiating treatment), relative to expectation. Decreases in HCV treatment initiation occurred in 2020 for people born between 1965 and 1974 (25.5%) and people who inject drugs (24.5%), relative to expectation. In summary, the pandemic was associated with short-term disruptions in HCV treatment initiation in BC, which were greater for people born 1965 to 1974 and people who inject drugs.
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Affiliation(s)
- Richard L. Morrow
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Julia Li
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
| | - Mike Irvine
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Sofia R. Bartlett
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jean Damascene Makuza
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Naveed Zafar Janjua
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; (R.L.M.); (J.L.); (M.I.); (S.R.B.); (S.W.); (D.J.); (J.D.M.); (J.W.); (A.Y.); (M.K.)
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
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Harney BL, Sacks-Davis R, van Santen DK, Traeger MW, Wilkinson AL, Asselin J, Fairley CK, Roth N, Bloch M, Matthews GV, Donovan B, Guy R, Stoové M, Hellard ME, Doyle JS. Hepatitis C virus reinfection incidence among gay and bisexual men with HIV in Australia from 2016 to 2020. Liver Int 2024; 44:1024-1031. [PMID: 38291946 DOI: 10.1111/liv.15841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND There is some concern that hepatitis C virus (HCV) reinfection might impact HCV micro-elimination efforts among gay and bisexual men (GBM) with HIV. However, there is a limited understanding of reinfection incidence in the context of unrestricted government-funded HCV treatment. We aimed to estimate HCV reinfection incidence among GBM with HIV in Australia from 2016 to 2020. METHODS Data were from 39 clinics participating in ACCESS, a sentinel surveillance network for blood borne viruses and sexually transmissible infections across Australia. GBM with HIV who had evidence of treatment or spontaneous clearance with at least one positive HCV RNA test, a subsequent negative HCV RNA test, and at least one additional HCV RNA test between 1st January 2016 and 31st December 2020 were eligible for inclusion. A new HCV RNA positive test and/or detectable viral load was defined as a reinfection. Generalised linear modelling was used to examine trends in reinfection. RESULTS Among 12 213 GBM with HIV who had at least one HCV test, 540 were included in the reinfection incidence analysis, of whom 38 (7%) had evidence of reinfection during the observation period. Over 1124 person-years of follow-up, the overall rate of reinfection was 3.4/100PY (95% CI 2.5-4.6). HCV reinfection incidence declined on average 30% per calendar year (Incidence Rate Ratio 0.70, 95% CI 0.54-0.91). CONCLUSION HCV reinfection incidence has declined among GBM with HIV in Australia since government-funded unrestricted DAAs were made available. Ongoing HCV RNA testing following cure and prompt treatment for anyone newly diagnosed is warranted to sustain this.
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Affiliation(s)
- Brendan L Harney
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela K van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Anna L Wilkinson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, Victoria, Australia
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
- Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Disease, Alfred Health & Monash University, Melbourne, Victoria, Australia
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O'Keefe D, Jacka D, Douglass C, Gunn J, Stoove M, Crawford S, Bryant M, Higgs P, Dietze P, Hellard M. Distribution of rapid HCV antibody self-test kits via needle/syringe dispensing machines: Implementation and evaluation of the Vend-C pilot study in Melbourne, Australia. J Viral Hepat 2024; 31:151-155. [PMID: 38158743 DOI: 10.1111/jvh.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/14/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
Recent guidance from the World Health Organization strongly recommended hepatitis C virus (HCV) self-testing. We implemented the Vend-C pilot study to explore the effectiveness and feasibility of distributing rapid HCV antibody self-test kits to people who inject drugs via needle/syringe dispensing machines (SDMs). Over a 51-day study period between August and September 2022, we distributed HCV antibody self-test kits via two SDMs. During the study period, 63 self-test kits were dispensed, averaging 1.2 self-test kits per day. Our access methods for evaluation questionnaires failed to attract participants (n = 4). We implemented the Vend-C pilot study in direct response to recent WHO recommendations. While self-test kits were effectively distributed from the two SDMs, our evaluation methodology failed. Consequently, we cannot determine the success of linkage to care. Even so, with HCV treatment numbers dropping in Australia, innovative engagement solutions are needed, and considering the number of self-test kits provided in our pilot, the model could have an important future place in HCV elimination efforts.
