Communicable Diseases Epidemiology

In March 2017 I commenced the Master of Applied Epidemiology program, hosted in the Communicable Diseases Branch at Health Protection New South Wales (NSW). Presented in this bound volume are four research projects: an epidemiological study, data analysis study, outbreak response, and an evaluation of a public health surveillance system. I was also heavily involved in routine public health work including on-call, outbreak investigations and follow-up of laboratory notifications. The epidemiological study was an audit that estimated true immunisation coverage of NSW children at one year of age on the Australian Immunisation Register (AIR), and explored reasons associated with under-reporting. Our estimate of true coverage was 96.2% with a 95% Confidence Interval 95.9%-96.4%; 2.1% higher than AIR reported coverage of 94.1%. The under-reporting was mainly due to data errors at the provider level and duplicate records. Included is a peer-reviewed article that I wrote and published on the subject in the Australian and New Zealand Journal of Public Health. The data analysis project investigated the over-representation of Aboriginal people diagnosed with Q fever in NSW, particularly in Western NSW. Following indirect standardisation, we found that Aboriginal people across Western NSW were notified with Q fever almost 35% more often as non-Indigenous people living in the same area. Aboriginal people reported working in occupations such as shearing at a much younger age than non-Indigenous people. Aboriginal community governance over the public health actions that arose from this analysis is provided in detail. I led an investigation into a large protracted outbreak of Salmonella Typhimurium with a novel multi-locus variable number tandem repeat analysis type profile that affected 235 people in the Australian Capital Territory, NSW and Queensland from 10 October 2018 to 31 May 2019. The chapter describes the outbreak investigation including epidemiological, environmental and laboratory components, and control actions taken. I evaluated the NSW Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) Surveillance System, including the RHD Register. Using open ended and closed question surveys, network consultation and analysis of data, the system was found to be useful in improving the management of ARF/RHD. Recommendations for improving attributes were made based on the Updated Guidelines for Evaluating Public Health Surveillance Systems by the United States Centers for Disease Control and Prevention. I had the opportunity to teach and present my research during the MAE and through concurrent employment as an academic tutor. I delivered presentations at local, state, national and international conferences throughout the placement, and produced a Lesson from the Field competency with the Gamilaraay title 'nginda MAE waala wiitha' (throwing the MAE into the fire); an acknowledgement of the feeling many peers felt undertaking data linkage projects with inconsistent or missing data. I saw an opportunity to start a conversation about reasons why Aboriginal and Torres Strait Islander identity data may be missing in datasets, which prompted the group to explore why an individual may identify in one place and not another