Island Dreaming: Applied Epidemiology in the Pacific Region

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.