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Higgs C, Kumar LS, Stevens K, Strachan J, Korman T, Horan K, Daniel D, Russell M, McDevitt CA, Sherry NL, Stinear TP, Howden BP, Gorrie CL. Comparison of contemporary invasive and non-invasive Streptococcus pneumoniae isolates reveals new insights into circulating anti-microbial resistance determinants. Antimicrob Agents Chemother 2023; 67:e0078523. [PMID: 37823632 PMCID: PMC10649040 DOI: 10.1128/aac.00785-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023] Open
Abstract
Streptococcus pneumoniae is a major human pathogen with a high burden of disease. Non-invasive isolates (those found in non-sterile sites) are thought to be a key source of invasive isolates (those found in sterile sites) and a reservoir of anti-microbial resistance (AMR) determinants. Despite this, pneumococcal surveillance has almost exclusively focused on invasive isolates. We aimed to compare contemporaneous invasive and non-invasive isolate populations to understand how they interact and identify differences in AMR gene distribution. We used a combination of whole-genome sequencing and phenotypic anti-microbial susceptibility testing and a data set of invasive (n = 1,288) and non-invasive (n = 186) pneumococcal isolates, collected in Victoria, Australia, between 2018 and 2022. The non-invasive population had increased levels of antibiotic resistance to multiple classes of antibiotics including beta-lactam antibiotics penicillin and ceftriaxone. We identified genomic intersections between the invasive and non-invasive populations and no distinct phylogenetic clustering of the two populations. However, this analysis revealed sub-populations overrepresented in each population. The sub-populations that had high levels of AMR were overrepresented in the non-invasive population. We determined that WamR-Pneumo was the most accurate in silico tool for predicting resistance to the antibiotics tested. This tool was then used to assess the allelic diversity of the penicillin-binding protein genes, which acquire mutations leading to beta-lactam antibiotic resistance, and found that they were highly conserved (≥80% shared) between the two populations. These findings show the potential of non-invasive isolates to serve as reservoirs of AMR determinants.
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Affiliation(s)
- Charlie Higgs
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Lamali Sadeesh Kumar
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kerrie Stevens
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Janet Strachan
- Communicable Diseases Branch, Department of Health, Victoria, Australia
| | - Tony Korman
- Department of Microbiology, Monash Health, Clayton, Victoria, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Diane Daniel
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Madeline Russell
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Christopher A. McDevitt
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Norelle L. Sherry
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Centre for Pathogen Genomics, University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin P. Howden
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Centre for Pathogen Genomics, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire L. Gorrie
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Centre for Pathogen Genomics, University of Melbourne, Melbourne, Victoria, Australia
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Marsland MJ, Strachan J, Gang RF, O'Hara M, Hughes NM, Glynn-Robinson A. Lessons from the re-emergence of imported measles cases following the COVID-19 pandemic in Victoria, Australia. Commun Dis Intell (2018) 2023; 47. [PMID: 37817334 DOI: 10.33321/cdi.2023.47.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Indexed: 10/12/2023]
Abstract
Introduction Australia was declared to have eliminated endemic measles in 2014; however, imported cases continue to pose a threat of outbreaks. International travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic led to a rapid decline in measles cases. The re-opening of the Australian international border to measles endemic regions returns the threat of outbreaks, which may be further compounded by disruptions in routine vaccinations during the COVID-19 pandemic. We consider lessons learned from the public health response to recent measles cases. Methods This case series includes all confirmed measles cases meeting the national case definition reported to the Victorian Government Department of Health (the Department) between 1 January and 31 December 2022. The Department conducted active case finding and contact tracing of all cases in line with national guidelines. Cases were descriptively analysed. Results In 2022, six of the seven measles cases reported in Australia occurred in Victoria, all of whom resided in Australia and acquired their infection overseas. Three cases were unlinked, and three formed an epidemiologically-linked household cluster. One case was partially vaccinated, one was not eligible for vaccination, one had unknown vaccination status, and three were unvaccinated, one of whom was under 12 months old but would have been eligible for vaccination prior to travel to endemic regions. None of the cases led to secondary transmission within Australia. Discussion Following the COVID-19 pandemic, measles importations have re-commenced in Victoria. Although few measles cases occurred in 2022 and none resulted in onwards transmission, imported measles cases remain complex and require substantial public health follow-up. Delays in case diagnosis and flight contact tracing pose a significant risk for outbreaks of measles. Public health interventions are needed to maintain high vaccination rates, improve contact tracing, and ensure public health authorities and healthcare providers can rapidly identify and respond to imported measles cases.
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Affiliation(s)
- Madeleine J Marsland
- Public Health Division, Department of Health, Victoria.;National Centre for Epidemiology & Population Health, Australian National University..
| | | | | | - Miriam O'Hara
- Public Health Division, Department of Health, Victoria
| | | | - Anna Glynn-Robinson
- National Centre for Epidemiology & Population Health, Australian National University
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Marsland MJ, Glynn-Robinson A, Gang RF, Strachan J. The impact of the National Shingles Vaccination Program on the epidemiology of herpes zoster among adults ≥ 60 years in Victoria, Australia. Commun Dis Intell (2018) 2023; 47. [PMID: 37817333 DOI: 10.33321/cdi.2023.47.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Indexed: 10/12/2023]
Abstract
Introduction In November 2016, Australia recommended herpes zoster (HZ) vaccination for adults aged ≥ 60 years and implemented a National Shingles Vaccination Program (NSVP) offering free HZ vaccination to adults aged 70-79 years. This study investigated trends in HZ epidemiology among Victorian adults aged ≥ 60 years and the impact of the NSVP in this population. Methods We conducted epidemiological analyses of routinely collected HZ surveillance data for Victorian adults aged ≥ 60 years who were notified as having a HZ illness or vaccination between 2012 and 2021. Annual incidence rates are presented for vaccinations, case notifications, emergency department presentations, hospitalisations and deaths by five-year age groups. Age-specific incidence rate ratios are calculated comparing the period prior to (1 January 2012 to 31 October 2016) and following (1 November 2016 to 31 December 2021) NSVP implementation. Results HZ vaccination rates were highest among those eligible to receive free vaccination (70-79 years), but appear to have plateaued across all age groups and remained below full coverage. Incidence rate ratios showed a statistically significant increase (p < 0.01) in HZ notifications across all age-groups. Emergency presentations and hospitalisations showed a statistically significant decline (p < 0.05) among the 70-79 year old age groups; however, these rates remained consistent or increased among other age groups for whom vaccination is recommended. Mortality rates declined, particularly among those aged 85+ years. Discussion HZ continues to cause significant disease among the older adult population in Victoria. The findings of this study suggest the NSVP has led to some changes in the epidemiology of HZ among the 70-79 years old age group in Victoria; however, there is less evidence that it has influenced other age groups for whom vaccination is recommended. An evaluation of the NSVP and epidemiology of HZ at a national level is required to identify strategies to improve vaccination coverage among the target populations.
