From Pomegranates to Polio: A Journey in the Applied Epidemiology of Communicable Diseases in Australia (2018-2019)

Abstract

This thesis presents four projects and additional work I completed to meet the competency requirements of the Master of Philosophy (Applied Epidemiology) program at the Australian National University, from February 2018 to November 2019. During this period I had a field placement within the Communicable Disease Epidemiology and Surveillance Section, Office of Health Protection at the Australian Government Department of Health in Canberra.

I participated in an investigation of a multi-jurisdictional outbreak of hepatitis A virus (HAV) infection in Australia. This investigation's findings, including the results of a case-control study demonstrated that the outbreak was associated with the consumption of imported frozen pomegranate arils. The investigation highlighted the need for reassessment of food safety risks associated with imported, minimally processed frozen fruit products from countries where HAV is considered to be endemic. I also co-authored a manuscript accepted for publication in a peer-reviewed journal.

I evaluated the Australian enhanced hepatitis A surveillance pilot system, which was a two year pilot project aimed at demonstrating the feasibility of incorporating viral genomic data into routine communicable disease surveillance (i.e. enhanced surveillance). Although an unprecedented number of HAV case notifications received during the pilot timeframe affected the system's overall performance, the system nevertheless demonstrated that enhanced surveillance is feasible in Australia. The evaluation's recommendations were aimed at strengthening the system's attributes and supporting continued enhanced hepatitis A surveillance in Australia.

For my epidemiological study, I developed a novel, evidence-based methodology to capture the key components of likelihood and impact that influence poliovirus reintroduction, outbreak and sustained transmission risk. This was the first structured, reproducible and comprehensive poliovirus reintroduction and outbreak risk assessment conducted for Australia, which generated confidence in the country's capacity and capability to manage its polio risk. Future application of the methodology will facilitate completion of rapid risk assessments, generate evidence for targeted investment, and provide a framework to support other countries to evaluate their poliovirus risk. I presented the methodology and results of this study at the inaugural Global Health Security Conference 2019 hosted in Sydney, and at the 10th TEPHINET Global Scientific Conference in Atlanta, USA. I also first-authored and submitted a manuscript for peer-reviewed publication of this work.

My final project involved a retrospective data analysis of multidrug-resistant tuberculosis (MDR-TB) case notifications in Australia from 1999 to 2018. This study was submitted as a manuscript for peer-reviewed publication. This study's findings demonstrated that Australia's MDR-TB burden is comparatively low, and recommended a review of data fields in the national tuberculosis (TB) dataset, with potential expansion or adjustment to improve national data reporting and monitoring of evidence-based recommendations for MDR-TB prevention and management.

I also gained frontline field epidemiology experience as an international consultant during a polio outbreak response in Papua New Guinea (PNG), coordinated a nationally notifiable status assessment for latent tuberculosis infection (LTBI), and taught applied epidemiological approaches and techniques to student peers.

In this thesis, I present my MAE journey, demonstrate my fulfillment of the requirements for the MAE program and the contribution my work has delivered to strengthen communicable disease control in Australia and the wider region. Show more