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Biomedical subjects

H A Kelly

Publications and source records attributed to H A Kelly.

At least 19 recordsLinked to original sources
PubMed2004

Mumps and rubella: a year of enhanced surveillance and laboratory testing.

In Victoria (Australia) surveillance for mumps and rubella has historically been passive, with most notified cases clinically diagnosed. In July 2001, the Victorian Department of Human Services implemented an enhanced surveillance system focusing on improved laboratory testing. We tested 85% of notifications and only 9% of all mumps and 27% of rubella notifications were laboratory confirmed. While most notified cases were children who had been clinically diagnosed, we found most laboratory-confirmed cases were in adults. The positive predictive value of the clinical case definition was low: mumps (10%); rubella (22%). These results highlight the value of laboratory confirmation of the diagnosis when mumps and rubella are rare, failure to do so is likely to overestimate disease incidence.

Adolescent↗
PubMed2001

A serosurvey evaluation of the school-based measles 'catch-up' immunisation campaign in Victorian school-aged children.

OBJECTIVE: To determine the proportion of Victorian primary school students protected against measles infection one year after the completion of the measles 'catch-up' immunisation campaign of 1998 and to compare this with the proportion of year 9 and 10 (aged 14-16 years) students. DESIGN & SETTING: Three-stage random cluster survey in Victorian primary and secondary schools. MAIN OUTCOME MEASURES: Proportion of primary and year 9 and 10 secondary school students protected against measles infection one year after the completion of the mass 'catch-up' immunisation campaign. SECONDARY OUTCOMES: the proportion of both primary and year 9 and 10 secondary school students protected against both mumps and rubella. RESULTS: Of 1,037 Victorian primary and 2,357 years 9 and 10 secondary school students invited to participate in this study, 403 (39%) and 752 (32%) respectively provided a blood specimen for serological testing for antibodies against measles, mumps and rubella. 94.8% (95% confidence interval, 91.5, 96.9) of primary school and 93.1% (90.9, 94.8) of year 9 and 10 students were protected against measles infection. CONCLUSION: One year after the completion of the school-based measles 'catch-up' immunisation campaign the level of protection in Victorian primary school aged students is sufficient to prevent the continuing circulation of measles virus within this age group. The proportion of year 9 and 10 secondary school students protected against measles is also probably sufficient to prevent continuing circulation of wild type virus in Victoria, even though this age group was not specifically targeted by the 'catch-up' campaign.

Adolescent↗
PubMed2001

Measles immunity among young adults in Victoria.

Measles outbreaks in Victoria in 1999 and 2001 have suggested that a substantial proportion of young Victorian adults may be susceptible to measles infection. We performed a serosurvey of 300 18-30-year-old healthy blood donors and 312 sera retrieved after diagnostic testing for a non-rash illness in patients of the same age group, with the aim of estimating the proportion of young adults in Victoria immune to measles. We also aimed to define more precisely the birth cohorts at risk of measles infection, with cohorts reflecting the measles immunisation policies of previous years. There was no significant difference in measles immunity between the 300 blood donors (79.0%, 95% confidence interval 73.9-83.5) and the 312 patients whose sera had been stored (84.0%, 95% CI 79.4-87.9, p=0.11). There was, however, a significant difference in immunity by birth cohort. In the combined results from both samples, the proportion of people born between 1968 and 1974 who were immune to measles was 88.4 per cent (95% CI 84.1-91.6) while the proportion of those born between 1975 and 1981 was 74.1 per cent (95% CI 68.7-79.1). This study confirms that a substantial proportion of young Victorian adults are susceptible to measles, but also demonstrates that those born between 1975 and 1981 are more likely to be non-immune than those born before 1975. A review of published Australian data supports this conclusion and confirms the need for a measles control program aimed at young adults.

Adolescent↗
PubMed2000

Measles outbreak in young adults in Victoria, 1999.