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Affiliation(s)
- Madeleine J Marsland
- Public Health Division, Department of Health, Victoria; National Centre for Epidemiology & Population Health, Australian National University.
| | - Anna Glynn-Robinson
- 2. National Centre for Epidemiology & Population Health, Australian National University
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Pendrey CG, Strachan J, Peck H, Aziz A, Moselen J, Moss R, Rahaman MR, Barr IG, Subbarao K, Sullivan SG. The re-emergence of influenza following the COVID-19 pandemic in Victoria, Australia, 2021 to 2022. Euro Surveill 2023; 28:2300118. [PMID: 37707981 PMCID: PMC10687983 DOI: 10.2807/1560-7917.es.2023.28.37.2300118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/28/2023] [Indexed: 09/16/2023] Open
Abstract
BackgroundCOVID-19 pandemic mitigation measures, including travel restrictions, limited global circulation of influenza viruses. In Australia, travel bans for non-residents and quarantine requirements for returned travellers were eased in November 2021, providing pathways for influenza viruses to be re-introduced.AimWe aimed to describe the epidemiological and virological characteristics of the re-emergence of influenza in Victoria, Australia to inform public health interventions.MethodsFrom 1 November 2021 to 30 April 2022, we conducted an epidemiological study analysing case notification data from the Victorian Department of Health to describe case demographics, interviewed the first 200 cases to establish probable routes of virus reintroduction and examined phylogenetic and antigenic data to understand virus diversity and susceptibility to current vaccines.ResultsOverall, 1,598 notifications and 1,064 positive specimens were analysed. The majority of cases (61.4%) occurred in the 15-34 years age group. Interviews revealed a higher incidence of international travel exposure during the first month of case detections, and high levels of transmission in university residential colleges were associated with return to campus. Influenza A(H3N2) was the predominant subtype, with a single lineage predominating despite multiple importations.ConclusionEnhanced testing for respiratory viruses during the COVID-19 pandemic provided a more complete picture of influenza virus transmission compared with previous seasons. Returned international travellers were important drivers of influenza reemergence, as were young adults, a group whose role has previously been under-recognised in the establishment of seasonal influenza epidemics. Targeting interventions, including vaccination, to these groups could reduce future influenza transmission.
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Affiliation(s)
- Catherine Ga Pendrey
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- Communicable Diseases, Health Protection Branch, Public Health Division, Department of Health, Victoria, Melbourne, Australia
| | - Janet Strachan
- Communicable Diseases, Health Protection Branch, Public Health Division, Department of Health, Victoria, Melbourne, Australia
| | - Heidi Peck
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Ammar Aziz
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jean Moselen
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Rob Moss
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Md Rezanur Rahaman
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Ian G Barr
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Immunology and Microbiology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Kanta Subbarao
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Immunology and Microbiology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Communicable Diseases, Health Protection Branch, Public Health Division, Department of Health, Victoria, Melbourne, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Higgs C, Kumar LS, Stevens K, Strachan J, Sherry NL, Horan K, Zhang J, Stinear TP, Howden BP, Gorrie CL. Population structure, serotype distribution and antibiotic resistance of Streptococcus pneumoniae causing invasive disease in Victoria, Australia. Microb Genom 2023; 9:mgen001070. [PMID: 37471116 PMCID: PMC10438814 DOI: 10.1099/mgen.0.001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
Streptococcus pneumoniae is a major human pathogen and can cause a range of conditions from asymptomatic colonization to invasive pneumococcal disease (IPD). The epidemiology and distribution of IPD-causing serotypes in Australia has undergone large changes following the introduction of the 7-valent pneumococcal conjugate vaccine (PCV) in 2005 and the 13-valent PCV in 2011. In this study, to provide a contemporary understanding of the IPD causing population in Victoria, Australia, we aimed to examine the population structure and prevalence of antimicrobial resistance using whole-genome sequencing and comprehensive antimicrobial susceptibility data of 1288 isolates collected between 2018 and 2022. We observed high diversity among the isolates with 52 serotypes, 203 sequence types (STs) and 70 Global Pneumococcal Sequencing Project Clusters (GPSCs) identified. Serotypes contained in the 13v-PCV represented 35.3 % (n=405) of isolates. Antimicrobial resistance (AMR) to at least one antibiotic was identified in 23.8 % (n=358) of isolates with penicillin resistance the most prevalent (20.3 %, n=261 using meningitis breakpoints and 5.1 % n=65 using oral breakpoints). Of the AMR isolates, 28 % (n=101) were multidrug resistant (MDR) (resistant to three or more drug classes). Vaccination status of cases was determined for a subset of isolates with 34 cases classified as vaccine failure events (fully vaccinated IPD cases of vaccine serotype). However, no phylogenetic association with failure events was observed. Within the highly diverse IPD population, we identified six high-risk sub-populations of public health concern characterized by high prevalence, high rates of AMR and MDR, or serotype inclusion in vaccines. High-risk serotypes included serotypes 3, 19F, 19A, 14, 11A, 15A and serofamily 23. In addition, we present our data validating seroBA for in silico serotyping to facilitate ISO-accreditation of this test in routine use in a public health reference laboratory and have made this data set available. This study provides insights into the population dynamics, highlights non-vaccine serotypes of concern that are highly resistant, and provides a genomic framework for the ongoing surveillance of IPD in Australia which can inform next-generation IPD prevention strategies.
