Topics

Abstract

Objective: To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010–2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning.

Design, setting and participants: This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010–2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis.

Main outcome measures: Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations.

Results: 331 493 mental health-related presentations to 115 NSW EDs during 2010–2014 were analysed. The presentation rate was highest for 15–19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10–14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0–9 years; the greatest increase was for the 10–19-year-old age group (27% per year).

Conclusions: The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care.

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1 Royal Prince Alfred Hospital, Sydney, NSW
2 Sydney Nursing School, University of Sydney, Sydney, NSW
3 The George Institute for Global Health, Sydney, NSW
4 Flinders University, Adelaide, SA
5 University of Sydney, Sydney, NSW
6 Sydney Medical School, University of Sydney, Sydney, NSW

Correspondence: Jayashanki.Perera@health.nsw.gov.au

Acknowledgements:

We acknowledge the NSW Ministry of Health and the Centre for Health Record Linkage (CHeReL) for granting access to and linkage of the data. This project was funded by the NSW Agency for Clinical Innovation and Emergency Care Institute.

Competing interests:

No relevant disclosures.

1. Patton GC, Coffey C, Sawyer SM, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet 2009; 374: 881-892.
2. Mokdad AH, Patton GC, Murray CJL, et al. Global burden of diseases, injuries, and risk factors for young people’s health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016; 387: 2383-2401.
3. Australian Bureau of Statistics. 3303.0. Causes of death, Australia, 2015. Suicide in Australia. Sept 2017. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0∼2016∼Main%20Features∼Intentional%20self-harm:%20key%20characteristics∼7 (viewed Feb 2018).
4. Australian Bureau of Statistics. 3303.0. Causes of death, Australia, 2015. Data cube: Intentional self-harm (suicide) (Australia). Sept 2017. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02016?OpenDocument (viewed Feb 2018).
5. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011 (AIHW Cat. No. BOD 4; Australian Burden of Disease Study Series No. 3). Canberra: AIHW, 2016.
6. Lawrence D, Johnson S, Hafekost J, et al. The mental health of children and adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra: Department of Health, 2015. https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/%24File/child2.pdf (viewed Apr 2017).
7. Hawton K, Saunders KE, O’Connor RC. Self-harm and suicide in adolescents. Lancet 2012; 379: 2373-2382.
8. Madge N, Hewitt A, Hawton K, et al. Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. J Child Psychol Psychiatry 2008; 49: 667-677.
9. Hawton K, Bergen H, Kapur N, et al. Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England. J Child Psychol Psychiatry 2012; 53: 1212-1219.
10. Spirito A, Lewander W. Assessment and disposition planning for adolescent suicide attempters treated in the emergency department. Clin Pediatr Emerg Med 2004: 5: 154-163.
11. Australian Health Ministers’ Conference. Fourth National Mental Health Plan. An agenda for collaborative government action in mental health (2009–2014). Canberra: AHMC, 2009. https://www.health.gov.au/internet/main/publishing.nsf/Content/9A5A0E8BDFC55D3BCA257BF0001C1B1C/$File/plan09v2.pdf (viewed Mar 2017).
12. Tankel AS, Di Palma MJ, Kramer KM, et al. Increasing impact of mental health presentations on New South Wales public hospital emergency departments 1999–2006. Emerg Med Australas 2011; 23: 689-696.
13. Alarcon Manchego P, Knott J, Graudins A, et al. Management of mental health patients in Victorian emergency departments: a 10 year follow-up study. Emerg Med Australas 2015; 27: 529-536.
