Hygiene and biosecurity: the language and politics of risk in an era of emerging infectious diseases

Infectious diseases, such as methicillin-resistant Staphylococcus aureus and avian influenza, have recently been high on the agenda of policy makers and the public. Although hygiene and biosecurity are preferred options for disease management, policy makers have become increasingly aware of the critical role that communication assumes in protecting people during outbreaks and epidemics. This article makes the case for a language-based approach to understanding the public perception of disease. Health language research carried out by the authors, based on metaphor analysis and corpus linguistics, has shown that concepts of journeys, pathways, thresholds, boundaries and barriers have emerged as principal framing devices used by stakeholders to advocate a hygiene based risk and disease management. These framings provide a common ground for debate, but lead to quite different perceptions and practices. This in turn might be a barrier to global disease management in a modern world.

Effective coordination and management of emerging infectious diseases in wildlife populations

A transdisciplinary, One Health approach is proposed for the coordination of wildlife health diagnostics, research, and policy development. In some countries, considerable effort has been made to establish specific activities including surveillance and integration of wildlife health within diagnostic and research laboratories. We suggest that some of these activities can be improved and many countries still require national structures to deal with wildlife disease investigation and management. We also suggest that scientists in this field should actively engage with national and international organizations and conferences to influence the development of policy, diagnostics, research, and management of emerging wildlife diseases.

Wildlife infectious disease dynamics in the context of seasonality and bird migration

The thesis contains chapters that elucidate questions with regards to wildlife infectious disease dynamics - avian influenza in particular - and how those dynamics are affected by seasonality and avian migration.

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

The incidence of Clostridium difficile infection (CDI) continues to rise, whilst treatment remains problematic due to recurrent, refractory and potentially severe nature of disease. The treatment of C. difficile is a challenge for community and hospital-based clinicians. With the advent of an expanding therapeutic arsenal against C. difficile since the last published Australasian guidelines, an update on CDI treatment recommendations for Australasian clinicians was required. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children.

Metals in the environment as risk factors for infectious diseases: gaps and opportunities

Many parts of the world in which common infectious diseases are endemic also have the highest prevalence of trace metal deficiencies or rising rates of trace metal pollution. Infectious diseases can increase human susceptibility to adverse effects of metal exposure (at suboptimal or toxic levels), and metal excess or deficiency can increase the incidence or severity of infectious diseases. The co-clustering of major infectious diseases with trace metal deficiency or toxicity has created a complex web of interactions with serious but poorly understood health repercussions, yet has been largely overlooked in animal and human studies. This book focuses on the distribution, trafficking, fate, and effects of trace metals in biological systems. Its goal is to enhance our understanding of the relationships between homeostatic mechanisms of trace metals and the pathogenesis of infectious diseases. Drawing on expertise from a range of fields, the book offers a comprehensive review of current knowledge on vertebrate metal-withholding mechanisms and the strategies employed by different microbes to avoid starvation (or poisoning). Chapters summarize current, state-of-the-art techniques for investigating pathogen-metal interactions and highlight open question to guide future research. The book makes clear that improving knowledge in this area will be instrumental to the development of novel therapeutic measures against infectious diseases. ContributorsM. Leigh Ackland, Vahid Fa Andisi, Angele L. Arrieta, Michael A. Bachman, J. Sabine Becker, Robert E. Black, Julia Bornhorst, Sascha Brunke, Joseph A. Caruso, Jennifer S. Cavet, Anson C. K. Chan, Christopher H. Contag, Heran Darwin, George V. Dedoussis, Rodney R. Dietert, Victor J. DiRita, Carol A. Fierke, Tamara Garcia-Barrera, David P. Giedroc, Peter-Leon Hagedoorn, James A. Imlay, Marek J. Kobylarz, Joseph Lemire, Wenwen Liu, Slade A. Loutet, Wolfgang Maret, Andreas Matusch, Trevor F. Moraes, Michael E. P. Murphy, Maribel Navarro, Jerome O. Nriagu, Ana-Maria Oros-Peusquens, Elisabeth G. Pacyna, Jozef M. Pacyna, Robert D. Perry, John M. Pettifor, Stephanie Pfaffen, Dieter Rehder, Lothar Rink, Anthony B. Schryvers, Ellen K. Silbergeld, Eric P. Skaar, Miguel C. P. Soares, Kyrre Sundseth, Dennis J. Thiele, Richard B. Thompson, Meghan M. Verstraete, Gonzalo Visbal, Fudi Wang, Mian Wang, Thomas J. Webster, Jeffrey N. Weiser, Günter Weiss, Inga Wessels, Bin Ye, Judith T. Zelikoff, Lihong Zhang

