Epidemiological review of Mycobacterium ulcerans in Australia 2005

Transcription

1 Epidemiological review of Mycobacterium ulcerans in Australia 2005 Paul Johnson Janet Fyfe Caroline Lavender John Hayman Maria Globan Chris Gilpin Joseph Azuolas Timothy Stinear Funding Austin Health/VIDRL VIDRL VIDRL Monash University/VIDRL VIDRL Queensland Mycobacterium reference laboratory Department of Primary Industries Monash University DHS Victoria

2 Australia: known sites of M. ulcerans acquisition (Hayman JA)

3 Australia--MU endemic areas Darwin Daintree River Western Australia Northern Territory Mossman Cairns Queensland Townsville Rockhampton Proserpine Mackay South Australia New South Wales Brisbane Victoria Melbourne Bairnsdale Phillip Island Tasmania

4 Compared with last year Region 2004 cases 2005 Cases Victoria Queensland 7 6 Northern Territory 2 0 Australia 34 47

5 Australia PCR/culture positive by region of acquisition State Likely place of acqui sition Cases Victoria East Gippsland (Bairnsdale) Mornington Peninsula St. Leonards Point Lonsdale Bellarine Peninsula other Bay (south -eastern suburbs of Melbourne ) Queensl and Mossman/Daintree Port Douglas Rockhampton/Yeppoon Other Subto tal Subto tal Australia total 47

6 Bairnsdale Victoria: Before 1980; low level activity in Bairnsdale/east Gippsland

7 Bairnsdale Warneet-Tooradin 1980+

8 Bairnsdale Frankston-Langwarrin Cowes

9 Bairnsdale Frankston-Langwarrin Cowes

10 Bairnsdale now.. Point Lonsdale Ocean Grove -2 cases 2005 Barwon Heads? -2 cases 2005/6 Seaford 2005 Frankston-Langwarrin Cowes

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12 41 year old drainage Contracter; Picture: Paul Johnson Austin Health, Melbourne Australia

13 9 year old boy; pictures courtesy Prof Richard Doherty and Dr. Justin Graham; Southern, Health, Melbourne, Australia; 2005

14 34 year woman; Photo courtesy Dr Bryan Speed and Dr Paul Johnson Austin Health Melbourne Australia

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16 Cowes, Phillip Island UBD maps

17 Cowes, Phillip Island IS2404 +VE IS2404 +VE UBD maps

18 Before 2002 N 1.5 km Queenscliff Golf Lake/wetland Road/street/lane Before 2002

19 2002 N 1.5 km Queenscliff Golf Lake/wetland Road/street/lane 2002

20 Point Lonsdale: location of cases N 1.5 km? Ocean Grove Queenscliff Golf Lake/wetland Road/street/lane

21 Outbreak investigation Mosquitoes Mud/organic material from wetlands Mud/soil from storm water drains Risk factors for acquisition (Funding: DHS Victoria)

22 ? N 1.5 km Queenscliff Golf Lake/wetland Road/street/lane Before 2002

23 Trapping mosquitoes 1. Dry ice is put into the top of the billy (source of CO 2 ) 2. The billy has small holes in the bottom to release the CO 2 3. Below the billy is a light source and a small fan powered by two torch batteries 4. When the mosquitoes come to investigate the CO 2 they are blown down into the container below

24 Confirmed positive soil/sediment samples and mosquito traps at Point Lonsdale N 1.5 km? Ocean Grove Queenscliff Golf Lake/wetland Road/street/lane 2002 to 2005 Soil/sediment sample Positive soil/sediment sample Positive mosquito trap

25 Mosquitoes Date Functioning Traps Season N trapped N tested N IS2404 pos Proportion pos 22 Dec Summer % 9 Feb Summer Feb Summer March Autumn % 9 March Autumn March Autumn July Winter August Winter % 14 Oct Spring % 24 Nov Spring % 12 Dec Summer % 12 Jan Summer Totals ,258 9, %

26 Risk factors for acquisition Case control study

27 Summary Incidence and range increasing esp Victoria Extremely focal distribution Endemic areas are low-lying compared with nearby control areas Mud, soil, mosquitoes PCR +ve Do mosquitoes transmit MU?