14. Australian Bureau of Statistics. 3101.0. Australian demographic statistics, Jun 2014. Dec 2014. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3101.0Main+Features1Jun%202014 (viewed Aug 2016).
15. SNOMED International. SNOMED CT browser. http://browser.ihtsdotools.org/? (viewed Mar 2017).
16. National Centre for Classification in Health. The International Statistical Classification of Diseases and Related Health Problems, tenth revision, Australian modification (ICD-10-AM). Eighth edition. Wollongong: National Casemix and Classification Centre, University of Wollongong, 2013.
17. NSW Ministry of Health. Emergency Department Data Collection. Updated July 2017. http://www.cherel.org.au/media/23786/eddc-data-dictionary-for-cherel-website_20170710.docx (viewed Sept 2017).
18. Centers for Disease Control and Prevention. ICD-9-CM. International classification of diseases, ninth revision: clinical modification, 6th edition. Atlanta (GA): US Department of Health and Human Services, CDC, Centers for Medicare and Medicaid Services, 2010.
19. Australasian College for Emergency Medicine. Guidelines on the implementation of the Australasian Triage Scale In emergency departments. Nov 2000; revised July 2016. https://acem.org.au/getmedia/51dc74f7-9ff0-42ce-872a-0437f3db640a/G24_04_Guidelines_on_Implementation_of_ATS_Jul-16.aspx (viewed Sept 2017).
20. Dinh MM, Berendsen Russell S, Bein KJ, et al. Understanding drivers of demand for emergency service trends in years 2010-2014 in New South Wales: an initial overview of the DESTINY project. Emerg Med Australas 2016; 28: 179-186.
21. Australian Institute of Health and Welfare. Suicide and hospitalised self-harm in Australia: trends and analysis (AIHW Cat. No. INJCAT 169; Injury Research and Statistics Series No. 93). Canberra: AIHW, 2014.
22. Freed GL, Bingham A, Allen A, et al. Actual availability of general practice appointments for mildly ill children. Med J Aust 2015; 203: 145. <MJA full text>
23. Smith AR, Chein J, Steinberg L. Impact of socio-emotional context, brain development, and pubertal maturation on adolescent risk-taking. Horm Behav 2013; 64: 323-332.
24. Patton GC, Coffey C, Romaniuk H, et al. The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. Lancet 2014; 383: 1404-1411.
25. Bell L, Stargatt R, Bosanac P, et al. Child and adolescent mental health problems and substance use presentations to an emergency department. Australas Psychiatry 2011; 19: 521-525.
26. Rowe SL, French RS, Henderson C, et al. Help-seeking behaviour and adolescent self-harm: a systematic review. Aust N Z J Psychiatry 2014; 48: 1083-1095.
27. Hamm MP, Newton AS, Chisholm A, et al. Prevalence and effect of cyberbullying on children and young people: a scoping review of social media studies. JAMA Pediatr 2015; 69: 770-777.
28. Ortega-Montiel G. Aussie teens online [online]. Australian Communications and Media Authority. July 2014. http://www.acma.gov.au/theACMA/engage-blogs/engage-blogs/Research-snapshots/Aussie-teens-online (viewed Feb 2017).
29. Hawton K, Witt KG, Taylor Salisbury TL, et al. Interventions for self-harm in children and adolescents. Cochrane Database Syst Rev 2015; (12): CD012013.
30. Wand T, D’Abrew N, Barnett C, et al. Evaluation of a nurse practitioner-led extended hours mental health liaison nurse service based in the emergency department. Aust Health Rev 2015; 39: 1-8.
31. Australian Health Ministers’ Advisory Council. Healthy, safe and thriving: National strategic framework for child and youth health. Aug 2015. http://www.coaghealthcouncil.gov.au/Portals/0/Healthy%20Safe%20and%20Thriving%20-%20National%20Strategic%20Framework%20for%20Child%20and%20Youth%20Health.pdf (viewed Nov 2016).
32. Moran P, Coffey C, Romaniuk H, et al. The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. Lancet 2012; 379: 236-243.

