1,2) indicates petechial blood in the region of infarction and parenchymal haematoma (PH 1,2) ind... more 1,2) indicates petechial blood in the region of infarction and parenchymal haematoma (PH 1,2) indicates blood clot with mass effect.
Community outbreak of psittacosis in a rural Australian town
Lancet, 1998
Health authorities in Victoria, Australia were notified of three men from a rural town with atypi... more Health authorities in Victoria, Australia were notified of three men from a rural town with atypical pneumonia, admitted to hospital over 8 days. Initial serological testing suggested Chlamydia psittaci as the cause. We did a case-control study to find risk factors for psittacosis. We searched for cases of pneumonia or severe flu-like illness through family physicians and the regional hospital. We selected three controls per case from the region's electoral roll. We collected blood for serological tests and administered questionnaires to all cases and controls. We found 16 cases of psittacosis and one died. Most cases were clustered within a small geographical area, with a median age of 58 years (range 23-76), 15 (94%) of whom were male. Keeping, handling, or feeding domestic or wild birds was not associated with illness. Cases spent a median of 17.5 h per week in their garden, compared with a median of 5.2 h for controls (p=0.04) and were more likely to have mowed lawns during the 3 weeks before onset of illness than controls (odds ratio 4.81 [95% CI 1.08-33.37]). We showed that psittacosis outbreaks are not limited to direct contact with birds and pose new challenges for disease control. Modifications may be needed to work outdoors to decrease the risk of psittacosis.
Background: Outbreak investigation is a core function of public health agencies. Suboptimal outbr... more Background: Outbreak investigation is a core function of public health agencies. Suboptimal outbreak investigation endangers both public health and agency reputations. While audits of clinical medical and nursing practice are conducted as part of continuous quality improvement, public health agencies rarely make systematic use of structured audits to ensure best practice for outbreak responses, and there is limited guidance or policy to guide outbreak audit.
Campylobacter outbreaks are rarely detected despite Campylobacter being the most common food-born... more Campylobacter outbreaks are rarely detected despite Campylobacter being the most common food-borne illness notified to public health authorities. We report a prolonged outbreak of Campylobacter occurring over a three month period at a training facility. Seventy-eight cases were detected, 16 of which were confirmed Campylobacter infections. In seven affected groups of people using the facility, the attack rate ranged between 19% and 67% . An investigation of one sporting group showed that illness was associated with consumption of cucumber served at a self-serve salad bar. Six people attending the facility in other weeks also reported illness after eating only at the salad bar. Transmission of Campylobacter ceased after changes were instituted to food preparation and storage in the facility kitchen. Comm Dis Intell 1997;21:57-61.
An outbreak of gastrointestinal illness occurred amongst attendees of a conference lunch in the H... more An outbreak of gastrointestinal illness occurred amongst attendees of a conference lunch in the Hunter area, New South Wales, in October 2001. A distinctive symptom reported by many ill persons was the presence of oily diarrhoea. The Hunter Public Health Unit investigated the outbreak by conducting a telephone interview of the cohort of conference attendees using a standard questionnaire. Twenty persons out of 44 attendees (46%) became ill following the conference. The median incubation period was 2.5 hours (range 1-90 hours). The most common symptoms reported were; diarrhoea (80%) -38 per cent of these reported oily diarrhoea; abdominal cramps (50%); nausea (45%); headache (35%) and vomiting (25%). For analyses, a case was defined as a person who developed oily diarrhea, or diarrhoea within 48 hours, or had at least two other symptoms of gastroenteritis within 6 hours, of the conference lunch. Seventeen persons had symptoms that met the case definition. None of the foods or beverages consumed were significantly associated with illness, however, all cases had consumed fish and none of those who did not eat fish (4 persons) became ill. Moreover, only 'fish' or 'potato chips' could explain a significant proportion of the illness. Analysis of the oil composition of the fish consumed was consistent with the known profile of the species marketed as 'escolar'. Among those who consumed fish the following potential risk factors did not have a significant association with the illness: Body Mass Index, age, health status and the amount of fish consumed. We concluded that consumption of fish within the marketing group escolar can cause severe abdominal cramping, nausea and vomiting, in addition to incontinent diarrhoea. Commun Dis Intell 2002;26:441-445.
