Sources, perceived usefulness and understanding of information disseminated to families who entered home quarantine during the H1N1 pandemic in Victoria, Australia: a cross-sectional study

Background Voluntary home quarantine of cases and close contacts was the main non-pharmaceutical intervention used to limit transmission of pandemic (H1N1) 2009 influenza (pH1N1) in the initial response to the outbreak of the disease in Australia. The effectiveness of voluntary quarantine logically depends on affected families having a clear understanding of what they are being asked to do. Information may come from many sources, including the media, health officials, family and friends, schools, and health professionals. We report the extent to which families who entered home quarantine received and used information on what they were supposed to do. Specifically, we outline their sources of information; the perceived usefulness of each source; and associations between understanding of recommendations and compliance. Methods Cross-sectional survey administered via the internet and computer assisted telephone interview to families whose school children were recommended to go into home quarantine because they were diagnosed with H1N1 or were a close contact of a case. The sample included 314 of 1157 potentially eligible households (27% response rate) from 33 schools in metropolitan Melbourne. Adjusting for clustering within schools, we describe self-reported 'understanding of what they were meant to do during the quarantine period'; source of information (e.g. health department) and usefulness of information. Using logistic regression we examine whether compliance with quarantine recommendations was associated with understanding and the type of information source used. Results Ninety per cent understood what they were meant to do during the quarantine period with levels of understanding higher in households with cases (98%, 95% CI 93%-99% vs 88%, 95% CI 84%-91%, P = 0.006). Over 87% of parents received information about quarantine from the school, 63% from the health department and 44% from the media. 53% of households were fully compliant and there was increased compliance in households that reported that they understood what they were meant to do (Odds Ratio 2.27, 95% CI 1.35-3.80). Conclusions It is critical that public health officials work closely with other government departments and media to provide clear, consistent and simple information about what to do during quarantine as high levels of understanding will maximise compliance in the quarantined population.

Leave entitlements, time off work and the household financial impacts of quarantine compliance during an H1N1 outbreak

Background The Australian state of Victoria, with 5.2 million residents, enforced home quarantine during a H1N1 pandemic in 2009. The strategy was targeted at school children. The objective of this study was to investigate the extent to which parents’ access to paid sick leave or paid carer’s leave was associated with (a) time taken off work to care for quarantined children, (b) household finances, and (c) compliance with quarantine recommendations. Methods We conducted an online and telephone survey of households recruited through 33 schools (85% of eligible schools), received 314 responses (27%), and analysed the subsample of 133 households in which all resident parents were employed. Results In 52% of households, parents took time off work to care for quarantined children. Households in which no resident parent had access to leave appeared to be less likely to take time off work (42% vs 58%, p=0.08) although this difference had only borderline significance. Among parents who did take time off work, those in households without access to leave were more likely to lose pay (73% vs 21%, p<0.001). Of the 26 households in which a parent lost pay due to taking time off work, 42% experienced further financial consequences such as being unable to pay a bill. Access to leave did not predict compliance with quarantine recommendations. Conclusions Future pandemic plans should consider the economic costs borne by households and options for compensating quarantined families for income losses.

Organizational factors in the diffusion of an industry standard: implementing an online documentation system for Australian exporters

At present, governments in many countries are actively engaged in the development of electronic trading and certification standards to enable the smooth operation of export markets. Standards and their usability underpin confidence in the operations of markets and their effective functioning. In institutional markets, an important role for government agencies lies in developing the initial specifications for standards for interoperable systems. Once these specifications are accepted, governments can then facilitate the eventual diffusion of a standard to the B2B marketplace. Acceptance of an industry standard can determine demand, which defines the viability of that market. In this paper, we describe an initiative by a government agency, the Australian Quarantine and Inspection Service (AQIS), in developing EXDOC, a standard for export documentation and the role that AQIS played in its implementation and diffusion. Our case study illustrates a successfully facilitated B2G implementation. It demonstrates how a standard can be supported and promulgated for the effective functioning of markets in the transition from manual to online export documentation. Once the overarching specifications for related industries have been established and diffused by government, opportunities arise for private sector markets to develop across these industries. Government agencies can promote the effective operation of standards for electronic markets. The EXDOC implementation and its iterations provide an exemplar of active engagement in the development of electronic trading and certification standards for an institutional market. Its successful diffusion provides a model of the implementation process for other export sectors and agencies.