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Narrative review

Tick-induced allergies: mammalian meat allergy and tick anaphylaxis

Sheryl A van Nunen

Med J Aust 2018; 208 (7): . || doi: 10.5694/mja17.00591
Published online: 16 April 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Immune system diseases

Wounds and injuries

Summary

Mammalian meat allergy after tick bites and tick anaphylaxis are the most serious tick-induced allergies. They are often severe, should be largely avoidable and offer fascinating insights into the development and prevention of allergies.
Australian clinicians reported the first cases of tick anaphylaxis and discovered the association between tick bites and the development of mammalian meat allergy. The subsequent finding of the allergen epitope within the meat responsible for the allergic reaction, α-gal (galactose-α-1,3-galactose), stimulated further interest in this emergent allergy.
Reports of mammalian meat allergy associated with bites from several tick species have now come from every continent where humans are bitten by ticks. The number of diagnosed patients has continued to rise.
Clinically, mammalian meat allergy and tick anaphylaxis present quite differently. The prominent role of cofactors in triggering episodes of mammalian meat allergy can make its diagnosis difficult.
Management of mammalian meat allergy is complicated by the manifold potential therapeutic implications due to the widespread distribution of the mammalian meat allergen, α-gal. Exposures to α-gal-containing medications have proved lethal in a minority of people, and fatal tick anaphylaxis has been reported in Australia. Prevention of tick bites is prudent and practicable; killing the tick in situ is crucial to both primary and secondary prevention of allergic reactions.
Mechanisms in the development of mammalian meat allergy constitute a paradigm for how allergies might arise.

1 Royal North Shore Hospital, Sydney, NSW
2 Tick-Induced Allergies Research and Awareness Centre, Sydney, NSW

Correspondence: vannunen@med.usyd.edu.au

Competing interests:

No relevant disclosures.