Campylobacter is a common cause of bacterial gastroenteritis in Australia. Antibiotic resistance ... more Campylobacter is a common cause of bacterial gastroenteritis in Australia. Antibiotic resistance among Campylobacter is an emerging problem in Europe and the United States of America. Monitoring may detect emerging resistance. Since there is no epidemiologically validated subtyping system for Campylobacter, antimicrobial resistance patterns may prove useful as an epidemiological marker. Campylobacter isolates from residents of the Hunter region were differentiated by PCR into two categories: C. jejuni and non-C. jejuni. Minimal inhibitory concentrations (MIC) were determined for 10 antibiotics using the National Committee for Clinical Laboratory Standards (NCCLS) agar dilution methodology. Risk factor information including travel history were obtained as part of a case-control study by conducting telephone interviews with infected individuals. Sixty-four per cent, 3.4 per cent, 3.4 per cent and 11.2 per cent of C. jejuni isolates were resistant to ampicillin (at MIC > 8 mg/L), erythromycin (> 8 mg/L), nalidixic acid (> 32 mg/L) and tetracycline (> 8 mg/L), respectively. A diverse pattern of antibiotic resistance ('resistotypes') was detected with some change occurring over time. Several possible clusters of Campylobacter infections were identified based on resistotype. Of seven infections acquired during overseas travel, 57 per cent (4/7) were resistant to more than one antibiotic class compared to 10 per cent (14/144) of locally-acquired isolates (p=0.004, Fisher exact). The potential usefulness of resistotyping as an epidemiological marker is worthy of further exploration. Commun Dis Intell 2003;27 Suppl:S80-S88.
Australian and New Zealand Journal of Public Health, 1999
Objective: To evaluate the timeliness of Salmonella serotype and phage type notifications in Sout... more Objective: To evaluate the timeliness of Salmonella serotype and phage type notifications in South Australia.Method: We surveyed all notifications of Salmonella to the South Australian Department of Human Services between July 1995 and June 1996 We entered data onto an Epi Info 6.02 database and calculated the time interval between various stages of typing notification.Results: The median time taken between collection of a faecal specimen and receipt of serotype notification was 10 days (range, 5–38), while phage type notification took a further seven days (range 0–40). The time interval between collection of a specimen and notification of a Salmonella final identity was 14 days (range 6–49). The internal mail system of the Department of Human Services delayed notification a median of two days. Environmental Health Officers supplied reports for 224 (58%) of 384 cases, 71% of which occurred before the final Salmonella isolate was known.Conclusions: We found that the internal departmental mail system delayed the notification of Salmonella. In South Australia, investigations should focus on clusters of cases of known Salmonella identity, rather than all notified cases.Implications: To improve communicable disease investigations, health agencies should evaluate the timeliness of surveillance systems and examine the feasibility of transferring laboratory data electronically.
A storm-related disaster in New South Wales, Australia in June 2007 caused infrastructure damage,... more A storm-related disaster in New South Wales, Australia in June 2007 caused infrastructure damage, interrupted essential services, and presented major public health risks. We investigated household disaster preparedness and information sources used before and during the disaster.
Introduction: On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) inf... more Introduction: On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) infection in Hunter New England (HNE), New South Wales (NSW), Australia (population 866,000) was identified. We used local surveillance data to estimate pH1N1-associated disease burden during the first wave of pH1N1 circulation in HNE.