AQIS, EXDOC and the 'meaties' : an interpretivist case study of an Australian export documentation system implementation

EXDOC is an on-line export documentation system implemented by the Australian Quarantine Inspection Service [AQIS] and used currently by 90% of meat exporters. At a time when governments world-wide are increasingly committed to introducing electronic service delivery [ESD], this is a timely exemplar of innovative practice. In this paper, we consider the initial implementation of EXDOC in the meat export sector in order to identify the factors that led to the successful adoption of this system.

We consider these factors in the context of diffusion of innovation literature supplemented with Bijker’s social constructivist framework. The theoretical flexibility provided by this combination of approaches enabled us to draw out a number of implications from the data that bear on strategy formulation.

Factors found to have significant bearing on the early adoption of EXDOC included: (1) idiosyncratic factors precipitating the initial implementation (2) the constraints based on accommodating user capabilities (3) the organisational role taken by AQIS (4) diffusion as a self-reinforcing and value-adding effect.

A standard represents both a problem as a requirement of such a system and a problem solving strategy eliciting compliance to the system requirements. Over the period of shaping and stabilizing of the industry standard, AQIS was required to act as facilitator in the coordination of the actors.

The implementation of systems like EXDOC enables users to identify what they want from a system, specifying their preferences and tradeoffs. Such implementations offer opportunities for systems redesign within export business sectors with major strategic implications for the industry.

Development of monoclonal antibodies against Vibrio pathogens

Monoclonal antibodies were developed against pathogenic vibrios for use in rapid identification in disease situations of humans, fish and shellfish. Of the 12 fusions performed using V. alginolyticus, V. anguillarum, V. carchariae, V. cholerae, V. damsela, V. furnissii, V. harveyi, V. ordalii, V. parahaemolyticus and V. vulnificus, a total of 102 hybridomas were obtained. Based on cross-reactivity of a wide range of Vibrio strains and other gram-negative bacteria, three broad types of monoclonal antibodies were found. The three categories were: (1) ones that were species-specific or specific to a particular surface antigen, (2) a large number that reacted with several Vibrio species, and (3) three that reacted with most Vibrio strains but no other gram-negative bacteria. Each species-specific monoclonal antibody only recognized its corresponding Vibrio species and was used for identifying unknown species, confirming diagnosis of clinical isolates. In addition, several monoclonal antibodies only cross-reacted with similar Vibrio species, e.g. V. parahaemolyticus and V. alginolyticus which share a common H-antigen. Monoclonal antibodies reacting with several Vibrio species were not of particular use in diagnostic situations. Three monoclonal antibodies of the last group did not react with other genera of the family Vibrionaceae, namely Aeromonas, Photobacterium and Plesiomonas nor a wide range of gram-negative enteric bacteria. These data indicated the existence of an antigenic surface determinant common to Vibrio species. One monoclonal reacted with the heat-stable antigenic determinants on the cell surface as v as lipopolysaccharide extracted from all the vibrios studied, thus making it useful for large- scale screening of acute infections of vibrios. In a blind test, seven Vibrio species, isolated from 6 marine and a freshwater source were identified by two laboratories using phenetic tests. Results of immunotyping using monoclonals, three of seven were diagnosed as the same species, another three were designated as Vibrio species but could not be classified further due to the library not having the corresponding monoclonal, and one was diagnostically questionable. Two further tests were carried out. An unknown Vibrio formalin-fixed isolated from diseased marine animal was identified as V. parahaemolyticus by ELISA and FITC. Clinical human isolates of V. alginolyticus, V. parahaemolyticus and V. vulnificus were confirmed by monoclonals. Australian isolates of V. anguillarum appeared to be mostly of serotype O1. monoclonals raised to V. anguillarum AFHRL 1 reacted with only serotype O1 from Denmark but also most Australian isolates. All vibrios pathogenic to fish and shellfish, i.e. V. anguillarum, V. ordalii, V. alginolyticus, V. carchariae, V. cholerae, V. damsela, V. harveyi, V. parahaemolyticus and V. vulnificus, were used for attachment studies to fish cells using phase contrast and FITC-immunofluorescence microscopy. Of these vibrios, V. anguillarum, V. ordalii and V. perahaemolyticus, were found to adhere to different cells and tissues of rainbow trout while others did not appear to attach. However, attachment was inhibited by monoclonal antibodies specific to only these three vibrios. Lipopolysaccharide is well known as being a contributing factor in pathogenicity of gram-negative bacteria. PAGE electrophoresis of extracted LPS from 9 strains covering 6 Vibrio species showed the presence of a common 15,000 D fragment. This fragment was verified by immunoblotting with a genus-specific monoclonal antibody (i.e. F11P411F) recognizing nearly all vibrios. The common LPS fragment was separated and used to raise polyclonal antisera in mouse which reacted strongly with LPS itself, live as well as sodium azide-killed vibrios, but not with other gram-negative bacteria. This raised the possibility of developing vaccine from Vibrio LPS. Monoclonal antibodies developed in the present study enabled rapid identification of a number of pathogenic Vibrio species. There is still further work to produce monoclonal antibodies against additional vibrios that are probably pathogenic. These included V. fluvialis, V. hollisae, V. metschnikovii, V. minicus, V. salmonella and V. tubiashii. Together the application will be of significance in clinical diagnostic work, in the monitoring of vibriosis in fish farms and in quarantine.