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Affiliation(s)
- Charlie Higgs
- Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Lamali Sadeesh Kumar
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kerrie Stevens
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Norelle L. Sherry
- Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Josh Zhang
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Timothy P. Stinear
- Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Centre for Pathogen Genomics, University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin P. Howden
- Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Centre for Pathogen Genomics, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire L. Gorrie
- Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Centre for Pathogen Genomics, University of Melbourne, Melbourne, Victoria, Australia
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6
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Bhatt P, Strachan J, Easton M, Franklin L, Drewett G. Effect of COVID-19 restrictions and border closures on vaccine preventable diseases in Victoria, Australia, 2020-2021. Commun Dis Intell (2018) 2022; 46. [PMID: 35591751 DOI: 10.33321/cdi.2022.46.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background In 2020, Victoria introduced multiple interventions aimed at containing the spread of coronavirus disease 2019 (COVID-19). We examine the effect of these restrictions on other vaccine preventable diseases (VPDs). Methods We analysed the mandatory reporting data, notified to the Victorian Department of Health, for VPDs from January 2015 to December 2021. Results Reductions in notifications were seen for most notifiable VPDs. A precipitous decline in influenza and measles notifications was recorded in April 2020, which was sustained for both diseases throughout 2020-2021. Notifications for chickenpox, invasive meningococcal disease, invasive pneumococcal disease, and pertussis were reduced by greater than 50% from the 2015-2019 average. No notified cases of diphtheria, poliomyelitis, or rubella were reported in 2020-2021. Conclusion Restrictions placed to mitigate the effects of the COVID-19 pandemic were associated with significant reductions in other VPDs, which were sustained into 2021. Nevertheless, it is important that high levels of population vaccine coverage continue, to prevent a rebound increase in VPDs as restrictions are eased, and to maximise protection against VPDs for all Australians.
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Affiliation(s)
- Paraag Bhatt
- School of Medicine, Monash University, Clayton, Victoria, Australia
| | | | | | | | - George Drewett
- Department of Health, Victoria, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Australia.,Burnet Institute, Victoria, Australia
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Birrell MT, Strachan J, Holmes NE, Stevens K, Howden BP, Franklin LJ, Ivan M, Kwong JC. Clinical manifestations of invasive meningococcal disease in Victoria with the emergence of serogroup W and serogroup Y Neisseria meningitidis. Intern Med J 2021; 51:390-397. [PMID: 32043702 DOI: 10.1111/imj.14771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Historically, Australian cases of invasive meningococcal disease (IMD) have been most frequently caused by Neisseria meningitidis serogroup B, but recently an increase in cases due to serogroup W (MenW) and serogroup Y (MenY) has occurred. AIM To determine whether clinical manifestations of IMD have changed due to increased incidence of MenW and MenY. METHODS We performed a retrospective review of IMD cases notified to the Department of Health and Human Services in Victoria, Australia. We compared the period between January 2013 and June 2015 (defined as P1) immediately before the increase in MenW and MenY was noted, with the equal time period of July 2015 to December 2017 (P2), when this increase was observed. RESULTS IMD was notified more frequently in P2 than P1 (1.24 vs 0.53 per 100 000 person-years, P < 0.001). IMD cases in P2 were older (46 vs 19 years, P < 0.001), and more likely due to MenW (92/187, 49.2% vs 11/80, 13.8%, P < 0.001) or MenY (31/187, 16.6% vs 4/80, 5.0%, P = 0.01). IMD cases from P2 were more likely bacteraemic (151/187, 80.7% vs 55/80, 68.8%, P = 0.04), while meningitis (68/187, 36.4% vs 41/80, 51.3%, P = 0.03) and rash (65/181, 35.9% vs 45/78, 57.7%, P = 0.002) were less frequent. Intensive care unit admission rates and in-hospital mortality were unchanged. CONCLUSION Alongside an increase in IMD in Victoria, the proliferation of cases of MenW and MenY occurred in older patients, and were more often identified through bacteraemia rather than meningitis or purpura fulminans. Clinicians should be aware of these changes to facilitate earlier identification and treatment of IMD.
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Affiliation(s)
- Michael T Birrell
- Victorian Department of Health and Human Services, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Janet Strachan
- Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Kerrie Stevens
- Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia
| | - Lucinda J Franklin
- Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Mihaela Ivan
- Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Jason C Kwong
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia
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8
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Gibney KB, MacLachlan J, Coutts R, Higgins N, Strachan J. Incidence of Invasive Pneumococcal Disease Higher Among People Notified With Markers of Hepatitis C Virus Infection: Population-based Surveillance in Victoria, Australia, 2001-2017. Clin Infect Dis 2021; 72:e319-e325. [PMID: 32750118 DOI: 10.1093/cid/ciaa1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Worse outcomes from invasive pneumococcal disease (IPD) have been reported among those coinfected with hepatitis C. We aimed to establish if IPD notification rates are higher among people notified with markers of hepatitis C virus infection than the general population. METHODS IPD cases notified in Victoria, Australia, from July 2001-December 2017 were linked with hepatitis C cases (diagnosed by serology or PCR testing) notified from January 1991-December 2017. IPD incidence was calculated using population data and the estimated number of Victorians with hepatitis C. RESULTS From July 2001-December 2017, 6407 IPD cases were notified. Hepatitis C infection was notified in 342 (5.3%) of IPD cases overall, and 24.4% among IPD cases aged 45-49 years. Among IPD cases also notified with hepatitis C, 55.3% were infected with 13-valent pneumococcal conjugate vaccine serotypes and 82.8% with 23-valent pneumococcal polysaccharide vaccine serotypes. Compared with IPD cases without hepatitis C, IPD cases also notified with hepatitis C were younger (mean age, 45.7 vs 49.4 years; P = .011) and more often male (65.5% vs 55.5%, P < .001). Annual IPD notification incidence was 6.8/100 000 among people without hepatitis C and 39.4/100 000 among people with hepatitis C (IRR, 5.8; 95% CI, 5.2-6.4; P < .001). CONCLUSIONS IPD notification incidence was 5 times higher among people notified with markers of hepatitis C than the general population. Pneumococcal vaccination should be offered to people with markers of hepatitis C virus infection. To facilitate appropriate treatment, young and middle-aged adults with IPD should be tested for hepatitis C.