Background The clinical diagnosis of encephalitis is often difficult and identification of a caus... more Background The clinical diagnosis of encephalitis is often difficult and identification of a causative organism is infrequent. The encephalitis syndrome may herald the emergence of novel pathogens with outbreak potential. Individual treatment and an effective public health response rely on identifying a specific pathogen. In Australia there have been no studies to try to improve the identification rate of encephalitis pathogens. This study aims to review the diagnostic assessment of adult suspected encephalitis cases. Methods A retrospective clinical audit was performed, of all adult encephalitis presentations between July 1998 and December 2007 to the three hospitals with adult neurological services in the Hunter New England area, northern New South Wales, Australia. Case notes were examined for evidence of relevant history taking, clinical features, physical examination, laboratory and neuroradiology investigations, and outcomes. Results A total of 74 cases were included in the case series. Amongst suspected encephalitis cases, presenting symptoms and signs included fever (77.0%), headache (62.1%), altered consciousness (63.5%), lethargy (32.4%), seizures (25.7%), focal neurological deficits (31.1%) and photophobia (17.6%). The most common diagnostic laboratory test performed was cerebrospinal fluid (CSF) analysis (n = 67, 91%). Herpes virus polymerase chain reaction (n = 53, 71.6%) and cryptococcal antigen (n = 46, 62.2%) were the antigenic tests most regularly performed on CSF. Neuroradiological procedures employed were computerized tomographic brain scanning (n = 68, 91.9%) and magnetic resonance imaging of the brain (n = 35, 47.3%). Thirty-five patients (47.3%) had electroencephalograms. The treating clinicians suspected a specific causative organism in 14/74 cases (18.9%), of which nine (12.1%) were confirmed by laboratory testing. Conclusions The diagnostic assessment of patients with suspected encephalitis was not standardised. Appropriate assessment is necessary to exclude treatable agents and identify pathogens warranting public health interventions, such as those transmitted by mosquitoes and those that are vaccine preventable. An algorithm and guidelines for the diagnostic workup of encephalitis cases would assist in optimising laboratory testing so that clinical management can be best tailored to the pathogen, and appropriate public health measures implemented.
Encephalitis is a clinical syndrome commonly caused by emerging pathogens, which are not under su... more Encephalitis is a clinical syndrome commonly caused by emerging pathogens, which are not under surveillance in Australia. We reviewed rates of hospitalization for patients with encephalitis in Australia's most populous state, New South Wales, from January 1990 through December 2007. Encephalitis was the primary discharge diagnosis for 5,926 hospital admissions; average annual hospitalization rate was 5.2/100,000 population. The most commonly identified pathogen was herpes simplex virus (n = 763, 12.9%). Toxoplasma encephalitis and subacute sclerosing panencephalitis showed notable declines. The average annual encephalitis case-fatality rate (4.6%) and the proportion of patients hospitalized with encephalitis with no identified pathogen (69.8%, range 61.5%-78.7%) were stable during the study period. The nonnotifiable status of encephalitis in Australia and the high proportion of this disease with no known etiology may conceal emergence of novel pathogens. Unexplained encephalitis should be investigated, and encephalitis hospitalizations should be subject to statutory notification in Australia.
Introduction: On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) inf... more Introduction: On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) infection in Hunter New England (HNE), New South Wales (NSW), Australia (population 866,000) was identified. We used local surveillance data to estimate pH1N1-associated disease burden during the first wave of pH1N1 circulation in HNE.
Health agencies are increasingly conducting systematic reviews of foodborne disease outbreak inve... more Health agencies are increasingly conducting systematic reviews of foodborne disease outbreak investigations to develop strategies to prevent future outbreaks. We surveyed state and territory health departments to summarise the epidemiology of foodborne disease outbreaks in Australia from 1995 to 2000. From 1995 through 2000, 293 outbreaks were identifi ed, with 214 being of foodborne origin. One hundred and seventy-four (81%) had a known aetiology, and accounted for 80 per cent (6,472/8,124) of illnesses. There were 20 deaths attributed to foodborne illness. Of the 214 outbreaks, bacterial disease was responsible for 61 per cent of outbreaks, 64 per cent of cases and 95 per cent of deaths. The most frequent aetiology of outbreaks was Salmonella in 75 (35%) outbreaks, Clostridium perfringens in 30 (14%), ciguatera toxin in 23 (11%), scombrotoxin in 7 (3%) and norovirus in 6 (3%). Salmonellosis was responsible for eight of the 20 (40%) deaths, as was Listeria monocytogenes. Restaurants and commercial caterers were associated with the highest number of outbreak reports and cases. Outbreaks in hospitals and aged care facilities were responsible for 35 per cent of deaths. The most frequently implicated vehicles in the 173 outbreaks with known vehicles were meats 64 (30%), fi sh 34 (16%), seafood 13 (6%), salad 12 (6%), sandwiches 11 (5%) and eggs 9 (4%). Chicken, the most frequently implicated meat, was associated with 27 (13%) outbreaks. This summary demonstrates the serious nature of foodborne disease and supports the move to risk-based food safety interventions focusing on mass catering and hospital and aged care facilities. Commun Dis Intell 2004;28:211-224.