1. van Nunen S. Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance. Asia Pac Allergy 2015; 5: 3-16.
2. van Nunen S. Galactose-alpha-1,3-galactose, mammalian meat and anaphylaxis: a world-wide phenomenon? Curr Treat Options Allergy 2014; 1: 262-277.
3. Rappo TB, Cottee AM, Ratchford AM, Burns BJ. Tick bite anaphylaxis: incidence and management in an Australian emergency department. Emerg Med Australas 2013; 25: 297-301.
4. van Nunen S, O’Connor KS, Fernando SL, et al. The association between Ixodes holocyclus tick bite reactions and red meat allergy. Intern Med J 2007; 39: A132.
5. van Nunen SA, O’Connor KS, Clarke LR, et al. An association between tick bite reactions and red meat allergy in humans. Med J Aust 2009; 190: 510-511. <MJA full text>
6. Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol 2009; 123: 426-433.
7. Jacquenet S, Moneret-Vautrin DA, Bihain BE. Mammalian meat-induced anaphylaxis: clinical relevance of anti-galactose-alpha-1,3-galactose IgE confirmed by means of skin tests to cetuximab. J Allergy Clin Immunol 2009; 124: 603-605.
8. Nuñez R, Carballada F, Gonzalez-Quintela A, et al. Delayed mammalian meat-induced anaphylaxis due to galactose-α-1,3-galactose in 5 European patients. J Allergy Clin Immunol 2011; 128: 1122-1124.e1.
9. Jappe U. Update on meat allergy. α-gal: a new epitope, a new entity? Hautarzt 2012; 63: 299-306.
10. Lee JH, Kim JH, Kim TH, Kim SC. Delayed mammalian meat-induced anaphylaxis confirmed by skin test to cetuximab. J Dermatol 2013; 40: 577-578.
11. Sekiya K, Fukutomi Y, Nakazawa T, et al. Delayed anaphylactic reaction to mammalian meat. J Invest Allergol Clin Immunol 2012; 22: 446-447.
12. Hamsten C, Tran TAT, Starkhammar M, et al. Red meat allergy in Sweden: association with tick sensitization and B-negative blood groups. J Allergy Clin Immunol 2013; 132: 1431-1434.
13. Michel S, Scherer K, Heijnen IA, Bircher AJ. Skin prick test and basophil reactivity to cetuximab in patients with IgE to alpha-gal and allergy to red meat. Allergy 2014; 69: 403-405.
14. Wickner PG, Commins S. The first central American cases of delayed meat allergy with galactose-alpha-1,3-galactose positivity clustered among field biologists in Panama. Abstract 736; American Academy of Allergy, Asthma and Immunology Annual Meeting; San Diego, CA (US); 28 Feb – 4 Mar 2014.
15. Shepherd M. Anaphylaxis shock warning over Highland tick bites. Edinburgh: Royal Environmental Health Institute of Scotland; 2015. https://www.rehis.com/sites/default/files/rehis_september_2015_e-newsletter_120915_1.pdf (viewed Feb 2018).
16. Calamari AM, Poppa M, Villalta D, Pravettoni V. Alpha-gal anaphylaxis: the first case report from Italy. Eur Ann Allergy Clin Immunol 2015; 47: 161-162.
17. Gray CL, van Zyl A, Strauss L. “Midnight anaphylaxis” to red meat in patients with alpha-gal sensitisation: a recent discovery in the food allergy world and a case report from South Africa. Curr Allergy Clin Immunol 2016; 29: 102-104.
18. Chinuki Y, Ishiwata K, Yamaji K, et al. Haemaphysalis longicornis tick bites are a possible cause of red meat allergy in Japan. Allergy 2016; 71: 421-425.
19. Cocco RR, Ensina LF, Aranda CS, Solé D. Galactose-α-1,3-galactose (alpha gal) allergy without anaphylaxis: a case report in Brazil. Clin Transl Allergy 2017; 7: 7.
20. Kaloga M, Kourouma S, Kouassi YI, et al. Allergy to red meat: a diagnosis made by the patient and confirmed by an assay for IgE antibodies specific for alpha-1,3-galactose. Case Rep Dermatol 2016; 8: 10-13.
21. Lied GA. Red meat allergy induced by tick bite: a Norwegian case report. Eur Ann Allergy Clin Immunol 2017; 49: 186-188.
22. McGain F, Welton R, Solley GO, Winkel KD. First fatalities in tick anaphylaxis. J Allergy Clin Immunol Pract 2016; 4: 769-770.