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Affiliation(s)
- Katherine B Gibney
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Australia.,The Peter Doherty Institute of Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - Jennifer MacLachlan
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Rachel Coutts
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Australia
| | - Nasra Higgins
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Australia
| | - Janet Strachan
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Australia
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9
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Meder KN, Jayasinghe S, Beard F, Dey A, Kirk M, Cook H, Strachan J, Sintchenko V, Smith H, Giele C, Howden B, Krause V, Mcintyre P. Long-term Impact of Pneumococcal Conjugate Vaccines on Invasive Disease and Pneumonia Hospitalizations in Indigenous and Non-Indigenous Australians. Clin Infect Dis 2021; 70:2607-2615. [PMID: 31388670 DOI: 10.1093/cid/ciz731] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 07/31/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Universal pneumococcal conjugate vaccine (PCV) programs began in Indigenous Australian children in 2001 and all children in 2005, changing to 13-valent PCV (PCV13) in 2011. We used laboratory data for invasive pneumococcal disease (IPD) and coded hospitalizations for noninvasive pneumococcal community-acquired pneumonia (PnCAP) to evaluate long-term impact. METHODS Annual incidence (per 100 000 population) was calculated for age-specific total IPD, PCV13 non-7-valent PCV (PCV7) serotypes, and PnCAP by Indigenous status. Incidence in the pre-universal PCV7 (2002-2004), early PCV7 (2005-2007), pre-PCV13 (2008 to mid-2011), and post-PCV13 (mid-2011 to 2016) periods was used to calculate incidence rate ratios (IRRs). RESULTS In the total population, all-age incidence of IPD declined from 11.8 pre-PCV7 to 7.1 post-PCV13 (IRR, 0.61 [95% confidence interval {CI}, .59-.63]) but for PnCAP declined among ages <1 year (IRR, 0.34 [95% CI, .25-.45]) and 1-4 years (IRR, 0.50 [95% CI, .43-.57]) but increased significantly among age ≥5 years (IRRs, 1.08-1.14). In Indigenous people, baseline PCV13 non-PCV7 IPD incidence was 3-fold higher, amplified by a serotype 1 epidemic in 2011. By 2015-2016, although incidence of IPD and PnCAP in children aged <5 years decreased by 38%, neither decreased in people aged ≥5 years. CONCLUSIONS Fifteen years post-PCV and 5 years post-PCV13, direct and indirect impact on IPD and PnCAP differed by age and between Indigenous and non-Indigenous people, with potential implications for long-term PCV impact in comparable settings.Fifteen years after pneumococcal conjugate vaccine (PCV) introduction and 5 years post-PCV13, direct and indirect impact on invasive pneumococcal disease and pneumococcal community-acquired pneumonia differed by age and between Indigenous and non-Indigenous people, with potential implications for long-term PCV impact in comparable settings.
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Affiliation(s)
- Kelley N Meder
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, Australia.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Martyn Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Heather Cook
- Centre for Disease Control, Northern Territory Department of Health, Darwin, Australia
| | - Janet Strachan
- Communicable Disease Epidemiology and Surveillance, Department of Health and Human Services, Melbourne, Australia
| | - Vitali Sintchenko
- University of Sydney, Sydney, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, The Institute for Clinical Pathology and Medical Research , Westmead Hospital, Sydney, Australia
| | - Helen Smith
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Coopers Plains, Australia
| | - Carolien Giele
- Public Health Division, Department of Health Western Australia, Perth, Australia
| | - Benjamin Howden
- Microbiological Diagnostic Unit, Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Vicki Krause
- Centre for Disease Control, Northern Territory Department of Health, Darwin, Australia
| | - Peter Mcintyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, Australia
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10
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Gibney KB, Attwood LO, Nicholson S, Tran T, Druce J, Healy J, Strachan J, Franklin L, Hall R, Cross GB. Emergence of Attenuated Measles Illness Among IgG-positive/IgM-negative Measles Cases: Victoria, Australia, 2008-2017. Clin Infect Dis 2021; 70:1060-1067. [PMID: 31056637 DOI: 10.1093/cid/ciz363] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Waning measles immunity among vaccinated individuals may result in an attenuated illness. This study compares the epidemiological, clinical, and laboratory profile of measles cases with waning immunity with other measles cases. METHODS Polymerase chain reaction-positive (+) measles cases notified to Victoria's Department of Health and Human Services from 2008 to 2017 with immunoglobulin (Ig) M and IgG tested at diagnosis were classified according to serology at diagnosis: IgG negative (-) (nonimmune), IgM+/IgG+ (indeterminate), or IgM-/IgG+ (waning immunity). RESULTS Between 2008 and 2017, 297 measles cases were notified, of whom 190 (64%) were included; 151 of 190 (79%) were nonimmune at diagnosis, 26 (14%) were indeterminate, and 13 (7%) had waning immunity. Between 2008-2013 and 2014-2017, the proportion of cases with waning immunity increased from 0 of 87 (0%) to 13 of 103 (13%) (P < .001) and the diagnostic sensitivity of initial IgM fell from 93% to 81% (P = .012), respectively. Seven (54%) waning immunity cases reported receiving measles-containing vaccines; 1 case had 2 documented doses. Compared with nonimmune and indeterminate cases, waning immunity cases were more likely to be male; less likely to report fever, coryza, and cough; and had lower burden of virus (higher cycle threshold values). Waning immunity cases had higher IgG titers than indeterminate cases (mean optical density values, 1.96 vs 0.71; P = .004). Onward transmission from 1 waning immunity case was documented. CONCLUSIONS Waning immunity among measles cases, associated with secondary vaccine failure and modified clinical illness, is emerging in Victoria with transmission potential.
