Antimicrobial resistance and sexually transmissible infections: the hunt for evidence to inform national policy

Abstract

This thesis consists of work undertaken for the Master of Philosophy (Applied Epidemiology) (MAE) while completing a placement within the Communicable Disease, Epidemiology and Surveillance Section of the Australian Government Department of Health and Aged Care. It describes four projects undertaken to meet MAE competencies and additional work I undertook as part of the placement. I present the first analysis of gonococcal antimicrobial sensitivity data collected on the National Notifiable Diseases Surveillance System in Australia. It describes gonorrhoea resistance to seven antimicrobials and determines risk factors for resistance to first line antibiotics for the treatment of gonorrhoea in Australia. My epidemiological project consists of a mixed methods study investigating the reasons for inadequate treatment of syphilis in pregnancy in Australia. Presented are a descriptive analysis, case control study and a qualitative review of documents describing the clinical and public health management of congenital syphilis cases. Equitable access to antenatal care was found to be vitally important if elimination of congenital syphilis is to become a reality in Australia. Using the United States Centre for Disease Control and Prevention's Guidelines for Evaluating Public Health Surveillance Systems I conducted an evaluation of CARAlert, the national alert system for critical antimicrobial resistances. I found the system was simple, stable and flexible; however, there were concerns related to overall utility due to timeliness, data depth, sensitivity and representativeness. I recommended the purpose of CARAlert be reviewed and then made recommendations to improve timeliness, data depth, sensitivity and representativeness based on its intended aims and objectives. In November 2022, there was an outbreak of acute gastrointestinal illness associated with a single caterer who supplied food to several events in the Canberra region over three days. The outbreak was confirmed to be caused by foodborne norovirus. I undertook retrospective cohort studies on two days to identify risk factors for illness and found that foods associated with illness and foods prepared by an asymptomatic food handler with a recently ill child were similar. As part of the placement, I was also involved in the Mpox outbreak that commenced in May 2022 in Australia. I contributed to the drafting of the Series of National Guidelines (SoNG) for Mpox and was the technical writer for the permanent listing of Mpox on the National Notifiable Diseases List. I present this material as an additional thesis chapter. Finally, I describe and reflect on two teaching activities undertaken to meet course requirements. Show more