OBJECTIVES: To describe an outbreak of measles in Victoria. DESIGN: Case series with cases identified through enhanced passive surveillance and outbreak-related active surveillance. SETTING: State of Victoria, 1999. MAIN OUTCOME MEASURES: Number of cases; epidemiological links and patterns of transmission; patient demographic features and vaccination status; complications. RESULTS: 75 cases were identified (74 laboratory-confirmed; and one epidemiologically linked to a laboratory-confirmed case), with onset between 11 February and 2 May 1999. The first case was in a 21-year-old woman who had recently holidayed in Bali and worked at a large cinema complex in Melbourne. Sixteen cases occurred in people who had contact with the index case at the cinema on one evening. The outbreak spread to regional Victoria and South Australia. Median age of patients was 22 years; 64 (85%) were born between 1968 and 1981, with only one patient in the age group targeted by the primary school component of the 1998 Australian Measles Control Campaign; this child had not been vaccinated. More than a third of patients (28) were hospitalised (total, 97 inpatient days), and five were healthcare workers. CONCLUSIONS: This outbreak was caused by international importation of measles virus. It highlights the change in epidemiology of measles in Australia, from a disease of childhood to one predominantly affecting young adults. A strong two-dose childhood vaccination program, vigilant surveillance, and rapid response to outbreaks will continue to be the basis of measles control, but better protection for young adults should be considered.

Adolescent↗
PubMed2000

Enhanced measles surveillance during an interepidemic period in Victoria.

OBJECTIVE: To describe results of the first two years of enhanced measles surveillance in Victoria. DESIGN: Case series identified through enhanced measles surveillance. PARTICIPANTS AND SETTING: All measles cases notified to the Disease Control Section, Department of Human Services, Victoria, in 1997 and 1998. MAIN OUTCOME MEASURES: Proportion of notified cases laboratory confirmed as measles, rubella, or human parvovirus infection; identification of clusters (two or more linked cases of measles); and utility of the National Health and Medical Research Council clinical case definition for suspected measles. RESULTS: Rates of laboratory testing of notified cases improved after introduction of a paediatric phlebotomy service in July 1997, from 21 of 90 notified patients (23%) in the preceding six months, to 258 of 317 notified patients (81%) between July 1997 and December 1998. Of the 317, only 19 (6%) were laboratory confirmed with measles, while a further 26 (8%) were laboratory confirmed with human parvovirus infection (18) or rubella (8). Three clusters of measles, involving 11 cases, were identified during 1998. Use of the NHMRC case definition did not greatly improve the positive predictive value for diagnosis of measles above that of notification alone (14% versus 8%). CONCLUSIONS: Circulation of measles virus in Victoria in 1997 and 1998 appeared minimal. In this interepidemic period most notified cases of measles were not measles; to identify true cases, surveillance during an interepidemic period must include laboratory testing of notified cases.

Adolescent↗
PubMed2000

The age-specific prevalence of human parvovirus immunity in Victoria, Australia compared with other parts of the world.

The age-specific immunity to human parvovirus infection was estimated in Victoria, Australia using prospectively collected samples from the Royal Children's Hospital, the Royal Women's Hospital and the Australian Red Cross Blood Service and from sera stored at the Victorian Infectious Diseases Reference Laboratory (VIDRL). All testing was performed at VIDRL using a commercial enzyme-linked immunosorbent assay (Biotrin). Of the 824 sera tested, 28% of those drawn from people aged 0-9 years contained protective antibodies to human parvovirus. This rose to 51% in the next decade of life. There was then a slow rise to about 78% immunity over 50 years of age. An analysis of all requests for parvovirus serology at VIDRL from 1992 to 1998 suggested that parvovirus tended to occur in 4-year cycles, with 2 epidemic years followed by 2 endemic years. A review of published reports of parvovirus immunity suggested that parvovirus infection may be more common, with a correspondingly higher proportion of the community immune, in temperate as opposed to tropical countries.

Adolescent↗
PubMed1999

What is the cause of a rash after measles-mumps-rubella vaccination?

