We report the earliest known cluster of SARS-CoV-2 infection so far reported, which occurred in New Zealand in late February 2020. The cluster includes one confirmed and five probable cases. The ...cluster was identified while investigating a weak positive nasopharyngeal swab (NPS) polymerase chain reaction (PCR) test that was returned by a male in his 60s in September 2020. The PCR result, combined with a clear clinical and epidemiological history of a COVID-19 like illness in late February 2020, prompted serological testing. SARS-CoV-2 IgG antibodies were detected and supported historical infection. Serology was also reactive for five close contacts who had also experienced a COVID-19 like illness in February 2020. Combined case histories and investigations suggest that this local cluster was import related, with the index case identified as a family member visiting from Italy in February. Case investigation also suggests this cluster was active in New Zealand prior to any previously documented local cases, indicating that SARS-CoV-2 was present and local transmission was occurring earlier than initially suspected. A weak positive PCR result, six months after acute infection, supports international evidence that SARS-CoV-2 genetic material can be detected for several months after initial COVID-19 infection, and that this is not necessarily indicative of infectivity.
Stringent nonpharmaceutical interventions (NPIs) such as lockdowns and border closures are not currently recommended for pandemic influenza control. New Zealand used these NPIs to eliminate ...coronavirus disease 2019 during its first wave. Using multiple surveillance systems, we observed a parallel and unprecedented reduction of influenza and other respiratory viral infections in 2020. This finding supports the use of these NPIs for controlling pandemic influenza and other severe respiratory viral threats.
Clinicians use urgent virology results to guide decisions on isolation and empiric antiviral treatment, so they focus on timeliness and efficiency. Testing is only one component of patient management ...and is prioritised among many competing demands and interruptions. Manual point of care testing processes, which require inflexible timing steps and exacting data entry, can fail in such a workplace and do not serve the patient well. The pathology department’s role is to provide support on issues of analytical test performance, quality control and reliable data management. We found that traditional laboratory approaches, such as determining a detailed test process, intensive training and formal documentation, were largely ineffective in the emergency department, and this was unacceptable to our accreditation authorities. We then offered the same respiratory syncytial virus (RSV) rapid antigen assay, performed as a stat test in our microbiology department from 09:00 to 23:00h. The testing process, quality assurance and data integrity were straightforward in the laboratory environment and turnaround time was acceptable to the emergency department. The sensitivity of only 60% was perceived as suboptimal by laboratory staff, yet clinicians were pleased with it. High positive predictive value, to direct cohorting and free up single bed rooms, was the clinically important issue.
Behavioural Family Therapy (BFT) is a skills based intervention that aims to support families where a member is experiencing a mental health problem. The Meriden Family Programme has extensive ...experience in supporting families who have complex needs. The programme delivers training in the approach and works with families with the aim of providing information, education and reducing stress within the family environment. Training has recently taken place within various mental health services to equip staff with the skills to work collaboratively with families and to understand and support their needs.
Current assays for anti-Streptolysin O (ASO) and anti-DNAse B are accurate and precise. The Royal College of Pathologists of Australasia (RCPA) serology quality assurance program documents ...interlaboratory coefficient of variation (CV) of 5–10% and good interchangeability of results between methods over the diagnostically informative range. The difficulty is in interpreting the results. At the age of 5, 80% of New Zealand children have detectable ASO and 55% have anti-DNAse B;most of the remainder seroconvert by the age of 10. Population antibody levels decline a little by the age of 15 but most remain seropositive. Sera referred for diagnostic testing at Waikato Hospital, NZ, show lifelong seropositivity, with 93% having detectable ASO and 68% detectable anti-DNAse B beyond the age of 40. The distribution of seropositive antibody levels is unimodal;there is no distinct population with higher levels pathognomonic of recent infection. Published data on temporal decline in levels after acute infection is sparse. Serology cannot be relied upon to diagnose recent infection. Paired sera may demonstrate a recent immunological response, so efforts should be made to obtain a second sample. Interpretive comments on laboratory reports should convey the modest contribution to specificity that serology can offer in the diagnosis of rheumatic fever and post streptococcal glomeruonephritis.
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