Applied Epidemiology in the ACT

Abstract

This thesis presents four projects along with additional public health experience to meet the competency requirements of the Master of Philosophy in Applied Epidemiology, undertaken at ACT Health in Canberra, working in the Communicable Disease Control section from February 2018 to December 2019. I undertook a cohort study following a cluster of gastrointestinal illness after a restaurant dinner. Bacillus cereus was identified as the likely cause. We identified inadequate hygiene practices and undocumented heating and cooling procedures which were rectified following our investigations. I presented this outbreak to the National Centre for Epidemiology and Population Health and to OzFoodNet at a face-to-face meeting. This outbreak was also published in the Communicable Disease Intelligence Journal in September, 2019. My data analysis project involved a descriptive review of 2009-2018 gonococcal notifications and antibiotic susceptibility test results. This study found that although notification rates have increased 5-fold since 2009, antibiotic resistance has not increased in the ACT. A key finding was a considerable difference in the proportion of notifications receiving a test of culture between sexual health specialists and GPs. I recommended ongoing education of GPs, particularly because heterosexual females have seen the largest rate rise in notifications since 2014 and they are primarily seen by GPs rather than sexual health specialists. This project was presented orally at the PHAA CDCC conference in Canberra in November 2019. For my epidemiological study I designed and implemented a 12-month study to estimate antenatal pertussis and influenza vaccination uptake in the ACT, and to describe key determinants of uptake. In my chapter I present an analysis of the first 6-months of study data. We found the highest self-reported uptake of antenatal vaccination currently reported in the Australian literature, 95% for pertussis and 74% for influenza. We found that those earning more are more likely to receive influenza vaccines and receive it for free in their workplace. I recommend addressing this access and affordability issue. This study was presented orally at the New Zealand Immunisation conference in September 2019 and as a poster presentation at the PHAA CDCC conference in Canberra in November 2019. My surveillance project involved developing a surveillance and response plan to control and manage the threat of antimicrobial resistance of N. gonorrhoea and shigella. Recommendations were made including: what data should be collected, how to capture the data using a new database system (REDCap), response guidelines upon identification of a multi-drug resistant case, and routine reporting. I also gained significant public health experience in contributing to the public health response for a number of small foodborne outbreaks, as well as measles, hepatitis A, typhoid and many Salmonella and Campylobacter investigations. This thesis presents my experiences and documents my competency to fulfil the requirements of the MAE and my contribution to frontline communicable disease control in the ACT and Australia. Show more