23. Mullins RJ, Wainstein BK, Barnes EH, et al. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clin Exp Allergy 2016; 46: 1099-1110.
24. van Wye JE, Hsu YP, Lane RS, et al. IgE antibodies in tick bite-induced anaphylaxis. J Allergy Clin Immunol 1991; 88: 968-970.
25. van Wye JE, Hsu YP, Terr AI, Moss RB. Anaphylaxis from a tick bite. N Engl J Med 1991; 324: 777-778.
26. Moneret-Vautrin DA, Beaudouin E, Kanny G, et al. Anaphylactic shock caused by ticks (Ixodes ricinus). J Allergy Clin Immunol 1998; 101: 144-145.
27. Fernández-Soto P, Dávila I, Laffond E, et al. Tick-bite-induced anaphylaxis in Spain. Ann Trop Med Parasitol 2001; 95: 97-103.
28. Fischer J, Yazdi AS, Biedermann T. Clinical spectrum of α-gal syndrome: from immediate-type to delayed immediate-type to mammalian innards and meat. Allergo J Int 2016; 25: 55-62.
29. Acero S, Blanco R, Bartolomé B. Anaphylaxis due to a tick bite. Allergy 2003; 58: 824-825.
30. Valls A, Pineda F, Belver M, et al. Anaphylactic shock caused by tick (Rhipicephalus sanguineous). J Investig Allergol Clin Immunol 2007; 17: 279-280.
31. Mateos-Hernández L, Villar M, Moral A, et al. Tick-host conflict: immunoglobulin E antibodies to tick proteins in patients with anaphylaxis to tick bite. Oncotarget 2017; 8: 20630-20644.
32. Gauci M, Loh RKS, Stone BF, Thong YH. Allergic reactions to the Australian paralysis tick, Ixodes holocyclus: diagnostic evaluation by skin test and radioimmunoassay. Clin Exp Allergy 1989; 19: 279-283.
33. Graft DF, Schuberth KC, Kagey-Sobotka A, et al. A prospective study of the natural history of large local reactions after Hymenoptera stings in children. J Pediatr 1984; 104; 664-668.
34. Galili U, Clark MR, Shohet SB, et al. Evolutionary relationship between the natural anti-gal antibody and the gal-alpha-1,3-gal epitope in primates. Proc Natl Acad Sci U S A 1987; 84: 1369-1373.
35. Galili U, Mandrell RE, Hamadeh RM, et al. Interaction between human natural anti-alpha-galactosyl immunoglobulin G and bacteria of the human flora. Infect Immun 1988; 56: 1730-1737.
36. Galili U. Evolution and pathophysiology of the human natural anti-α-galactosyl IgG (anti-gal) antibody. Springer Semin Immunopathol 2004; 15: 155-171.
37. Commins S, Lucas S, Hosen J, et al. Anaphylaxis and IgE antibodies to galactose-alpha-1,3-galactose (alphaGal): insight from the identification of novel IgE ab to carbohydrates on mammalian proteins. J Allergy Clin Immunol 2008; 121: S25.
38. Gauci M, Stone BF, Thong YH. Detection in allergic individuals of IgE specific for the Australian paralysis tick, Ixodes holocyclus. Int Arch Appl Immunol 1988; 85: 190-193.
39. Gauci M, Stone BF, Thong YH. Isolation and immunological characterisation of allergens from salivary glands of the Australian paralysis tick, Ixodes holocyclus. Int Arch Appl Allergy Immunol 1988; 87: 208-212.
40. Broady KW. Presentation of findings: tick allergens; TiARA (Tick-induced Allergies Research and Awareness) Committee Meeting. Royal North Shore Hospital; Sydney (Australia), 20 Aug 2013.
41. Dorey C. Allergens of the Australian paralysis tick, Ixodes holocyclus [dissertation]. Sydney: University of Technology Sydney, 1998.
42. Padula MP. The development of proteomic techniques to study the Australian paralysis tick [dissertation]. Sydney: University of Technology Sydney, 2008.
43. Cooper PJ. Interactions between helminth parasites and allergy. Curr Opin Allergy Clin Immunol 2009; 9: 29-37.
44. Tyagi N, Farnell EJ, Fitzsimmons CM, et al. Comparisons of allergenic and metazoan parasite proteins: allergy the price of immunity. PLoS Comput Biol 2015; 11: e1004546.
45. Commins SP, Platts-Mills TA. Tick bites and red meat allergy. Curr Opin Allergy Clin Immunol 2013; 13: 354-359.