1,2) indicates petechial blood in the region of infarction and parenchymal haematoma (PH 1,2) ind... more 1,2) indicates petechial blood in the region of infarction and parenchymal haematoma (PH 1,2) indicates blood clot with mass effect.
Community outbreak of psittacosis in a rural Australian town
Lancet, 1998
Health authorities in Victoria, Australia were notified of three men from a rural town with atypi... more Health authorities in Victoria, Australia were notified of three men from a rural town with atypical pneumonia, admitted to hospital over 8 days. Initial serological testing suggested Chlamydia psittaci as the cause. We did a case-control study to find risk factors for psittacosis. We searched for cases of pneumonia or severe flu-like illness through family physicians and the regional hospital. We selected three controls per case from the region's electoral roll. We collected blood for serological tests and administered questionnaires to all cases and controls. We found 16 cases of psittacosis and one died. Most cases were clustered within a small geographical area, with a median age of 58 years (range 23-76), 15 (94%) of whom were male. Keeping, handling, or feeding domestic or wild birds was not associated with illness. Cases spent a median of 17.5 h per week in their garden, compared with a median of 5.2 h for controls (p=0.04) and were more likely to have mowed lawns during the 3 weeks before onset of illness than controls (odds ratio 4.81 [95% CI 1.08-33.37]). We showed that psittacosis outbreaks are not limited to direct contact with birds and pose new challenges for disease control. Modifications may be needed to work outdoors to decrease the risk of psittacosis.
Background: Outbreak investigation is a core function of public health agencies. Suboptimal outbr... more Background: Outbreak investigation is a core function of public health agencies. Suboptimal outbreak investigation endangers both public health and agency reputations. While audits of clinical medical and nursing practice are conducted as part of continuous quality improvement, public health agencies rarely make systematic use of structured audits to ensure best practice for outbreak responses, and there is limited guidance or policy to guide outbreak audit.
Campylobacter outbreaks are rarely detected despite Campylobacter being the most common food-born... more Campylobacter outbreaks are rarely detected despite Campylobacter being the most common food-borne illness notified to public health authorities. We report a prolonged outbreak of Campylobacter occurring over a three month period at a training facility. Seventy-eight cases were detected, 16 of which were confirmed Campylobacter infections. In seven affected groups of people using the facility, the attack rate ranged between 19% and 67% . An investigation of one sporting group showed that illness was associated with consumption of cucumber served at a self-serve salad bar. Six people attending the facility in other weeks also reported illness after eating only at the salad bar. Transmission of Campylobacter ceased after changes were instituted to food preparation and storage in the facility kitchen. Comm Dis Intell 1997;21:57-61.
An outbreak of gastrointestinal illness occurred amongst attendees of a conference lunch in the H... more An outbreak of gastrointestinal illness occurred amongst attendees of a conference lunch in the Hunter area, New South Wales, in October 2001. A distinctive symptom reported by many ill persons was the presence of oily diarrhoea. The Hunter Public Health Unit investigated the outbreak by conducting a telephone interview of the cohort of conference attendees using a standard questionnaire. Twenty persons out of 44 attendees (46%) became ill following the conference. The median incubation period was 2.5 hours (range 1-90 hours). The most common symptoms reported were; diarrhoea (80%) -38 per cent of these reported oily diarrhoea; abdominal cramps (50%); nausea (45%); headache (35%) and vomiting (25%). For analyses, a case was defined as a person who developed oily diarrhea, or diarrhoea within 48 hours, or had at least two other symptoms of gastroenteritis within 6 hours, of the conference lunch. Seventeen persons had symptoms that met the case definition. None of the foods or beverages consumed were significantly associated with illness, however, all cases had consumed fish and none of those who did not eat fish (4 persons) became ill. Moreover, only 'fish' or 'potato chips' could explain a significant proportion of the illness. Analysis of the oil composition of the fish consumed was consistent with the known profile of the species marketed as 'escolar'. Among those who consumed fish the following potential risk factors did not have a significant association with the illness: Body Mass Index, age, health status and the amount of fish consumed. We concluded that consumption of fish within the marketing group escolar can cause severe abdominal cramping, nausea and vomiting, in addition to incontinent diarrhoea. Commun Dis Intell 2002;26:441-445.
