Communicable Disease Control in New South Wales and globally
Date
2015
Authors
Yapa, Chaturangi Maheshi
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Effective communicable disease control calls for a wide range of
core public health competencies. In fulfilling the requirements
of the Masters of Philosophy in Applied Epidemiology (MAE), I
conducted projects in my placement at Health Protection New South
Wales (NSW) between March 2014 and October 2015 which highlight
some of these competencies.
In May 2014, the Communicable Diseases Branch was notified of
hepatitis E virus (HEV) infection in two men who had not recently
travelled overseas, but had both shared a meal with seven other
work colleagues at a single Sydney restaurant. We conducted an
investigation to assess the source and extent of the outbreak.
We found a further 15 HEV cases linked to the restaurant. Pork
pate was consumed by all 17 diners. Pork livers used to make
pate were traced back to a single Australian farm. This is the
first reported outbreak of locally-acquired HEV in Australia and
has important clinical and public health implications. We
recommend that clinicians consider locally-acquired HEV infection
in patients with unexplained acute hepatitis regardless of travel
history and that the public cook pork products thoroughly.
An outbreak was also the basis for my epidemiological project
which involved a case-control study assessing risk factors for
acquisition of a novel strain of Methicillin-resistant
Staphylococcal aureus (MRSA) in a local health district (LHD) in
NSW. Despite this new strain replacing endemic MRSA strains in
nine hospitals in the LHD, we found no significant differences in
clinical infection, admission to an intensive care unit or
mortality when compared to people infected with endemic strains.
Whole genome sequencing was used to describe transmission
pathways. This modality may play a role in better characterising
MRSA outbreaks in future.
In November 2014, I volunteered to assist in the Ebola virus
disease (EVD) epidemic that affected three countries in West
Africa. I worked in Monrovia, Liberia as a clinician at a
Medecins sans Frontieres Ebola transit centre. At this centre,
we admitted and tested patients with signs and symptoms of EVD.
I analysed clinical and demographic data of patients who
presented to the centre in our first month of opening and found
that almost half did not have a measured temperature greater than
37.5oC. This has important implications for screening procedures
in EVD-affected countries and elsewhere.
Acute Rheumatic Fever (ARF) and its sequelae, Rheumatic Heart
Disease (RHD) are conditions thought to be rare in NSW. With an
aim of improving cardiac outcomes in Aboriginal and Torres Strait
Islander people, NSW Health committed to establishing a
register-based control program for these diseases. In
establishing this program, my work included quantifying the
burden of disease, engaging with stakeholders and designing a
system for notification and registration of cases. Both
conditions were made notifiable in NSW in October 2015.
This thesis documents the investigation of Australia’s first
reported locally-acquired hepatitis E outbreak, the assessment of
a novel strain of MRSA, the establishment of a system for
notification of two important public health conditions in
Australia and the public health response to a global health
emergency. Findings from these projects will contribute to the
body of knowledge and provide important information to guide
public health policy and stimulate ongoing research.
Description
Keywords
Communicable Disease Control, Locally acquired hepatitis E virus outbreak, Ebola outbreak, Epidemiology, Acute Rheumatic Fever, Rheumatic Heart Disease, Methicillin-resistant Staphylococcus aureus, Measles, NSW Health
Citation
Collections
Source
Type
Thesis (MPhil)
Book Title
Entity type
Access Statement
License Rights
Restricted until
Downloads
File
Description