46. James HR, Commins SP, Kelly LA, et al. Further evidence for tick bites as a cause of the IgE responses to alpha-gal that underlie a major increase in delayed anaphylaxis to meat. J Allergy Clin Immunol 2011; 127: AB243.
47. Kennedy JL, Stallings AP, Platts-Mills TA, et al. Galactose-α-1,3-galactose and delayed anaphylaxis, angioedema and urticaria in children. Pediatrics 2013; 131: e1545-e1552.
48. Mullins RJ, James H, Platts-Mills TA, Commins S. Relationship between red meat allergy and sensitization to gelatin and galactose-α-1,3-galactose. J Allergy Clin Immunol 2012; 129: 1334-1342.e1.
49. Renaudin J, Jacquenet S, Metz-Favre C, et al. Interest of specific IgE measurement for galactose-alpha-1,3-galactose in unexplained urticaria and angioedema, predominantly nocturnal: about 6 cases. J Allergy Clin Immunol 2012; 129: AB177.
50. Morisset M, Richard C, Astier C, et al. Anaphylaxis to pork kidney is related to IgE antibodies specific for galactose-alpha-1,3-galactose. Allergy 2012; 67: 699-704.
51. Morisset M, Richard C, Zanna H, et al. Allergy to cow’s milk related to IgE antibodies specific for galactose-alpha-1,3-galactose. Abstract 1617. European Academy of Allergology and Clinical Immunology Congress and World Allergy Organization; Milan (Italy); 22-26 June 2013.
52. Caponetto P, Fischer J, Biedermann T. Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-α-1,3-galactose. J Allergy Clin Immunol Pract 2013; 1: 302-303.
53. Hamsten C, Starkhammar M, Tran TA, et al. Identification of galactose-α-1,3-galactose in the gastrointestinal tract of the tick Ixodes ricinus; possible relationship with red meat allergy. Allergy 2013; 68: 549-552.
54. Jappe U, Platts-Mills T, Przybilla B, et al. IgE-reactivity to galactose-[alpha]-1,3-galactose: a prospective multicentre study on meat allergy, urticaria and anaphylaxis [abstract #202]. Proceedings for the Thirty-first European Academy of Allergy and Clinical Immunology Congress; Geneva, Switzerland; 2012 June 16–20.
55. Baumgart KW, Mok A, Sivertsen T, et al. Allergen-specific IgE after anaphylaxis to tick or mammalian/marsupial meat in Australia. European Academy of Allergy and Clinical Immunology Congress; Copenhagen (Denmark); 7–11 June 2014. Allergy 2014; 69: 1-646.
56. Platts-Mills TA, Commins SP. Emerging antigens involved in allergic responses. Curr Opin Immunol 2013; 25: 769-774.
57. Fischer J, Yazdi A, Biedermann T. Mammalian meat allergy: a diagnostic challenge. Allergo J Int 2015; 24: 81-83.
58. van Nunen SA, Said MG, Batty G. Use of expanded search criteria in diagnosing mammalian meat allergy provoked by previous tick bites in individuals who do not live where ticks are endemic. Abstract 2602. European Academy of Allergy and Clinical Immunology Congress and World Allergy Organization; Milan (Italy); 22-26 June 2013.
59. Wölbing F, Fischer J, Köberle M, et al. About the role and underlying mechanisms of cofactors in anaphylaxis. Allergy 2013; 68: 1085-1092.
60. Versluis A, van Os-Medendorp H, Kruizinga A, et al. Cofactors in allergic reactions to food: physical exercise and alcohol are the most important. Immun Inflamm Dis 2016; 4: 392-400.
61. Commins SP, James HR, Stevens W, et al. Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. J Allergy Clin Immunol 2014; 134: 108-115.
62. Gonzalez-Quintela A, Dam Laursen AS, Vidal C, et al. IgE antibodies to alpha-gal in the general population: relationship to tick bites, atopy, and cat ownership. Clin Exp Allergy 2014; 44: 1061-1068.
63. Olafson PU. Ticks and the mammalian meat allergy. Beef Research 2014; 4: 1-3.
64. Fischer J, Lupberger E, Hebsaker J, et al. Prevalence of type I sensitization to alpha-gal in forest service employees and hunters. Allergy 2017; 72: 1540-1547.
65. McKay WJS. Tick bite and allergy. Med J Aust 1940; 1: 458-459.
66. Trinca JC. Insect allergy in Australia. Results of a five-year survey. Med J Aust 1964; 2: 659-663.
