Infectious diseases

Objectives To characterise the clinical, microbiological and economic burden of hospital-admitted, injection-related infections among incarcerated people who inject drugs. Study Type Retrospective observational cohort study. Setting Secure unit of the Princess Alexandra Hospital, Brisbane, Australia. Participants Adults incarcerated in Queensland prisons who were admitted to hospital with an injection-related infection between 1 July 2019 and 30 June 2023. Main Outcome Measures Types of injection-related infection, microbiological findings, requirement for surgical or radiological source control, hospital length of stay and inpatient healthcare costs. Results There were 321 hospital admissions for injection-related infection among 265 patients, accounting for 282 unique infections. Most patients were male (241; 90.9%), with a mean age of 33years (standard deviation [SD], 7.4years), and 76 (28.7%) identified as First Nations. The most frequent infections were soft tissue infections (77/282; 27.3%), acute hepatitis C (64/282; 22.7%) and cellulitis (43/282; 15.2%). Surgical or radiological source control was required in 95 infections (34.0%), and infectious diseases consultation occurred in 130 infections (46.1%). Among 39 true-positive blood cultures, Staphylococcus aureus was identified in 17 (43.6%), Burkholderia species in 10 (25.6%) and non-tuberculous Mycobacterium species in 3 (7.7%). Among the 218 non-acute hepatitis C infections, 50 (22.9%) were hepatitis C virus (HCV) RNA positive. Overall, HCV RNA was present in 114 of 282 infections (40.4%). The total inflation-adjusted inpatient cost was $8.39 million, with a median cost per infection of $11,602 (interquartile range, $7426–$34,544). Conclusion Injection-related infections among incarcerated people who inject drugs were associated with substantial morbidity and healthcare costs in this large hospital cohort. A wide clinical spectrum was observed, including atypical pathogens, and clinically overt acute hepatitis C requiring hospital admission. These findings describe a significant burden of preventable disease in custodial settings and support the introduction of established primary prevention and harm-reduction interventions in prisons.

Andrew Palmer, Matthew Carter, Jeremy Yeo, Cecilia Shim, Jason Connor, Jeremy Hayllar, Gerald Holtmann, Naomi Moy, Elliott G. Playford, Naomi Runnegar, Paul J. Clark

Seasonal influenza causes significant morbidity and mortality in Australia. Despite long-standing recommendations for influenza vaccination and nationally funded programs for higher risk age or population groups, coverage remains suboptimal, especially among children. Introduction of the intranasal live attenuated influenza vaccine (LAIV) in 2026 offers an additional safe and effective needle-free vaccine option. Easier administration may improve access by making delivery by a range of health care providers possible. This perspective article outlines the evidence supporting the use of the LAIV and its potential to improve vaccination uptake among children in Australia.

Cyra Patel, Alexis Pillsbury, Tran Nguyen, Xia Wang, Helen E. Quinn, Clayton K. Chiu, Allen C. Cheng, Katie L. Flanagan, Zhicheng Wang

Implementation of differentiated and simplified PrEP care models, tailored to the specific needs of key populations, has the potential to increase equitable access to PrEP and achieve virtual elimination of HIV transmission by 2030

Tyson Arapali · Sarah Warzywoda · Anthony K J Smith · Curtis Chan · Timothy R Broady · Erin Sullivan · Catherine MacPhail · Mohamed A Hammoud · Alexander Dowell‐Day · Benjamin R Bavinton

The patient experienced headache, anorexia, body aches, and confusion during a camping holiday through central Queensland

Emily Gibson · Megan Whitley · Peter Murray · Linda Hueston · Jane Bennett · Raguharan Kathiresu · David N Durrheim

Universal newborn screening could improve timely detection and avert neurological and other adverse consequences of CMV infections

Ece Egilmezer · Suzy M Teutsch · Carlos Nunez · Stuart T Hamilton · Adam W Bartlett · Pamela Palasanthiran · Elizabeth J Elliott · William D Rawlinson

