Applied Epidemiology - within, at the border and outside Australia

My placement was with the Immunisation and the Health Emergency Management branches in the Office of Health Protection at the Australian Government Department of Health during 2017-2018. During this time, I also had the opportunity to also work at the Australian Institute of Health and Welfare (AIHW), the Canberra Hospital and on a deployment to Fiji. I focused on the following five projects during my training. I deployed as an epidemiologist through the World Health Organization Global Outbreak Alert and Response Network mechanism to assist in an international response to an outbreak of multi-resistant Acinetobacter baumannii in the neonatal intensive care unit (NICU) at the Colonial War Memorial Hospital, Suva, Fiji. Review of patient clinical variables identified several plausible risk factors, with the most significant being re-use of single-use respiratory equipment. Transmission was successfully ceased. The mission also included an evaluation of infection control practices at the three major hospitals in Fiji and was presented together with the findings of the outbreak response in a technical report. In the first five months of 2017 the Canberra Hospital experienced its first known outbreak of vancomycin resistant enterococci (VRE) in the NICU. Multivariate analysis identified an association of colonisation with prematurity. Whole genome sequencing showed that the VRE strain was closely related to a highly successful VRE clone endemic to the Canberra Hospital, likely introduced to the NICU from other wards. The study contributed to the growing literature on these emerging VRE strains. As part of a larger Burden of Vaccine Preventable Diseases study (BoVPD) at AIHW, I developed an incidence-based burden of disease model for invasive pneumococcal disease (IPD). A published model from the European Centres for Disease Control and Prevention was adapted to Australian conditions following a systematic literature review. I used data from national Australian databases to inform the model. IPD accounted for the second highest overall burden of all the VPDs in the study and was shown to have a high burden on both on a population and individual level. The surveillance system for yellow fever at the Australian border is designed to identify unvaccinated travellers that may have been exposed to yellow fever and are still within the incubation period. I evaluated he surveillance system using a survey to assess the number of travellers posing a risk of yellow fever introduction, the reasons for not vaccinating, and to inform the transition to an electronic incoming passenger card (eIPC). The system was found to be inefficient due to a high number of false positives. Recommendations how this could be minimised in the eIPC were made. The traveller with illness checklist (TIC) surveillance system is designed to identify individuals that may have a listed human disease. These are some of the most severe diseases and have the potential for pandemic spread. Review of the TICs showed that the data quality, sensitivity and positive predictive value could be improved. It was recommended to transition to an electronic application-based format of the TIC