Dignity and human rights in correctional practice

Interventions with offenders have a normative layer as well as a scientific basis and therefore it is not possible to quarantine ethical questions from discussions of best practice. My aim in this paper is to provide an expanded ethical canvass from which to approach correctional practice with offenders. The cornerstone of this broader ethical perspective will be the concept of human dignity and its protection by human rights norms and theories. I also explore the relationship between responses to crime and offender rehabilitation based on an enriched theory of punishment that is sensitive to offenders’ moral equality and their attendant rights.

Modeling the propagation of peer-to-peer worms

Propagation of Peer-to-Peer (P2P) worms in the Internet is posing a serious challenge to network security research because of P2P worms' increasing complexity and sophistication. Due to the complexity of the problem, no existing work has solved the problem of modeling the propagation of P2P worms, especially when quarantine of peers is enforced. This paper presents a study on modeling the propagation of P2P worms. It also presents our applications of the proposed approach in worm propagation research.

Motivated by our aspiration to invent an easy-to-employ instrument for worm propagation research, the proposed approach models the propagation processes of P2P worms by difference equations of a logic matrix, which are essentially discrete-time deterministic propagation models of P2P worms. To the best of our knowledge, we are the first using a logic matrix in network security research in general and worm propagation modeling in particular.

Our major contributions in this paper are firstly, we propose a novel logic matrix approach to modeling the propagation of P2P worms under three different conditions; secondly, we find the impacts of two different topologies on a P2P worm's attack performance; thirdly, we find the impacts of the network-related characteristics on a P2P worm's attack performance in structured P2P networks; and fourthly, we find the impacts of the two different quarantine tactics on the propagation characteristics of P2P worms in unstructured P2P networks. The approach's ease of employment, which is demonstrated by its applications in our simulation experiments, makes it an attractive instrument to conduct worm propagation research.

Pandemic (H1N1) 2009 influenza in Australia : absenteeism and redeployment of emergency medicine and nursing staff

Objective: The aim of the present study was to examine the impact of Pandemic (H1N1) 2009 Influenza on the Australian emergency nursing and medicine workforce, specifically absenteeism and deployment.

Methods: Data were collected using an online survey of 618 members of the three professional emergency medicine or emergency nursing colleges.

Results: Despite significant increases in emergency demand during the Pandemic (H1N1) 2009 Influenza, 56.6% of emergency nursing and medicine staff reported absenteeism of at least 1 day and only 8.5% of staff were redeployed. Staff illness with influenza-like illness was reported by 37% of respondents, and 87% of respondents who became ill were not tested for the Pandemic (H1N1) 2009 Influenza. Of the respondents who became ill, 43% (n = 79) reported missing no days of work and only 8% of respondents (n = 14) reported being absent for more than 5 days. The mean number of days away from work was 3.73 (standard deviation = 3.63). Factors anecdotally associated with staff absenteeism (caregiver responsibilities, concern about personal illness, concern about exposing family members to illness, school closures, risk of quarantine, stress and increased workload) appeared to be of little or no relevance. Redeployment was reported by 8% of respondents and the majority of redeployment was for operational reasons.

Conclusion: Future research related to absenteeism, redeployment during actual pandemic events is urgently needed. Workforce data collection should be an integral part of organizational pandemic planning.