A 45-year-old man presented to a regional New South Wales emergency department with five days of malaise, lethargy and dyspnoea

Ashleigh Drury · Philippa Harrison · Aiveen Bannan

Avian influenza viruses can be detected by human diagnostic testing platforms routinely used for testing for influenza A viruses

Lisa M Sedger · Vishal Ahuja · Katherine A Lau · Deane L Byers · Torsten Theis · Peter D Kirkland · Catherine Pitman

A well 37-year-old male patient presented to a tertiary hospital in New South Wales in July 2024 with presyncope and his smart watch alerts indicating resting bradycardia at 40 beats per minute

Eunice Chuah · Hari Sritharan · Zachariah Seidman · Avedis A Ekmejian · Karin Chia

Without advance knowledge of the virulence and behaviour of a novel pathogen, pandemic response planning is difficult. Australia’s ability to manage future pandemics will depend not only on robust scientific and health care systems but also on fostering public trust and resilience

Matthew Brown · Alan W Hampson · John Gerrard

Generating strong, convincing evidence about effective prevention and treatment of skin infections and its benefits in reducing immune-mediated diseases will require a large, sustained, international research effort

Michael G Baker · Julie Bennett · Teuila Percival · Alison Leversha · Jason Gurney · Nicole J Moreland

Longitudinal research, with diverse patient groups and treatment-focused approaches, is needed to improve outcomes

Marie‐Claire Seeley · Gemma Wilson · Eric Ong · Amy Langdon · Jonathan Chieng · Danielle Bailey · Kristina Comacchio · Amanda Page · Dennis H Lau · Celine Gallagher

Remote patient monitoring is a beacon of resilience and innovation in modern medicine

Tuan Duong · Wenyong Wang · Clair Sullivan

Community remote monitoring is feasible and safe, and could be expanded to managing other medical conditions

Myong Gyu Kim · Phuong Thao Phan · Cambell McMaster · Praveen Indraratna · Jennifer Yu · Allison Martin · Rebecca Pinheiro · Lisa Altman · Guenter Schreier · Benjamin Kwan · Pamela Konecny · Jeffrey J Post · Nigel Lovell · Sze‐Yuan Ooi · Kristen Overton

A 28?year?old man developed a painful left eye with purulent discharge two weeks after recovering from coronavirus disease 2019

Chloe Story · Tina Marinelli · Simeon Crawford · Amrita Ronnachit

Annual COVID-19 vaccination campaigns at the same time as those for influenza vaccination could reduce the number of COVID-19-related hospitalisations

Fenella McAndrew · Romesh Abeysuriya · Nick Scott

Immunising 71% of infants was associated with 57% fewer hospital admissions with the leading cause of hospitalisation of infants

Lauren E Bloomfield · Nevada V Pingault · Rachel E Foong · Sarah French · Jo‐Anne Morgan · Ushma Wadia · Hannah C Moore · Christopher C Blyth · Peter C Richmond · Paul K Armstrong · Paul V Effler

A review of advancements in respiratory syncytial virus (RSV) prevention within Australia, focusing on the recent introduction of nirsevimab, a long-acting monoclonal antibody, and Abrysvo, a maternal RSV vaccine.

Sam T Barnett · Jane Tuckerman · Ian G Barr · Nigel W Crawford · Danielle F Wurzel

Integrating social sciences with natural sciences and epidemiology is essential to better mitigating the negative effects of future pandemics

Shanti Narayanasamy · Alisa Pedrana · Katherine B Gibney · Lisa Gibbs · Margaret E Hellard

Needle and syringe programs are evidence-based best practice interventions that reduce the harm associated with needle sharing

Alexander J Thompson · Michael H Levy

Each dollar spent on a needle and syringe program in Australian prisons could save $2.60 in treatment costs

Farah Houdroge · Samantha Colledge‐Frisby · Nadine Kronfli · Rebecca J Winter · Joanne Carson · Mark Stoove · Nick Scott