Island Dreaming: Applied Epidemiology in the Pacific Region
Date
2017
Authors
Sheel, Meru
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Abstract
This bound volume describes four significant public health
problems in Australia and the Pacific Island Countries of Fiji
and American Samoa. The four main epidemiological components
are:
1) Australian vaccine preventable disease epidemiological review
series: varicella-zoster virus infections, 1998–2015. The
review was conducted to assess the impact of the national
varicella immunisation program and provide a baseline for
monitoring the impact of the national herpes zoster immunisation
program. The national varicella immunisation program led to
significant reductions in varicella. In Australia, the burden of
herpes zoster is substantial, and high quality and timely
surveillance will be crucial to assess the impact of the national
herpes zoster immunisation program.
2) Investigation into increased lymphogranuloma venereum (LGV) in
New South Wales, Australia. LGV is a sexually transmitted
infection (STI) caused by L1-L3 serovars of chlamydia, and can
lead to irreversible complications. LGV is notifiable condition
in New South Wales (NSW). Following a noticeable increase in
number of LGV notifications, I conducted a retrospective case
series of all cases diagnosed between 1 January 2016 and 31 March
2017. During this period, all reported cases were among men who
have sex with men. This chapter examines factors contributing to
increase in LGV cases in NSW in 2016. It also describes the
challenges associated with investigating STI outbreaks in NSW.
3) An evaluation of an early warning alert and response system
(EWARS in a Box) implemented after Cyclone Winston, Fiji 2016.
The World Health Organization recommends implementation of early
warning systems for timely disease surveillance and early
detection of outbreaks during humanitarian emergencies. This
chapter describes the EWARS system, and its usefulness at timely
monitoring of communicable diseases trends during a national
health emergency. Findings include strengths and limitations of
the system at conducting surveillance, along with practical
recommendations for improving surveillance using EWARS.
4) Identifying residual transmission of lymphatic filariasis in
post-mass drug administration surveillance phase: Comparing
school-based versus community-based surveys – American Samoa,
2016. This study compares the effectiveness of two
cross-sectional survey designs, a school-based and a
community-based survey, for assessing transmission of lymphatic
filariasis. Under the Global Programme for Elimination of
Lymphatic Filariasis, American Samoa conducted seven rounds of
mass drug administration (MDA) from 2000-2006. The World Health
Organization recommends systematic post-MDA surveillance for
epidemiological assessment of recent lymphatic filariasis
transmission. Finger prick blood samples were collected from
study participants to measure the prevalence of circulating
filarial antigen (CFA). I recruited 1143 grade 1 and 2 school
students from 29 elementary schools. For the community survey, 30
out of 70 villages were randomly selected, from which 2507
community members were recruited. The school survey was cheaper
and logistically easier to implement. The estimated CFA
prevalence by school survey was 0.7%, and was significantly lower
than the community survey (6.2%). The community survey was more
effective for collecting information required for identifying
residual transmission of lymphatic filariasis. Both surveys
provided evidence of ongoing lymphatic filariasis transmission in
American Samoa.
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Epidemiology, Immunisation, Varicella, Herpes zoster, Surveillance, Survey, Filariasis, Lymphogranuloma Venereum, Global health
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