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Affiliation(s)
- Katherine B Gibney
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia.,The Peter Doherty Institute for Infection and Immunity, the University of Melbourne and the Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lucy O Attwood
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Julia Healy
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Janet Strachan
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Lucinda Franklin
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Robert Hall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gail B Cross
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Department of Infectious Diseases, National University Hospital, Singapore
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11
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Dixon F, O'Hara R, Ghuman N, Strachan J, Khanna A, Keeler BD. Major colorectal resection is feasible using a new robotic surgical platform: the first report of a case series. Tech Coloproctol 2020; 25:285-289. [PMID: 33156413 PMCID: PMC7645403 DOI: 10.1007/s10151-020-02366-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
Background The number of abdominal procedures performed via a robotic-assisted approach is increasing as potential advantages of the modality are recognised. We report the first in human case series of major colorectal resection performed using a new system, Versius®, and assess the feasibility of its use. Methods The initial cases performed using Versius® at a single centre in the UK were included in the study. Anonymised data were prospectively collected including patient demographics, operative details and postoperative outcomes. Results Twenty-three operations were performed, including left (n = 14) and right (n = 9)-sided colonic resections. Rectal mobilisation was performed in 13. Fifty-seven percent of the patients were male, with a malignant indication for surgery in 70% of cases. Overall mean age was 59.1 ± 15.3 (range 23–89) years. Overall mean body mass index was 28.9 ± 5.2 with a mean of 31.3 ± 4.5 for left-sided resections. The median console operating time was 166 min (range 75–320 min). All malignant cases had negative resection margins and the mean lymph node yield was 18 (SD 9.4). Only one operation (4%) was converted from robotic to open approach. Postoperative length of stay was a median of 5 days (range 3–34 days) and there were no readmissions within 30 days. Conclusions These results compare favourably with the literature on existing robotic systems and also conventional laparoscopic surgery; hence, we believe that this series indicates the Versius® system is feasible for use in major colorectal resection. These early results from a robot-naïve centre show exciting promise for an expanding robotic market and highlight the need for further evaluation.
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Affiliation(s)
- F Dixon
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, MK6 5LD, UK
| | - R O'Hara
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, MK6 5LD, UK
| | - N Ghuman
- Department of Anaesthetics, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - J Strachan
- Department of Anaesthetics, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - A Khanna
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, MK6 5LD, UK
| | - B D Keeler
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, MK6 5LD, UK.
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12
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Bennett N, Sutton B, Strachan J, Hoskins A, Malloy MJ, Worth LJ. Measles immunisation status of healthcare workers in smaller Victorian hospitals: can we do better? Aust N Z J Public Health 2020; 44:346-348. [DOI: 10.1111/1753-6405.12989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/01/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Noleen Bennett
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Doherty Institute for Infection and Immunity Victoria
- Department of Nursing, Melbourne School of Health Sciences The University of Melbourne Victoria
| | - Brett Sutton
- Department of Health and Human Services Victorian State Government
| | - Janet Strachan
- Department of Health and Human Services Victorian State Government
| | - Alex Hoskins
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Doherty Institute for Infection and Immunity Victoria
| | - Michael J. Malloy
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Doherty Institute for Infection and Immunity Victoria
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health The University of Melbourne Victoria
| | - Leon J. Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Doherty Institute for Infection and Immunity Victoria
- Department of Medicine The University of Melbourne Victoria
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13
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Lee RS, Gonçalves da Silva A, Baines SL, Strachan J, Ballard S, Carter GP, Kwong JC, Schultz MB, Bulach DM, Seemann T, Stinear TP, Howden BP. The changing landscape of vancomycin-resistant Enterococcus faecium in Australia: a population-level genomic study. J Antimicrob Chemother 2019; 73:3268-3278. [PMID: 30189014 DOI: 10.1093/jac/dky331] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022] Open
Abstract
Background Vancomycin-resistant Enterococcus faecium (VREfm) represent a major source of nosocomial infection worldwide. In Australia, there has been a recent concerning increase in bacteraemia associated with the vanA genotype, prompting investigation into the genomic epidemiology of VREfm. Methods A population-level study of VREfm (10 November-9 December 2015) was conducted. A total of 321 VREfm isolates (from 286 patients) across Victoria State were collected and sequenced with Illumina NextSeq. SNPs were used to assess relatedness. STs and genes associated with resistance and virulence were identified. The vanA-harbouring plasmid from an isolate from each ST was assembled using long-read data. Illumina reads from remaining isolates were then mapped to these assemblies to identify their probable vanA-harbouring plasmid. Results vanA-VREfm comprised 17.8% of isolates. ST203, ST80 and a pstS(-) clade, ST1421, predominated (30.5%, 30.5% and 37.2%, respectively). Most vanB-VREfm were ST796 (77.7%). vanA-VREfm were more closely related within hospitals versus between them [core SNPs 10 (IQR 1-357) versus 356 (179-416), respectively], suggesting discrete introductions of vanA-VREfm, with subsequent intra-hospital transmission. In contrast, vanB-VREfm had similar core SNP distributions within versus between hospitals, due to widespread dissemination of ST796. Different vanA-harbouring plasmids were found across STs. With the exception of ST78 and ST796, Tn1546 transposons also varied. Phylogenetic analysis revealed Australian strains were often interspersed with those from other countries, suggesting ongoing cross-continental transmission. Conclusions Emerging vanA-VREfm in Australia is polyclonal, indicating repeat introductions of vanA-VREfm into hospitals and subsequent dissemination. The close relationship to global strains reinforces the need for ongoing screening and control of VREfm in Australia and abroad.