Campylobacter is a common cause of bacterial gastroenteritis in Australia. Antibiotic resistance ... more Campylobacter is a common cause of bacterial gastroenteritis in Australia. Antibiotic resistance among Campylobacter is an emerging problem in Europe and the United States of America. Monitoring may detect emerging resistance. Since there is no epidemiologically validated subtyping system for Campylobacter, antimicrobial resistance patterns may prove useful as an epidemiological marker. Campylobacter isolates from residents of the Hunter region were differentiated by PCR into two categories: C. jejuni and non-C. jejuni. Minimal inhibitory concentrations (MIC) were determined for 10 antibiotics using the National Committee for Clinical Laboratory Standards (NCCLS) agar dilution methodology. Risk factor information including travel history were obtained as part of a case-control study by conducting telephone interviews with infected individuals. Sixty-four per cent, 3.4 per cent, 3.4 per cent and 11.2 per cent of C. jejuni isolates were resistant to ampicillin (at MIC > 8 mg/L), erythromycin (> 8 mg/L), nalidixic acid (> 32 mg/L) and tetracycline (> 8 mg/L), respectively. A diverse pattern of antibiotic resistance ('resistotypes') was detected with some change occurring over time. Several possible clusters of Campylobacter infections were identified based on resistotype. Of seven infections acquired during overseas travel, 57 per cent (4/7) were resistant to more than one antibiotic class compared to 10 per cent (14/144) of locally-acquired isolates (p=0.004, Fisher exact). The potential usefulness of resistotyping as an epidemiological marker is worthy of further exploration. Commun Dis Intell 2003;27 Suppl:S80-S88.
Australian and New Zealand Journal of Public Health, 1999
Objective: To evaluate the timeliness of Salmonella serotype and phage type notifications in Sout... more Objective: To evaluate the timeliness of Salmonella serotype and phage type notifications in South Australia.Method: We surveyed all notifications of Salmonella to the South Australian Department of Human Services between July 1995 and June 1996 We entered data onto an Epi Info 6.02 database and calculated the time interval between various stages of typing notification.Results: The median time taken between collection of a faecal specimen and receipt of serotype notification was 10 days (range, 5–38), while phage type notification took a further seven days (range 0–40). The time interval between collection of a specimen and notification of a Salmonella final identity was 14 days (range 6–49). The internal mail system of the Department of Human Services delayed notification a median of two days. Environmental Health Officers supplied reports for 224 (58%) of 384 cases, 71% of which occurred before the final Salmonella isolate was known.Conclusions: We found that the internal departmental mail system delayed the notification of Salmonella. In South Australia, investigations should focus on clusters of cases of known Salmonella identity, rather than all notified cases.Implications: To improve communicable disease investigations, health agencies should evaluate the timeliness of surveillance systems and examine the feasibility of transferring laboratory data electronically.
A storm-related disaster in New South Wales, Australia in June 2007 caused infrastructure damage,... more A storm-related disaster in New South Wales, Australia in June 2007 caused infrastructure damage, interrupted essential services, and presented major public health risks. We investigated household disaster preparedness and information sources used before and during the disaster.
Introduction: On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) inf... more Introduction: On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) infection in Hunter New England (HNE), New South Wales (NSW), Australia (population 866,000) was identified. We used local surveillance data to estimate pH1N1-associated disease burden during the first wave of pH1N1 circulation in HNE.
