A 3-month outbreak of invasive group A Streptococcus disease at an eldercare facility, in which 5 persons died, was biphasic. Although targeted chemoprophylaxis contained the initial outbreak, a ...second phase of the outbreak occurred after infection control processes ended. To retrospectively investigate the genomic epidemiology of the biphasic outbreak, we used whole-genome sequencing and multiple bioinformatics approaches. Analysis of isolates from the outbreak and isolates prospectively collected during the outbreak response indicated a single S. pyogenes emm81 clone among residents and staff members. Outbreak isolates differed from nonoutbreak emm81 isolates by harboring an integrative conjugative genomic element that contained the macrolide resistance determinant erm(TR). This study shows how retrospective high-resolution genomic investigations identified rapid spread of a closed-facilty clonal outbreak that was controlled, but not readily cleared, by infection control management procedures.
The Canterbury Health System has invested substantially in its transformation to a patient-centred, integrated system, enabling improved performance despite the significant and long-term impacts of ...the Christchurch earthquakes in 2010 and 2011. Questions have been raised about whether this transformation is sustainable and affordable. We argue that there is a need for a post-disaster health funding strategy that takes into account the challenge of following population movements after a large natural disaster, and higher costs resulting from the disruption and the effect on the population. Such a strategy should also provide stability in an unstable environment. However, funding for health in Canterbury has followed a 'business as usual' model using the population-based funding formula, which we view as problematic. Additionally, increases in funding using that formula have been below the national average, which we believe is perverse. Canterbury has received an additional $84 million government in deficit funding since 2010/11, and this has covered part of the extra cost attributable to the earthquake. However, without system-wide integration and innovation that was underway before, and that has continued since the earthquakes, it is likely the Canterbury Health System would not have been able to meet the health needs of its population. If health funding for Canterbury had continued to increase at the average rate applied across New Zealand over the past five years, deficit funding would not have been required.
To evaluate the performance of the 2013 Canterbury under-18 seasonal influenza vaccination programme (Christchurch, New Zealand).
Routinely collected under 18 influenza vaccination uptake data were ...analysed to determine levels of vaccination uptake and equity of uptake across ethnic groups (NZ European, Maori and Pacific) and by level of deprivation. Qualitative data were collected to identify strategies that helped to achieve high uptake in primary care practices and schools.
Overall uptake of influenza vaccination in 2013 was 32.9%, (compared to 18.5% in 2012), close to the target of 40%. Overall uptake in primary care was higher than in the school-based programme (29.2% versus 19.7%). Maori students had higher uptake than NZ European students in the school-based programme. In primary care, uptake for both Maori and Pacific children was lower than overall uptake and there was a marked gradient in uptake by socioeconomic quintile, with 30.2% uptake in the least deprived quintile compared to 21.9% uptake in the most deprived quintile.
The cumulative effect of 3 years' consistency in offering the under-18 influenza vaccination in primary care practices, assisted by a timely media campaign and additional awareness generated by the school-based programme, has resulted in a marked increase in uptake of the vaccine in primary care in 2013. However, this was not equitably distributed. The school-based programme achieved better equity of uptake by deprivation and ethnicity. The challenge is to achieve both high and equitable uptake.
The city of Christchurch and the wider Canterbury region recently experienced two major destructive earthquakes, the first in September 2010 and the second in February 2011, both followed by ...thousands of aftershocks. Christchurch has an untreated artesian water supply and the earthquakes resulted in major disruption to its wells, reservoirs and water distribution networks. The major wastewater treatment plant was also badly damaged, as were sewerage networks with extensive raw sewage discharges into rivers and the ocean. Ground liquefaction was extensive and created additional hazards with contaminated silt being almost ubiquitous. Despite these hazards and the extent and duration of the disruption to vital public health infrastructure, no outbreaks of gastro-intestinal or respiratory infection occurred in the aftermath of the earthquakes.