Separate and invisible : a carceral history of Australian islands

This article examines the history of four islands used for incarceration in Australia: the ‘secondary punishment’ of convicts on Norfolk Island; the management and quarantine of indigenous people on Palm Island; the quarantine of all new migrants and visitors on Bruny Island; and the incarceration of enemy aliens on Rottnest Island. Incarceration has been used throughout Australia’s history as a method of social and political control, targeting categories of people perceived to pose a threat to the racial composition, social cohesion, or national security of the Australian community. By providing a space both separate and invisible to the community, Australia’s carceral islands served as a solution to a recurring problem for a young nation apprehensive about the composition, durability and security of its community. The human consequences of incarceration could be devastating.

Recommendations for and compliance with social restrictions during implementation of school closures in the early phase of the influenza A (H1N1) 2009 outbreak in Melbourne, Australia

Background Localized reactive school and classroom closures were implemented as part of a suite of pandemic containment measures during the initial response to influenza A (H1N1) 2009 in Melbourne, Australia. Infected individuals, and those who had been in close contact with a case, were asked to stay in voluntary home quarantine and refrain from contact with visitors for seven days from the date of symptom onset or exposure to an infected person. Oseltamivir (Tamiflu®) was available for treatment or prophylaxis. Methods We surveyed affected families through schools involved in the closures. Analyses of responses were descriptive. We characterized recommendations made to case and contact households and quantified adherence to guidelines and antiviral therapy. Results Of the 314 respondent households, 51 contained a confirmed case. The prescribed quarantine period ranged from 1-14 days, reflecting logistic difficulties in reactive implementation relative to the stated guidelines. Household-level compliance with the requirement to stay at home was high (84.5%, 95% CI 79.3,88.5) and contact with children outside the immediate family infrequent. Conclusions Levels of compliance with recommendations in our sample were high compared with other studies, likely due to heightened public awareness of a newly introduced virus of uncertain severity. The variability of reported recommendations highlighted the difficulties inherent in implementing a targeted reactive strategy, such as that employed in Melbourne, on a large scale during a public health emergency. This study emphasizes the need to understand how public health measures are implemented when seeking to evaluate their effectiveness.

Screening for resistance to potato cyst nematode in Australian potato cultivars and alternative solanaceous hosts

The potato cyst nematodes (PCN), Globodera rostochiensis (Woll.) and G. pallida (Stone), are major pests of ware and seed potato (Solanum tuberosum L.) crops worldwide and severely impact the movement of potatoes around the globe through quarantine restrictions. In Australia, only G. rostochiensis has been discovered, on four separate occasions between 1986 and 2008. The infested areas are the subject of strict regulation and quarantine procedures and while they are considered to be contained, managing nematode populations remains a priority. This study has identified the G. rostochiensis Ro1 resistance-status of potato cultivars currently grown by Australian potato growers, and new cultivars emerging from the Australian Potato Breeding Program. Resistance was assessed by a simple and robust procedure carried out in a purpose-built quarantine facility. Of the 24 potato cultivars grown in the affected Koo Wee Rup district in 2004, 10 were resistant to nematode infestation, including the locally important cultivar Atlantic. Other cultivars important to the Victorian and Australian potato industry, such as Kennebec, Desiree, Sebago and Coliban, were classified as susceptible. Importantly, this study provided evidence that the Koo Wee Rup PCN population was able to complete its lifecycle on the native plant species, S. aviculare (kangaroo apple), potentially acting as an alternate host and spreading PCN among potato crops.

The initial laboratory diagnosis of equine influenza in Australia in 2007

Until August 2007, Australia had not recorded an outbreak of equine influenza; indeed, significant quarantine precautions exist to safeguard against such an event. This article outlines the lead up to virus confirmation and the procedures to first test, then contain it.

The 2007 outbreak of equine influenza in Australia: lessons learned for international trade in horses

In August 2007 Australia experienced its first outbreak of equine influenza. The disease occurred first in a quarantine station for imported horses near Sydney and subsequently escaped into the general horse population. After an extensive campaign the disease was eradicated and Australia is again recognised as free of this disease. Equine influenza was then, and is now, recognised to be the major disease risk associated with live horse imports into Australia and measures designed to mitigate this risk formed the basis of the quarantine protocols then in place. Subsequent investigations into the cause of the outbreak identified failures in compliance with these quarantine requirements as a contributing factor. It is also likely that the immunity of horses vaccinated as part of the import protocol was less than optimal, and that this had a significant role to play in the escape of the disease from quarantine.