Background The clinical diagnosis of encephalitis is often difficult and identification of a caus... more Background The clinical diagnosis of encephalitis is often difficult and identification of a causative organism is infrequent. The encephalitis syndrome may herald the emergence of novel pathogens with outbreak potential. Individual treatment and an effective public health response rely on identifying a specific pathogen. In Australia there have been no studies to try to improve the identification rate of encephalitis pathogens. This study aims to review the diagnostic assessment of adult suspected encephalitis cases. Methods A retrospective clinical audit was performed, of all adult encephalitis presentations between July 1998 and December 2007 to the three hospitals with adult neurological services in the Hunter New England area, northern New South Wales, Australia. Case notes were examined for evidence of relevant history taking, clinical features, physical examination, laboratory and neuroradiology investigations, and outcomes. Results A total of 74 cases were included in the case series. Amongst suspected encephalitis cases, presenting symptoms and signs included fever (77.0%), headache (62.1%), altered consciousness (63.5%), lethargy (32.4%), seizures (25.7%), focal neurological deficits (31.1%) and photophobia (17.6%). The most common diagnostic laboratory test performed was cerebrospinal fluid (CSF) analysis (n = 67, 91%). Herpes virus polymerase chain reaction (n = 53, 71.6%) and cryptococcal antigen (n = 46, 62.2%) were the antigenic tests most regularly performed on CSF. Neuroradiological procedures employed were computerized tomographic brain scanning (n = 68, 91.9%) and magnetic resonance imaging of the brain (n = 35, 47.3%). Thirty-five patients (47.3%) had electroencephalograms. The treating clinicians suspected a specific causative organism in 14/74 cases (18.9%), of which nine (12.1%) were confirmed by laboratory testing. Conclusions The diagnostic assessment of patients with suspected encephalitis was not standardised. Appropriate assessment is necessary to exclude treatable agents and identify pathogens warranting public health interventions, such as those transmitted by mosquitoes and those that are vaccine preventable. An algorithm and guidelines for the diagnostic workup of encephalitis cases would assist in optimising laboratory testing so that clinical management can be best tailored to the pathogen, and appropriate public health measures implemented.
Encephalitis is a clinical syndrome commonly caused by emerging pathogens, which are not under su... more Encephalitis is a clinical syndrome commonly caused by emerging pathogens, which are not under surveillance in Australia. We reviewed rates of hospitalization for patients with encephalitis in Australia's most populous state, New South Wales, from January 1990 through December 2007. Encephalitis was the primary discharge diagnosis for 5,926 hospital admissions; average annual hospitalization rate was 5.2/100,000 population. The most commonly identified pathogen was herpes simplex virus (n = 763, 12.9%). Toxoplasma encephalitis and subacute sclerosing panencephalitis showed notable declines. The average annual encephalitis case-fatality rate (4.6%) and the proportion of patients hospitalized with encephalitis with no identified pathogen (69.8%, range 61.5%-78.7%) were stable during the study period. The nonnotifiable status of encephalitis in Australia and the high proportion of this disease with no known etiology may conceal emergence of novel pathogens. Unexplained encephalitis should be investigated, and encephalitis hospitalizations should be subject to statutory notification in Australia.
Introduction: On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) inf... more Introduction: On May 26, 2009, the first confirmed case of Pandemic (H1N1) 2009 virus (pH1N1) infection in Hunter New England (HNE), New South Wales (NSW), Australia (population 866,000) was identified. We used local surveillance data to estimate pH1N1-associated disease burden during the first wave of pH1N1 circulation in HNE.
Health agencies are increasingly conducting systematic reviews of foodborne disease outbreak inve... more Health agencies are increasingly conducting systematic reviews of foodborne disease outbreak investigations to develop strategies to prevent future outbreaks. We surveyed state and territory health departments to summarise the epidemiology of foodborne disease outbreaks in Australia from 1995 to 2000. From 1995 through 2000, 293 outbreaks were identifi ed, with 214 being of foodborne origin. One hundred and seventy-four (81%) had a known aetiology, and accounted for 80 per cent (6,472/8,124) of illnesses. There were 20 deaths attributed to foodborne illness. Of the 214 outbreaks, bacterial disease was responsible for 61 per cent of outbreaks, 64 per cent of cases and 95 per cent of deaths. The most frequent aetiology of outbreaks was Salmonella in 75 (35%) outbreaks, Clostridium perfringens in 30 (14%), ciguatera toxin in 23 (11%), scombrotoxin in 7 (3%) and norovirus in 6 (3%). Salmonellosis was responsible for eight of the 20 (40%) deaths, as was Listeria monocytogenes. Restaurants and commercial caterers were associated with the highest number of outbreak reports and cases. Outbreaks in hospitals and aged care facilities were responsible for 35 per cent of deaths. The most frequently implicated vehicles in the 173 outbreaks with known vehicles were meats 64 (30%), fi sh 34 (16%), seafood 13 (6%), salad 12 (6%), sandwiches 11 (5%) and eggs 9 (4%). Chicken, the most frequently implicated meat, was associated with 27 (13%) outbreaks. This summary demonstrates the serious nature of foodborne disease and supports the move to risk-based food safety interventions focusing on mass catering and hospital and aged care facilities. Commun Dis Intell 2004;28:211-224.
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Papers by Craig Dalton