Surveillance and laboratory confirmation of measles will increase in importance as Australia implements enhanced measles control. We describe a 17-month-old child with fever and rash after measles-mumps-rubella vaccination. Detection of vaccine-strain measles virus in his urine by polymerase chain reaction confirmed the diagnosis of a vaccine reaction rather than wild-type measles. We propose that measles virus should be sought and identified as vaccine or wild-type virus when the relationship between vaccination and measles-like illness is uncertain.

Diagnosis, Differential↗
PubMed1999

Australia's last reported case of wild poliovirus infection.

In 1986 tests on faeces collected from a 22 year old Australian born man who had symptoms consistent with poliomyelitis yielded poliovirus type 3. In a neutralisation test using a panel of monoclonal antibodies the isolate was identified as wild poliovirus type 3 at that time. After further classification using microneutralisation, nucleic acid probe hybridisation, immunoassay and sequencing carried out in three laboratories between 1994 and 1997, the isolate has been reclassified as 'Sabin-like' with 'wild type' characteristics. This case has been quoted in the literature as Australia's last case of locally acquired wild poliovirus. Efforts are now being made to identify the true last case in Australia. This article describes the isolation, identification and further characterisation of this virus.

Adult↗
PubMed1999

Fifth disease in a small rural community. What are the consequences?

OBJECTIVE: To characterise the implications of an outbreak of human parvovirus in a small community. METHOD: A community survey was conducted over a period of 18 months in a small rural town in Western Australia with a population of approximately 4300 people. Outbreak cases were assessed by the single general practice in the town. Notification of the survey was placed in both the schools and by advertisement in the local paper. Survey questionnaires distributed to community members were returned on a voluntary basis. After 12 months repeat surveys were sent to all adults who had responded to the initial survey. RESULTS: Eighty-eight definite and 14 equivocal cases were identified as part of the outbreak, which occurred between late July 1994 and February 1995. Serological testing which confirmed human parvovirus B19 infection was available for 29% of cases. The highest attack rate was in the 5-9 year age group. One-third of cases were adults and 9% of them developed symptoms lasting longer than 6 months. Transient anaemia almost certainly due to parvovirus infection was identified in one adult women during the course of the outbreak. No pregnant woman suffered any adverse fetal outcome as a result of human parvovirus infection. CONCLUSION: In an outbreak of parvovirus, children will be most commonly affected although adults can develop polyarthralgia/arthritis which may persist for several months and some may suffer transient anaemia. Pregnant women are potentially at risk of the development of fetal hydrops and fetal death, but advice to them can be based on the estimate of a less than 1% risk of adverse fetal outcome due to parvovirus infection.

Adolescent↗
PubMed1998

The immunological response of llamas (Lama glama) following experimental infection with Mycobacterium bovis.

Llamas were experimentally infected with Mycobacterium bovis in order to evaluate the axillary skin test and the ELISA as diagnostic procedures for tuberculosis in llamas (Lama glama). Six llamas were given a single intratracheal challenge with 1 of 2 doses of a recent field isolate of M. bovis and 2 llamas were left as noninfected controls. This resulted in a progressive disease in some animals with 1 mortality as early as 68 d post-infection (PI). The tuberculin skin test, at the axillary site, was positive in 4 of 5 infected llamas at 80 d PI. At 143 d PI, all 3 surviving lamas were positive, including the one which had not responded at 80 d PI. The application of skin and serological tests throughout the course of this experiment adds support for the need to further evaluate the skin test and its anamnestic effect on serodiagnosis since serological responses were generally not observed in the absence of skin testing or antibiotic treatment. The wide variation in M. bovis antigens recognized by the serological response would indicate that a diagnostic panel should include multiple antigens such as MPB70 and lipoarabinomannan (LAM). While skin testing or serology alone may be of limited value to diagnose tuberculosis in llamas, together they may offer an enhanced potential for immunodiagnosis of tuberculosis.

Animals↗
PubMed1996

A cluster of murine typhus cases in Western Australia.

Measures to control rodents have resulted in a decreased incidence of murine typhus, but it is also likely that it is being underdiagnosed because many medical practitioners do not include it in their differential diagnosis of pyrexia of unknown origin. Four recent cases are described, and historical aspects of this disease in Australia are presented.

Adult↗