Download Medical Officer of Health Report January 2015

Medical Officer of Health Report
January 2015
Ebola
In March last year the World Health Organization (WHO) confirmed an outbreak of Ebola in
Guinea. In August, by which time the outbreak had spread to Sierra Leone, Congo, Nigeria,
and Liberia, WHO declared the outbreak to be a public health emergency of international
concern. As at 14 January this year the WHO confirmed there have been 21,296 reported
cases of Ebola including 8429 deaths.
Guinea, Sierra Leone, and Liberia are still reporting new cases on a weekly basis but the
peak of the epidemic appears to have passed with the number of new cases per week in
each of these countries now being the lowest since August last year. This pleasing
downward trend is the result of significant effort on many fronts including the strengthening
of local health service capacity, the isolation and treatment of cases, the follow-up and
quarantining of the close contacts of cases, safer burial practices, as well as attention to
general infection control strategies in affected villages and in healthcare settings.
A total of 843 health-care workers are known to have been infected with Ebola during the
current outbreak with 500 of them dying from it. Unlike influenza or tuberculosis Ebola does
not spread through the air. Ebola spreads between people via direct contact (through
broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids
of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated
with these fluids. There is not yet any specific curative treatment for Ebola. A range of
options are being evaluated including blood products, immune therapies and drug therapies.
No licensed vaccines are available yet, but two potential vaccines are undergoing human
safety testing.
Back in July the Ministry of Health advised local health services to actively review their
standard operating procedures for dealing with sick travellers arriving in New Zealand.
Aircraft and ship captains were reminded of the requirement to report to border officials if
they have travellers who are experiencing symptoms of concern at the earliest possible
opportunity – in the case of planes ideally at least one hour before landing. Each DHB
confirmed plans for the reception of patients with a history of recent travel to an Ebola
affected country and who had symptoms compatible with Ebola infection. Agreement was
reached that any individual patient suspected of being a possible case of Ebola would be
transferred to one of four tertiary referral hospitals. For Lakes and Bay of Plenty DHBs this
means that following a discussion with the relevant infectious disease specialists such a
patient would be transported by road ambulance to Middlemore Hospital.
No suspected case of Ebola has yet been reported in New Zealand. The likelihood that an
individual would arrive in New Zealand infected with the Ebola virus is very low. Historically,
few people travel in either direction between New Zealand or the affected countries in Africa,
nor are there any direct flights. Probably the highest risk scenario relates to kiwi aid/health
workers returning to New Zealand after volunteering as part of the Ebola response. Such
volunteers are almost always part of a formal programme via organisations such as Red
Cross and Medicins Sans Frontieres. These agencies have developed protocols for the
follow-up of staff immediately after their deployment to an affected country. This will include
the individual concerned reporting to local health agencies upon return to his or her home
country.
The current Ebola outbreak provides a timely prompt about the need to constantly revisit our
response capacity to infectious diseases, including the rare ones. It is also a sage reminder
of our responsibilities living as we do in a global village.
Notifiable Disease Brief
Campylobacteriosis
Campylobacter jejuni is a bacterium found in the gut of birds - wild
birds and domesticated poultry, and also in the gut of animals
such as cattle, sheep, cats, and dogs.
The most common way for humans to become infected is by
consuming raw or undercooked chicken (a particular risk when
using the barbecue), but it can also be caught from contact with
infected animals, drinking contaminated water, or from direct
contact with another person who already has the infection.
The onset of campylobacter illness can be from 1-10 days after
infection and may last for several days. Infection can cause severe abdominal pain,
diarrhoea, fever, and nausea. Approximately one in ten cases is hospitalised. A person
may be infectious for 2-7 weeks. Rare complications include post-infection arthritis and
campylobacter infection has also been associated with Guillain-Barrè syndrome, a rare
neurological disorder.
New Zealand has had an internationally high rate of campylobacter infection since the
disease became notifiable in the 1980s and this peaked in 2006. Research efforts in
sampling animal and environmental sources, along with molecular typing of isolates, resulted
in retail poultry being confirmed as the highest attributable source. Food processing policies,
monitoring, and regulatory changes resulted in a 50% decrease in the number of cases over
the next few years.
Local Case Information
The graph below shows the rate of Campylobacteriosis for the past ten years for the Bay of
Plenty and Lakes (DHB) areas compared with the national rate. The local rates of infection
are very similar to national trends.
Number of Cases per 100, 000
Campylobacter Notification Rates
450
400
350
300
250
200
150
100
50
0
2005
2006
2007
2008
Bay of Plenty DHB
2009
2010
Lakes DHB
2011
2012
2013
2014
New Zealand
The data from the past five years indicate that children under five have the highest rate of
infection compared with other age groups and the majority of notified cases are European
(>80%) with a higher rate for males than females.
Outbreaks
Toi Te Ora has investigated six outbreaks since 2010. The number of cases per outbreak
ranged from two to seven cases. The likely source of infection in three of the six outbreaks
was raw or undercooked chicken livers; two of the six outbreaks involved raw milk
consumption, an increasingly worrying fad.
Risk Factors
Campylobacter
cases
have
a
seasonal profile of a summer peak
and winter trough. Nationally, the
most common risk factors were
contact with farm animals and food
from retail premises (ESR Annual
Report 2013).
A recent analysis of 130 local cases
(September to November 2014)
showed a wide variety of risk factors
including overseas travel, farm
animals, raw chicken exposure,
camping, and notably, raw milk
consumption.
Public Health Response
Health protection officers investigate all cases and outbreaks of Campylobacteriosis infection
in order to ensure that individuals understand the disease and how to minimise risks in
future; this contributes to the national disease surveillance system (ESR and the Ministry of
Health).
Public Health Advice – Key Messages
 Handle raw poultry with care: freeze to minimise risk; cook until juices run clear.
 All cases should remain off school or work until well and without symptoms for 48 hours.
 Ensure that you receive your drinking water from a Council supply; or a private supply
with an appropriate system to protect against bacterial contamination.
 Hand washing is important especially after animal contact and during food preparation.
For Further Information
http://www.ttophs.govt.nz/campylobacter_
https://www.healthed.govt.nz/resource/campylobacter
http://wwwnc.cdc.gov/eid/article/17/6/10-1272_article - Marked Campylobacteriosis Decline
after Interventions Aimed at Poultry, New Zealand
Dr Phil Shoemack
Medical Officer of Health