This presentation will discuss the microbiological hazards encountered in the immediate post-disaster period and the initial public health response measures taken to reduce disease risk including water testing and chlorination. It will also describe the enhanced surveillance measures instituted to monitor gastrointestinal and respiratory disease and some of the recent research findings about liquefaction. Finally, the presentation will review progress on post-disaster recovery with respect to water and waste services.
Discusses a strategic policy-level health impact assessment (HIA) on the Greater Christchurch Urban Development Strategy (UDS). Describes why a UDS in needed and informs that this is one of the first ...HIAs in NZ that assesses the link between urban design, health determinants and health outcomes at a high level of strategic planning. Considers six key health determinants: air and water quality, housing, transport and social connectedness, along with a second work stream focused on developing an engagement process with local Māori around the UDS. Informs of the values of the HIA trial to participants and makes recommendations for local government. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
The first health impact assessment (HIA) performed on a high level local government policy in New Zealand was undertaken on the Greater Christchurch Urban Development Strategy in 2005. This report ...describes its development and implementation and the results from the process evaluation including some recommendations made in the assessment. We concluded that HIA is a useful tool for local government policy analysts and we recommend it.
Given the highly variable clinical phenotype of Coronavirus disease 2019 (COVID-19), a deeper analysis of the host genetic contribution to severe COVID-19 is important to improve our understanding of ...underlying disease mechanisms. Here, we describe an extended genome-wide association meta-analysis of a well-characterized cohort of 3255 COVID-19 patients with respiratory failure and 12 488 population controls from Italy, Spain, Norway and Germany/Austria, including stratified analyses based on age, sex and disease severity, as well as targeted analyses of chromosome Y haplotypes, the human leukocyte antigen region and the SARS-CoV-2 peptidome. By inversion imputation, we traced a reported association at 17q21.31 to a ~0.9-Mb inversion polymorphism that creates two highly differentiated haplotypes and characterized the potential effects of the inversion in detail. Our data, together with the 5th release of summary statistics from the COVID-19 Host Genetics Initiative including non-Caucasian individuals, also identified a new locus at 19q13.33, including NAPSA, a gene which is expressed primarily in alveolar cells responsible for gas exchange in the lung.
Background
Coronavirus-associated acute respiratory distress syndrome (CARDS) has limited effective therapy to date. NLRP3 inflammasome activation induced by SARS-CoV-2 in COVID-19 contributes to ...cytokine storm.
Methods
This randomised, multinational study enrolled hospitalised patients (18–80 years) with COVID-19-associated pneumonia and impaired respiratory function. Eligible patients were randomised (1:1) via Interactive Response Technology to DFV890 + standard-of-care (SoC) or SoC alone for 14 days. Primary endpoint was APACHE II score at Day 14 or on day-of-discharge (whichever-came-first) with worst-case imputation for death. Other key assessments included clinical status, CRP levels, SARS-CoV-2 detection, other inflammatory markers, in-hospital outcomes, and safety.
Findings
Between May 27, 2020 and December 24, 2020, 143 patients (31 clinical sites, 12 countries) were randomly assigned to DFV890 + SoC (
n
= 71) or SoC alone (
n
= 72). Primary endpoint to establish clinical efficacy of DFV890 vs. SoC, based on combined APACHE II score, was not met; LSM (SE), 8·7 (1.06) vs. 8·6 (1.05);
p
= 0.467. More patients treated with DFV890 vs. SoC showed ≥ 1-level improvement in clinical status (84.3% vs. 73.6% at Day 14), earlier clearance of SARS-CoV-2 (76.4% vs. 57.4% at Day 7), and mechanical ventilation-free survival (85.7% vs. 80.6% through Day 28), and there were fewer fatal events in DFV890 group (8.6% vs. 11.1% through Day 28). DFV890 was well tolerated with no unexpected safety signals.
Interpretation
DFV890 did not meet statistical significance for superiority vs. SoC in primary endpoint of combined APACHE II score at Day 14. However, early SARS-CoV-2 clearance, improved clinical status and in-hospital outcomes, and fewer fatal events occurred with DFV890 vs. SoC, and it may be considered as a protective therapy for CARDS.
Trial registration
ClinicalTrials.gov, NCT04382053.
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