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Affiliation(s)
| | - David Jacka
- Monash Health, Dandenong, Victoria, Australia
| | | | - Jack Gunn
- Burnet Institute, Melbourne, Victoria, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Victoria, Australia
| | | | | | - Peter Higgs
- Burnet Institute, Melbourne, Victoria, Australia
| | - Paul Dietze
- Burnet Institute, Melbourne, Victoria, Australia
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Beard N, McGrath M, Scott D, Nehme Z, Lubman DI, Ogeil RP. Using ambulance surveillance data to characterise blood-borne viral infection histories among patients presenting with acute alcohol and other drug-related harms. Emerg Med Australas 2024. [PMID: 38414361 DOI: 10.1111/1742-6723.14394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Preventable transmission of blood-borne viruses (BBV), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV), continue in at-risk populations, including people who use alcohol and drugs (AODs). To our knowledge, no studies have explored the use of ambulance data for surveillance of AOD harms in patients with BBV infections. METHODS We used electronic patient care records from the National Ambulance Surveillance System for people who were attended by an ambulance in Victoria, Australia between July 2015 and July 2016 for AOD-related harms, and with identified history of a BBV infection. Descriptive and geospatial analyses explored the epidemiological and psychosocial characteristics of patients for these attendances. RESULTS The present study included 1832 patients with a history of a BBV infection who required an ambulance for AOD-related harms. Amphetamines were reported in 24.7% of attendances where the patient identified HIV history, and heroin was reported more often for patients with viral hepatitis history (HCV: 19.2%; HBV: 12.7%). Higher proportions of attendances with a viral hepatitis history were observed in patients from the most socially disadvantaged areas. Geospatial analyses revealed higher concentrations of AOD attendances with a BBV history occurring in metropolitan Melbourne. CONCLUSIONS Our study describes the utility of ambulance data to identify a sub-population of patients with a BBV history and complex medical and social characteristics. Repeat attendances of BBV history patients to paramedics could present an opportunity for ongoing surveillance using ambulance data and possible paramedic intervention, with potential linkage to appropriate BBV services.
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Affiliation(s)
- Naomi Beard
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Michael McGrath
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Debbie Scott
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Rowan P Ogeil
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
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van Santen DK, Sacks-Davis R, Stewart A, Boyd A, Young J, van der Valk M, Smit C, Rauch A, Braun DL, Jarrin I, Berenguer J, Lazarus JV, Lacombe K, Requena MB, Wittkop L, Leleux O, Salmon D, Bonnet F, Matthews G, Doyle JS, Spelman T, Klein MB, Prins M, Asselin J, Stoové MA, Hellard M. Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: Findings from a multinational cohort between 2010 and 2019. EClinicalMedicine 2023; 56:101810. [PMID: 36618902 PMCID: PMC9816910 DOI: 10.1016/j.eclinm.2022.101810] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Broad direct-acting antiviral (DAA) access may reduce hepatitis C virus (HCV) incidence through a "treatment as prevention" (TasP) effect. We assessed changes in primary HCV incidence following DAA access among people living with HIV (PLHIV). METHODS We used pooled individual-level data from six cohorts from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). Follow-up started from the first recorded negative HCV antibody test date and ended at last negative antibody test or estimated infection date. Follow-up was restricted to 2010-2019. We used segmented Poisson regression to model trends across pre-, limited- (i.e., restrictions on access) and broad-DAA access periods. FINDINGS Overall, 45,942 participants had at least one HCV antibody negative result and follow-up between 2010 and 2019. We observed 2042 incident HCV infections over 248,189 person-years (PY). Pooled incidence decreased from 0.91 per 100 PY in 2015 to 0.41 per 100 PY in 2019. Compared to the average pre-DAA period incidence (0.90 per 100 PY), average incidence was similar during the limited-DAA access period (Incidence rate ratio [IRR] = 0.98; 95%CI = 0.87, 1.11), and 52% lower during the broad-DAA access period (IRR = 0.48; 95%CI = 0.42, 0.52). The average annual decline in HCV incidence was 2% in the pre-DAA period; an additional 9% annual decline in incidence was observed during the limited-DAA access period (IRR = 0.91; 95%CI = 0.82, 1.00) and a further 20% decline in the broad-DAA access period (IRR = 0.80, 95%CI = 0.73, 0.89). INTERPRETATION Our findings suggest that broad DAA access has a TasP effect on primary HCV incidence among PLHIV. Based on the initial years of DAA availability, the countries in the InCHEHC collaboration are on track to meet the World Health Organization's 80% HCV incidence reduction target for PLHIV by 2030. FUNDING This study was funded by the Australian Government National Health and Medical Research Council (Grant number GNT1132902).
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Affiliation(s)
- Daniela K. van Santen
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author.
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ashleigh Stewart
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Marc van der Valk
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Colette Smit
- Stichting Hiv Monitoring, Amsterdam, the Netherlands
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Inmaculada Jarrin
- Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases. Hospital General Universitario Gregorio Marañón (IsSGM), Madrid, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Karine Lacombe
- Sorbonne Université, IPLESP INSERM UMR-S1136, St Antoine Hospital, APHP, Paris, France
| | | | - Linda Wittkop
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
- INRIA SISTM Team, Talence, France
- CHU de Bordeaux, Service d'information Médicale, INSERM, Institut Bergonié, CIC-EC 1401, F-33000, Bordeaux, France
| | - Olivier Leleux
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France
| | - Fabrice Bonnet
- Univ. Bordeaux, INSERM, Institut Bergonié BPH U1219, CIC-EC 1401, F-33000, Bordeaux, France
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, F-33000, Bordeaux, France
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Tim Spelman
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Marina B. Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jason Asselin
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
| | - Mark A. Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
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