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Affiliation(s)
- Robyn S Lee
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia.,Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Level 5, Boston, MA, USA
| | - Anders Gonçalves da Silva
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Sarah L Baines
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Janet Strachan
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Susan Ballard
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Glen P Carter
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Jason C Kwong
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Mark B Schultz
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Dieter M Bulach
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Torsten Seemann
- Melbourne Bioinformatics Group, Lab-14, 700 Swanston Street, Carlton, Victoria, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia.,Infectious Diseases Department, Austin Health, Studley Rd, Heidelberg, Victoria, Australia
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14
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Oliver J, Wilmot M, Strachan J, St George S, Lane CR, Ballard SA, Sait M, Gibney K, Howden BP, Williamson DA. Recent trends in invasive group A Streptococcus disease in Victoria. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Invasive Group A Streptococcus (iGAS) disease can cause permanent disability and death. The incidence of iGAS has increased in many developed countries since the 1980s. iGAS disease is not nationally notifiable in Australia or at the state level in Victoria. The Victorian Hospital Pathogen Surveillance Scheme (VHPSS) is a voluntary laboratory-based surveillance system established in 1988. We assessed the trends and molecular epidemiology of iGAS disease in Victoria from 2007-2017. Methods A case of iGAS was defined as an individual for whom Group A Streptococcus (GAS) was isolated from a normally sterile body site. Data on all iGAS cases, as reported to the VHPSS, between 1 January 2007 and 31 December 2017 were examined. Results A total of 1,311 iGAS cases had associated isolates, and M Protein Gene (emm) typing was performed for 91.6%. The mean annual incidence was 2.1 (95% CI: 1.8-2.5) per 100,000 population per year, increasing 2.7-fold over the study period. In total, 140 different iGAS emm-types were observed, with the ten most prevalent types comprising 63.1% of the sample. Conclusions Despite limitations in this surveillance data, we observed increasing rates of iGAS disease in Victoria. iGAS incidence exceeded the mean annual incidence for invasive meningococcal disease, calculated using Victorian data from the National Notifiable Diseases Surveillance System (2.1 vs. 0.6 cases per 100,000 population per year, respectively). Mandatory case notification could enhance disease control and prevention. Further, the diversity in emm-types emphasises the importance of effective secondary chemoprophylaxis in prevention, alongside GAS vaccine development.
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Affiliation(s)
- Jane Oliver
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000 - Murdoch Children’s Research Institute, Royal Children’s Hospital, 50 Flemington Rd, Parkville, Victoria, Australia, 3052
| | - Mathilda Wilmot
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
| | - Janet Strachan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
| | - Siobhan St George
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
| | - Courtney R Lane
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
| | - Susan A Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
| | - Michelle Sait
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
| | - Katherine Gibney
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000 - The Royal Melbourne Hospital and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria, Australia, 3000
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15
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Williamson DA, Lane CR, Easton M, Valcanis M, Strachan J, Veitch MG, Kirk MD, Howden BP. Increasing Antimicrobial Resistance in Nontyphoidal Salmonella Isolates in Australia from 1979 to 2015. Antimicrob Agents Chemother 2018; 62:e02012-17. [PMID: 29180525 PMCID: PMC5786757 DOI: 10.1128/aac.02012-17] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/13/2017] [Indexed: 12/28/2022] Open
Abstract
Australia has high and increasing rates of salmonellosis. To date, the serovar distribution and associated antimicrobial resistance (AMR) patterns of nontyphoidal Salmonella enterica (NTS) in Australia have not been assessed. Such information provides critical knowledge about AMR in the food chain and informs decisions about public health. We reviewed longitudinal data on NTS in two Australian states over a 37-year period, between 1979 and 2015, and antimicrobial resistance since 1984. Overall, 17% of isolates were nonsusceptible to at least one antimicrobial, 4.9% were nonsusceptible to ciprofloxacin, and 0.6% were nonsusceptible to cefotaxime. In total, 2.5% of isolates were from invasive infections, with no significant difference in AMR profiles between invasive and noninvasive isolates. Most isolates with clinically relevant AMR profiles were associated with travel, particularly to Southeast Asia, with multiple "incursions" of virulent and resistant clones into Australia. Our findings represent the largest longitudinal surveillance system for NTS in Australia and provide valuable public health knowledge on the trends and distribution of AMR in NTS. Ongoing surveillance is critical to identify local emergence of resistant isolates.
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Affiliation(s)
- Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Courtney R Lane
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Marion Easton
- Department of Health and Human Services, Victoria, Australia
| | - Mary Valcanis
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Janet Strachan
- Department of Health and Human Services, Victoria, Australia
| | - Mark G Veitch
- Department of Health and Human Services, Tasmania, Australia
| | | | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia
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16
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Abstract
This text discusses whether senior trainees should endeavour to Join a College Approval Panel as one of the visiting team, what the advantages would be to the trainees being visited of having a senior trainee representative as a member of the assessing group and what the benefits are to senior trainees in terms of training and broadening their own curriculum vitae.
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17
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Staples M, Graham RMA, Hicks V, Strachan J, Gonçalves da Silva A, Peverall J, Wicks V, Jennison AV. Discovery of Streptococcus pneumoniae serogroup 35 variants in Australian patients. Clin Microbiol Infect 2017; 23:476-479. [PMID: 28062316 DOI: 10.1016/j.cmi.2016.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Streptococcus pneumoniae isolates from Australian invasive pneumococcal disease cases displaying an atypical 35B phenotype. Whole genome sequencing was used to analyse these strains and identify changes to the capsule gene regions. METHODS Four atypical serogroup 35 isolates from Australian reference laboratories were unable to be assigned to one of the four known group 35 serotypes by the Quellung serotyping method. Genetic characterization of the capsule locus was performed by bioinformatic analysis of whole genome sequencing data for all isolates. RESULTS Genetic analysis identified four independent disruptions to the wciG gene, which encodes an O-acetyltransferase responsible for the O-acetylation of the 6Galβ1 residue in the capsular polysaccharide repeat unit of serotype 35B. CONCLUSIONS This is the first published report on the incidence and capsular gene characteristics of a S. pneumoniae 35B variant.
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Affiliation(s)
- M Staples
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Coopers Plains, Queensland, Australia.
