Applied Epidemiology in the Australian Capital Territory

Abstract

In this thesis, I present a body of work that was completed during my Master of Philosophy in Applied Epidemiology (MAE) placement at the Communicable Disease Control Section at the ACT Health Protection Service from March 2014 to November 2015. I discuss my experiences as an MAE scholar and my role in the day-to-day activities of the section, including the surveillance of notifiable diseases and my participation in the response to several acute public health events. I present the findings from an epidemiological study, describing the asbestos exposures of people diagnosed with mesothelioma in the Australian Capital Territory (ACT). I describe and evaluate a surveillance system that I helped establish, which monitors passengers returning from an Ebola-affected country in response to the epidemic in West Africa. An evaluation found that the system was able to assess and monitor returned travellers in a timely manner. I investigated a foodborne outbreak of gastroenteritis at a large function in the ACT. Enterotoxin producing Clostridium perfringens was isolated from a sample of butter chicken consumed at the function. This was consistent with the epidemiological investigation that showed eating the butter chicken was associated with illness. This resulted in the preparation of an article for publication. I present findings from a study that describes trends in pathology testing and test positivity for sexually transmissible infections in the ACT, 2003–2012. There has been a dramatic increase in notification rates for STIs, such as chlamydia and gonorrhoea. Analysis of ACT data show that for the period studied, test positivity was relatively stable. The study demonstrates that it is feasible to utilise pathology testing data to better understand notification-based surveillance data. I presented the findings in an oral presentation at the Communicable Disease Conference 2015 in Brisbane. To demonstrate competencies around peer-led teaching, I prepared a ‘Lesson From the Field’ on choosing the right statistical test and conducted a teaching session for first year MAEs on the appropriate use and interpretation of p-values and confidence intervals. In summary, this thesis describes my experiences in the MAE program, and presents the findings of several epidemiological studies. The work presented in this thesis supported the public health response to a number of high-profile health events and helped to improve our understanding of communicable disease surveillance in the ACT.