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Health protection

  • To identify, prevent and minimise public health risks to the community
  • Whether infectious, chemical or radiological
  • Of any source
    • other humans
    • animals
    • the inanimate environment

Methods in public health

Surveillance and monitoring

  • Surveillance of notifiable conditions
  • Identifying and defining conditions, behaviours and practices that pose public health risk
  • monitoring vaccination...
  • analysing information...

Primary prevention at individual level

  • Contact tracing exposed individuals
  • Conducting school vaccination program
  • Supporting community and hospital vaccination programs more generally

Enforcement and response

  • Public health act
  • responding to disease notifiations
  • investigating disease and cluster outbreaks
  • maintaining and enforcing environmental .....
  • .......

Education and advocacy

  • providing information to general public
  • educating health professionals, local government staff and educating those responsible
  • ...
  • ..

Public health units

  • human regulation ("discipline 1")
    • public health nurses and surveillance officers
    • medical staff
  • environmental regulation ("discipline 2")
    • environmental health officers
  • work together where an infectious disease has an environmental source
  • Rotavirus has declined due to vaccination, now Norovirus is increasing (changes every few years)
  • Syphilis is notifiable. Increased notifications from 2000 onwards.
  • HIV status cannot be disclosed on identified patients without proper controls
  • Norovirus: nursing homes, hotels, restaurants, cruise ships. PHU surveillance over Sydney Harbour cruise ships
  • Vaccination is not compulsory, but there are financial incentives and also they can be excluded from school etc if not immunised
  • Non-compliant people for HIV, TB, syphilis can be locked up but it's very destructive etc
  • PHU should be notified when there is suspicion of a notifiable disease. They'll want to know where they've been and if they've been overseas (e.g. local acquisition of what is not normally seen here), what their occupation is, contact tracing, how can we prevent spread
  • Pertussis notifications have been high recently. Mainly in young-school age children
    • Disease is out of control. Vaccination programme is effective to a small degree. Natural immunity is not long lasting (can get pertussis multiple times). Vaccination has a positive effect but is not able to stop circulation in the community
    • Only reasonable suspicion for grounds for notification for PHU
    • Ring while they're there
    • Nose swab, PCR, serology
    • Erythromycin/Azithromycin (based on age) renders them non-infectious, but doesn't stop symptoms. Useful for public health
    • Infectious only in the catarrhal stage
  • Look at doctor/hospital notification form (they'd prefer people to ring them though; make a note that the notification has been made, the date, and who you spoke to. The ones they want you to ring for have a phone next to their checkbox)
  • Legionairre's disease
    • Research cases to see where they were in the incubation period - find out there's a particular airconditioning cooling tower with a lot of Legionella. Cooling towers use water to cool the air. Water warms up and air cools down, so if the water isn't disinfected, or is dirty, then the legionella will live in there.
    • Legionairre's disease = Pneumophila Legionella serotype 1. Incubation period = 2-10 days
    • Atypical pneumonia with multi-organ failure. High case fatality rate
    • Urinary antigen rapid test (same day), and also need swab for organism
    • Not infectious to others so need to search for environmental source.
    • Can force businesses to turn off cooling tower, clean it, then turn it back on again later.