| | - R M A Graham
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Coopers Plains, Queensland, Australia
| | - V Hicks
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Coopers Plains, Queensland, Australia
| | - J Strachan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - A Gonçalves da Silva
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, The Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - J Peverall
- PathWest Laboratory, Western Australia Department of Health, QEII Medical Centre, Western Australia, Australia
| | - V Wicks
- PathWest Laboratory, Western Australia Department of Health, QEII Medical Centre, Western Australia, Australia
| | - A V Jennison
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Coopers Plains, Queensland, Australia
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18
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Carter GP, Buultjens AH, Ballard SA, Baines SL, Tomita T, Strachan J, Johnson PDR, Ferguson JK, Seemann T, Stinear TP, Howden BP. Emergence of endemic MLST non-typeable vancomycin-resistant Enterococcus faecium. J Antimicrob Chemother 2016; 71:3367-3371. [PMID: 27530751 DOI: 10.1093/jac/dkw314] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/20/2016] [Accepted: 07/08/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Enterococcus faecium is a major nosocomial pathogen causing significant morbidity and mortality worldwide. Assessment of E. faecium using MLST to understand the spread of this organism is an important component of hospital infection control measures. Recent studies, however, suggest that MLST might be inadequate for E. faecium surveillance. OBJECTIVES To use WGS to characterize recently identified vancomycin-resistant E. faecium (VREfm) isolates non-typeable by MLST that appear to be causing a multi-jurisdictional outbreak in Australia. METHODS Illumina NextSeq and Pacific Biosciences SMRT sequencing platforms were used to determine the genome sequences of 66 non-typeable E. faecium (NTEfm) isolates. Phylogenetic and bioinformatics analyses were subsequently performed using a number of in silico tools. RESULTS Sixty-six E. faecium isolates were identified by WGS from multiple health jurisdictions in Australia that could not be typed by MLST due to a missing pstS allele. SMRT sequencing and complete genome assembly revealed a large chromosomal rearrangement in representative strain DMG1500801, which likely facilitated the deletion of the pstS region. Phylogenomic analysis of this population suggests that deletion of pstS within E. faecium has arisen independently on at least three occasions. Importantly, the majority of these isolates displayed a vancomycin-resistant genotype. CONCLUSIONS We have identified NTEfm isolates that appear to be causing a multi-jurisdictional outbreak in Australia. Identification of these isolates has important implications for MLST-based typing activities designed to monitor the spread of VREfm and provides further evidence supporting the use of WGS for hospital surveillance of E. faecium.
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Affiliation(s)
- Glen P Carter
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Andrew H Buultjens
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Susan A Ballard
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Sarah L Baines
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Takehiro Tomita
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Janet Strachan
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Paul D R Johnson
- Infectious Diseases Department, Austin Health, Heidelberg, Victoria 3084, Australia
| | - John K Ferguson
- Hunter New England Health, Pathology North and Universities of Newcastle and New England, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Torsten Seemann
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia
- Victorian Life Sciences Computation Initiative, Carlton, Victoria 3053, Australia
| | - Timothy P Stinear
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Benjamin P Howden
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
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Zarnowiecki D, Wilson A, Bogomolova S, Fielder A, Procter N, O’Dea K, Itsiopoulos C, Strachan J, Ballestrin M, Parletta N. Effectiveness of a Mediterranean diet intervention for improving food intake in people with serious mental illness. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chadwick L, Gentle L, Strachan J, Layfield R. Review: unchained maladie - a reassessment of the role of Ubb(+1) -capped polyubiquitin chains in Alzheimer's disease. Neuropathol Appl Neurobiol 2012; 38:118-31. [PMID: 22082077 DOI: 10.1111/j.1365-2990.2011.01236.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Molecular misreading allows the formation of mutant proteins in the absence of gene mutations. A mechanism has been proposed by which a frameshift mutant of the ubiquitin protein, Ubb(+1) , which accumulates in an age-dependent manner as a result of molecular misreading, contributes to neuropathology in Alzheimer's disease (Lam et al. 2000). Specifically, in the Ubb(+1) -mediated proteasome inhibition hypothesis Ubb(+1) 'caps' unanchored (that is, nonsubstrate linked) polyubiquitin chains, which then act as dominant inhibitors of the 26S proteasome. A review of subsequent literature indicates that this original hypothesis is broadly supported, and offers new insights into the mechanisms accounting for the age-dependent accumulation of Ubb(+1) , and how Ubb(+1) -mediated proteasome inhibition may contribute to Alzheimer's disease. Further, recent studies have highlighted a physiological role for free endogenous unanchored polyubiquitin chains in the direct activation of certain protein kinases. This raises the possibility that Ubb(+1) -capped unanchored polyubiquitin chains could also exert harmful effects through the aberrant activation of tau or other ubiquitin-dependent kinases, neuronal NF-κB activity or NF-κB-mediated neuroinflammatory processes.
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Affiliation(s)
- L Chadwick
- School of Biomedical Sciences, University of Nottingham, UK
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Strachan J. 428 Building a winning team for sports injury prevention. J Sci Med Sport 2005. [DOI: 10.1016/s1440-2440(17)30926-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ibrahim M, de Escobar GM, Visser TJ, Durán S, van Toor H, Strachan J, Williams FLR, Hume R. Iodine deficiency associated with parenteral nutrition in extreme preterm infants. Arch Dis Child Fetal Neonatal Ed 2003; 88:F56-7. [PMID: 12496228 PMCID: PMC1756012 DOI: 10.1136/fn.88.1.f56] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Infants are in negative iodine balance on current standard regimens of total parenteral nutrition, with a mean iodine intake of 3 micro g/kg/day (150 ml/kg/day). The recommended enteral intake of iodine for preterm infants is 30 micro g/kg/day. Gastrointestinal absorption of iodine is high, suggesting that parenteral intakes should approach enteral recommendations.
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Affiliation(s)
- M Ibrahim
- Tayside Institute of Child Health, University of Dundee, Ninewells Hospital and Medical School, Scotland, UK
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Affiliation(s)
- J Strachan
- Department of Biochemical Medicine, Tayside University Hospitals NHS Trust and University of Dundee, UK
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Affiliation(s)
- G Hogg
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia
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Abstract
OBJECTIVE The aim of this study is to examine the frequency and severity of hyponatraemia in a psychogeriatric inpatient population taking selective serotonin re-uptake inhibitors (SSRIs). METHOD Casenotes for 1 year were reviewed and 53 patients with 55 admissions were identified. Eighteen were treated with fluoxetine and 37 with paroxetine. Five (28%) of the patients on fluoxetine and eight (22%) on paroxetine were, or became, hyponatraemic. RESULTS The SSRI was discontinued in two symptomatic patients. Serum sodium returned to normal in nine patients maintained on the SSRI. Two patients maintained on an SSRI remained hyponatraemic but asymptomatic. CONCLUSIONS Hyponatraemia may be a relatively common early asymptomatic side effect of SSRIs, especially in older women. Serum sodium should be measured before commencing an SSRI and monitored during the first month. Any patient who exhibits symptoms of hyponatraemia, or whose depression apparently worsens, while on an SSRI must have their serum sodium measured. Discontinuation of the SSRI may be avoidable if serum sodium levels can be closely monitored.