Identifying and integrating patient and caregiver perspectives for clinical practice guidelines on the screening and management of infectious microorganisms in hemodialysis units

Introduction: The integration of patient and caregiver input into guideline development can help to ensure that clinical care addresses patient expectations, priorities, and needs. We aimed to identify topics and outcomes salient to patients and caregivers for inclusion in the Kidney Health Australia Caring for Australasians with Renal Impairment (KHA-CARI) clinical practice guideline on the screening and management of infectious microorganisms in hemodialysis units.

Methods: A facilitated workshop was conducted with 11 participants (patients [n = 8], caregivers [n = 3]). Participants identified and discussed potential topics for inclusion in the guidelines, which were compared to those developed by the guideline working group. The workshop transcript was thematically analyzed to identify and describe the reasons underpinning their priorities.

Findings: Patients and caregivers identified a range of topics already covered by the scope of the proposed guidelines and also suggested additional topics: privacy and confidentiality, psychosocial care during/after disease notification, quality of transportation, psychosocial treatment of patients in isolation, patient/caregiver education and engagement, and patient advocacy. Five themes characterized discussion and underpinned their choices: shock and vulnerability, burden of isolation, fear of infection, respect for privacy and confidentiality, and confusion over procedural inconsistencies.

Discussion: Patients and caregivers emphasized the need for guidelines to address patient education and engagement, and the psychosocial implications of communication and provision of care in the context of infectious microorganisms in hemodialysis units. Integrating patient and caregiver perspectives can help to improve the relevance of guidelines to enhance quality of care, patient experiences, and health and psychosocial outcomes.

Freedom from equine infectious anaemia virus infection in Spanish Purebred horses

Introduction: No cases of equine infectious anaemia (EIA) have been reported in Spain since 1983. Factors that could increase the risk of reintroducing equine infectious anaemia virus (EIAV) into Spain include the recent occurrence of the disease in Europe and the absence of compulsory serological testing before importation into Spain. Aims and objectives: Given the importance of the Spanish Purebred (SP) horse breeding industry in Spain, the aim of this cross-sectional study was to provide evidence of freedom from EIAV in SP stud farms in Central Spain. Materials and methods: Serum samples from 555 SP horses, collected between September 2011 and November 2013, were tested using a commercially available EIAV ELISA with a published sensitivity of 100 per cent. Results: All 555 samples were negative for antibody to EIAV, providing evidence of a true EIAV seroprevalence between 0 per cent and 0.53 per cent (95% CIs of the sensitivity and specificity of the ELISA technique used Q10 were 100 per cent and 99.3 per cent, respectively) among the SP breeding population in Central Spain. Conclusions: These findings should serve to increase confidence when exporting SP horses to other countries.

