Medicine (RMH) - Research Publications

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Author: Hellard, Margaret × Author: McBryde, Emma × Author: Spelman, Timothy × End date: 2020 ×

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    Intrahousehold Transmission of Pandemic (H1N1) 2009 Virus, Victoria, Australia
    van Gemert, C ; Hellard, M ; McBryde, ES ; Fielding, J ; Spelman, T ; Higgins, N ; Lester, R ; Vally, H ; Bergeri, I (CENTERS DISEASE CONTROL & PREVENTION, 2011-09)
    To examine intrahousehold secondary transmission of pandemic (H1N1) 2009 virus in households in Victoria, Australia, we conducted a retrospective cross-sectional study in late 2009. We randomly selected case-patients reported during May-June 2009 and their household contacts. Information collected included household characteristics, use of prevention and control measures, and signs and symptoms. Secondary cases were defined as influenza-like illness in household contacts within the specified period. Secondary transmission was identified for 18 of 122 susceptible household contacts. To identify independent predictors of secondary transmission, we developed a model. Risk factors were concurrent quarantine with the household index case-patient, and a protective factor was antiviral prophylaxis. These findings show that timely provision of antiviral prophylaxis to household contacts, particularly when household members are concurrently quarantined during implementation of pandemic management strategies, delays or contains community transmission of pandemic (H1N1) 2009 virus.
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    Description of social contacts among student cases of pandemic influenza during the containment phase, Melbourne, Australia, 2009
    van Gemert, C ; McBryde, ES ; Bergeri, I ; Sacks-Davis, R ; Vally, H ; Spelman, T ; Sutton, B ; Hellard, M (WORLD HEALTH ORGANIZATION, REGIONAL OFFICE WESTERN PACIFIC, 2018)
    INTRODUCTION: Students comprised the majority of early cases of influenza A(H1N1)pdm09 in Melbourne, Australia. Students and school settings were targeted for public health interventions following the emergence of pH1N1. This study was conducted to describe changes in social contacts among the earliest confirmed student cases of pH1N1 in Melbourne, Australia, to inform future pandemic control policy and explore transmission model assumptions. METHODS: A retrospective cross-sectional behavioural study of student cases with laboratory-confirmed pH1N1 between 28 April and 3 June 2009 was conducted in 2009. Demographics, symptom onset dates and detailed information on regular and additional extracurricular activities were collected. Summary measures for activities were calculated, including median group size and median number of close contacts and attendance during the students' exposure and infectious periods or during school closures. A multivariable model was used to assess associations between rates of participation in extracurricular activities and both school closures and students' infectious periods. RESULTS: Among 162 eligible cases, 99 students participated. Students reported social contact in both curricular and extra-curricular activities. Group size and total number of close contacts varied. While participation in activities decreased during the students' infectious periods and during school closures, social contact was common during periods when isolation was advised and during school closures. DISCUSSION: This study demonstrates the potential central role of young people in pandemic disease transmission given the level of non-adherence to prevention and control measures. These finding have public health implications for both informing modelling estimates of future pandemics and targeting prevention and control strategies to young people.
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    A 'test and treat' prevention strategy in Australia requires innovative HIV testing models: a cohort study of repeat testing among 'high-risk' men who have sex with men
    Wilkinson, AL ; El-Hayek, C ; Spelman, T ; Fairley, CK ; Leslie, D ; McBryde, ES ; Hellard, M ; Stoove, M (BMJ PUBLISHING GROUP, 2016-09)
    OBJECTIVES: HIV diagnoses among men who have sex with men (MSM) in several high-income countries, including Australia, have increased substantially over recent years. Australia, in line with global prevention strategies, has emphasised a 'test and treat' HIV prevention strategy which relies on timely detection of HIV through frequent testing by those at risk. We examined trends in repeat testing among MSM defined as 'high-risk' according to Australian testing guidelines. METHODS: HIV test records from MSM attending high caseload clinics in Melbourne 2007-2013 and classified as high-risk were analysed. Binary outcomes of 'test within 3 months' and 'test within 6 months' were assigned to tests within individuals' panel of records. Negative binomial regressions assessed trends in overall HIV testing and returning within 3 and 6 months. Annualised proportions of return tests (2007-2012) were compared using two-sample z tests. RESULTS: Across 18 538 tests among 7117 high-risk MSM attending primary care clinics in Melbourne (2007-2013), the number of annual HIV tests increased (p<0.01). Between 2007 and 2012 annualised proportions of tests with a subsequent test within 3 and 6 months also increased (p<0.01); however, by 2012 only 36.4% and 15.1% of tests were followed by another test inside 6 and 3 months, respectively. CONCLUSIONS: Repeat testing among high-risk MSM in Australia remains unacceptably low, with recent modest increases in testing unlikely to deliver meaningful prevention impact. Removing known barriers to HIV testing is needed to maximise the potential benefit of test and treat-based HIV prevention.