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Affiliation(s)
- J Strachan
- Department of Psychiatry and Behavioural Science, Auckland University, New Zealand
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McKendry RJ, Wells GA, Dale P, Adam O, Buske L, Strachan J, Flor L. Factors influencing the emigration of physicians from Canada to the United States. CMAJ 1996; 154:171-81. [PMID: 8548706 PMCID: PMC1488117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To determine whether location of postgraduate medical training and other factors are associated with the emigration of physicians from Canada to the United States. DESIGN Case-control study, physicians were surveyed with the use of a questionnaire mailed in May 1994 (with a reminder sent in September 1994), responses to which were accepted until Dec. 31, 1994. PARTICIPANTS Physicians randomly selected from the CMA database, 4000 with addresses in Canada and 4000 with current addresses in the United States and previous addresses in Canada. OUTCOME MEASURES Sex, age, location of undergraduate and postgraduate medical training, qualifications, practice location, opinions concerning residence decisions, current satisfaction and plans. RESULTS The overall response rate was 49.6% (50.0% among physicians in the United States and 49.2% among those in Canada). Age and sex distributions were similar among the 8000 questionnaire recipients and the nearly 4000 respondents. Physicians living in the United States were more likely to be older (mean 53.2 v. 49.6 years of age), male (87% v. 75%) and specialists (79% v. 52%) than those practising in Canada. Postgraduate training in the United States was associated with subsequent emigration (odds ratio 9.2, 95% confidence interval 7.8 to 10.7). However, in rating the importance of nine factors in the decision to emigrate or remain in Canada, there was no significant difference between the two groups in the rating assigned to location of postgraduate training. Professional factors rated most important by most physicians in both groups were professional/clinical autonomy, availability of medical facilities and job availability. Remuneration was considered an equally important factor by those in Canada and in the United States. Six of seven personal/family factors were rated as more important to their choice of practice location by respondents in Canada than by those in the United States. Current satisfaction was significantly higher among respondents in the United States. Most physicians in each group planned to continue practising at their current location. Of Canadian respondents, 22% indicated that they were more likely to move to the United States than they were a year beforehand, whereas 4% of US respondents indicated that they were more likely to return to Canada. CONCLUSIONS Factors affecting the decision to move to the United States or remain in Canada can be categorized as "push" factors (e.g., government involvement) and "pull" factors (e.g., better geographic climate in the US). Factors can also be categorized by whether they are amenable to change (e.g., availability of medical facilities) or cannot be managed (e.g., proximity of relatives). An understanding of the reasons why physicians immigrate to the United States or remain in Canada is essential to planning physician resources nationally.
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Abstract
Rapid population growth has put family planning on personal and political agendas in the Solomon Islands. With the release of a population policy in 1988, national leaders sanctioned the concept of family planning as a key strategy in reducing the rate of population growth. On a personal level, Solomon Islanders share their government's concern about population problems. There is a shortage of arable land, health services are stretched, and there are limited places in school for children. A study in Choiseul Province, a rural area in Solomon Islands, suggests that people want smaller families but have limited means to control their fertility. Meagre resources and infrastructure, compounded by geography, climate, culture and religion, constrain the development of family planning services.
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Affiliation(s)
- D Rowling
- Tropical Health Program, University of Queensland, Brisbane
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Strachan J, Fleming L, Dick J, Henderson I, Fraser C, Jones M, McGregor E. Poor response to erythropoietin. BMJ 1995; 311:633. [PMID: 7663282 PMCID: PMC2550691 DOI: 10.1136/bmj.311.7005.633a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Quin JD, Miell JP, Smith K, Gordon D, Strachan J, Dick JB, MacCuish AC. Effect of insulin-like growth factor-I therapy on erythropoetin concentrations in extreme insulin resistance. Diabetologia 1994; 37:439. [PMID: 8063048 DOI: 10.1007/bf00408484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Adamson AS, Strachan J, Witherow RO. Carcinoma of the prostate presenting as impotence. Br J Urol 1991; 68:320. [PMID: 1913076 DOI: 10.1111/j.1464-410x.1991.tb15332.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A S Adamson
- Department of Urology, St Mary's Hospital, London
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Strachan J. The change-loss connection in counselling. Can J Psychiatr Nurs 1979; 20:6-8. [PMID: 253598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hewett CL, Gilbert IM, Redpath J, Savage DS, Strachan J, Sleigh T, Taylor R. 18-Norandrosta-8,11,13-trienes. II. Aromatisation of 18-norandrost-13-enes by bromination and dehydrobromination. J Chem Soc Perkin 1 1974; 8:897-903. [PMID: 4859589 DOI: 10.1039/p19740000897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Friedman JH, Strachan J. A self-insured free policy for geriatric mental health. J Am Geriatr Soc 1972; 20:490-6. [PMID: 5078083 DOI: 10.1111/j.1532-5415.1972.tb02146.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Ritter GJ, Fleck LC, Benesch E, Adanti G, Moll F, Votoček E, Dickson W, Prussia L, Wasicky R, Strachan J, Hughes E, Schleicher A, Rössler B, Kolthoff JM, Porst CEG, Crown HA. Zellstoff, Holz, Papier. Anal Bioanal Chem 1925. [DOI: 10.1007/bf01380445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Strachan J. THE MEDICAL SUPERVISION OF SCHOOLS. West J Med 1907. [DOI: 10.1136/bmj.1.2414.841-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Strachan J. The Causation of Insanity. West J Med 1904. [DOI: 10.1136/bmj.2.2294.1666-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Strachan J. THE FOOD AND OTHER FACTORS IN EDUCATION. West J Med 1903. [DOI: 10.1136/bmj.2.2235.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Strachan J. THE FOOD FACTOR IN EDUCATION. West J Med 1903. [DOI: 10.1136/bmj.2.2230.776-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Strachan J. Case of Pernicious Anaemia Successfully Treated with Arsenic. West J Med 1888; 2:982-4. [DOI: 10.1136/bmj.2.1453.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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