What do infectious diseases physicians do? a 2-week snapshot of inpatient consultative activities across Australia, New Zealand and Singapore

The practice of an infectious diseases (ID) physician is evolving. A contemporary understanding of the frequency and variety of patients and syndromes seen by ID services has implications for training, service development and setting research priorities. We performed a 2-week prospective survey of formal ID physician activities related to direct inpatient care, encompassing 53 hospitals throughout Australia, New Zealand and Singapore, and documented 1722 inpatient interactions. Infections involving the skin and soft tissue, respiratory tract and bone/joints together accounted for 49% of all consultations. Suspected/confirmed pathogens were primarily bacterial (60%), rather than viral (6%), fungal (4%), mycobacterial (2%) or parasitic (1%). Staphylococcus aureus was implicated in 409 (24%) episodes, approximately four times more frequently than the next most common pathogen. The frequency of healthcare-related infections (35%), immunosuppression (21%), diabetes mellitus (19%), prosthesis-related infections (13%), multiresistant pathogens (13%) and non-infectious diagnoses (9%) was high, although consultation characteristics varied between geographical settings and hospital types. Our study highlights the diversity of inpatient-related ID activities and should direct future teaching and research. ID physicians' ability to offer beneficial consultative advice requires broad understanding of, and ability to interact with, a wide range of referring specialities.

Geographic variation in seasonality and its influence on the dynamics of an infectious disease

Seasonal changes in environmental drivers - such as temperature, rainfall, and resource availability - have the potential to shape infection dynamics through their reverberating effects on biological processes including host abundance and susceptibility to infection. However, seasonality varies geographically. We therefore expect marked differences in infection dynamics between regions with different seasonal patterns. By pairing extensive Avian Influenza Virus (AIV) surveillance data - 65 358 individual bird samples from 12 species of dabbling ducks sampled at 174 locations across North America - with quantification of seasonality using remote sensed data indicative for primary productivity (normalised differenced vegetation index, NDVI), we provide evidence that seasonal dynamics influence infection dynamics across a continent. More pronounced epidemics were seen to occur in regions experiencing a higher degree of seasonality, and epidemics of lower amplitude and longer duration occurred in regions with a more protracted and lower seasonal amplitude. These results demonstrate the potential importance of geographic variation in seasonality for explaining geographic variation in the dynamics of infectious diseases in wildlife.

Economic evaluation and catheter-related bloodstream infections

Catheter-related bloodstream infections are a serious problem. Many interventions reduce risk, and some have been evaluated in cost-effectiveness studies. We review the usefulness and quality of these economic studies. Evidence is incomplete, and data required to inform a coherent policy are missing. The cost-effectiveness studies are characterized by a lack of transparency, short time-horizons, and narrow economic perspectives. Data quality is low for some important model parameters. Authors of future economic evaluations should aim to model the complete policy and not just single interventions. They should be rigorous in developing the structure of the economic model, include all relevant economic outcomes, use a systematic approach for selecting data sources for model parameters, and propagate the effect of uncertainty in model parameters on conclusions. This will inform future data collection and improve our understanding of the economics of preventing these infections.

Management of sharps in ambulance care : a state-wide survey of paramedic knowledge and reported practice

Paramedics are at high risk of exposure to infectious diseases because they frequently undertake procedures such as the use and disposal of sharps as components of everyday practice. While the literature demonstrates that the management of sharps is problematic across all health disciplines, there is a paucity of research examining sharps management practices in the Australian pre-hospital paramedic context. This study examines knowledge and practices of sharps control among paramedics in Queensland, Australia. A mail survey focusing on infection control knowledge and practices was sent to all clinical personnel of the Queensland Ambulance Service (QAS) (N = 2274). A total of 1258 surveys were returned, a response rate of 55.3%. Participants responded to 12 true/false statements on the management of sharps and three questions about recapping practices. Most respondents were knowledgeable about the correct management of sharps, with a mean of 11.28 (out of 12, SD = 1.32). When gauging reported practices, more than half (59.1%, n = 736) of participants reported recapping a needle, and 38.5% (n = 479) reported never having done so. These results reflect good knowledge of general management of sharps among respondents, but suggest deficits regarding reported practices. The results suggest that a comprehensive ambulance in-service education programme focusing particularly on sharps management is required. The study highlights the need for further research on sharps management practices in the field, identification of barriers to safe sharps practices in pre-hospital settings, and 'best practice' for translating good sharps management knowledge into practice.