67. Banfield JF. Tick bites in man. Med J Aust 1966; 2: 600-601.
68. Kemp A. Tick bites. Med J Aust 1986; 144: 615.
69. Brown AF, Hamilton DL. Tick bite anaphylaxis in Australia. J Accid Emerg Med 1998; 15: 111-113.
70. Sánchez M, Venturini M, Blasco A, et al. Tick bite anaphylaxis in a patient allergic to bee venom. J Investig Allergol Clin Immunol 2014; 24: 284-285.
71. van Nunen S, Basten A, Cowdery N, et al. Tick removal techniques practised by tick anaphylaxis sufferers. Intern Med J 2014; 44: 1-37.
72. Gauci M, Stone BF, Thong YH. Detection in allergic individuals of IgE specific for the Australian paralysis tick, Ixodes holocyclus. Int Arch Allergy Appl Immunol 1988; 85: 190-193.
73. Gauci M, Stone BF, Thong YH. Isolation and immunological characterisation of allergens from salivary glands of the Australian paralysis tick Ixodes holocyclus. Int Arch Allergy Appl Immunol 1988; 87: 208-212.
74. Galili U. Anti-gal: an abundant human natural antibody of multiple pathogeneses and clinical benefits. Immunology 2013; 140: 1-11.
75. Pointreau Y, Commins SP, Calais G, et al. Fatal infusion reactions to cetuximab: role of immunoglobulin E-mediated anaphylaxis. J Clin Oncol 2012; 30: 334; author reply 335.
76. Stone CA, Hemler JA, Commins SP, et al. Anaphylaxis after zoster vaccine: implicating alpha-gal allergy as a possible mechanism. J Allergy Clin Immunol 2017; 139: 1710-1713.e2
77. Naso F, Gandaglia A, Bottio T, et al. First quantification of alpha-gal epitope in current glutaraldehyde-fixed heart valve bioprostheses. Xenotransplantation 2013; 20: 252-261.
78. Fournier PE, Thuny F, Grisoli D, et al. A deadly aversion to pork. Lancet 2011; 377: 1542.
79. Mozzicato SM, Tripathi A, Posthumus JB, et al. Porcine or bovine valve replacement in 3 patients with IgE antibodies to the mammalian oligosaccharide galactose-alpha-1,3-galactose. J Allergy Clin Immunol Pract 2014; 2: 637-638.
80. Fischer J, Eberlein B, Hilger C, et al. Alpha-gal is a possible target of IgE-mediated reactivity to antivenom. Allergy 2017; 72: 764-771.
81. Commins SP, Jerath MR, Cox K, et al. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int 2016; 65: 16-20.
82. Australasian Society of Clinical Immunology and Allergy. Tick allergy [website]. Sydney: ASCIA; 2016. https://www.allergy.org.au/patients/insect-allergy-bites-and-stings/tick-allergy (viewed Nov 2017).
83. Stone BF. Dealing with ticks affecting humans in Australia, especially the Australian paralysis tick Ixodes holocyclus. St Lucia (Australia); Department of Microbiology and Parasitology, School of Molecular and Microbial Sciences, University of Queensland; 2000.
84. Due C, Fox W, Medlock JM, et al. Tick bite prevention and tick removal. BMJ 2013; 347: f7123.
85. Ferreira BR, Silva JS. Successive tick infestations selectively promote a T-helper 2 cytokine profile in mice. Immunology 1999; 96: 434-439.
86. Jyo T, Kuwabara M, Kodommari Y, et al. Cases of immediate-type allergy in oyster shuckers due to galacto-oligosaccharide. J Hiroshima Med Assoc 1993; 25: 19-26.
87. Goh DL, Chua KY, Chew FT, et al. Immunochemical characterization of edible bird’s nest allergens. J Allergy Clin Immunol 2001; 107: 1082-1087.
88. Araujo RN, Franco PF, Rodrigues H, et al. Amblyomma sculptum tick saliva: α-gal identification, antibody response and possible association with red meat allergy in Brazil. Int J Parasitol 2016; 46: 213-220.
89. Commins SP, Karim S. Development of a novel murine model of alpha-gal meat allergy. J Allergy Clin Immunol 2017; 139: AB193.

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Research

Damp housing, gas stoves, and the burden of childhood asthma in Australia

Luke D Knibbs, Solomon Woldeyohannes, Guy B Marks and Christine T Cowie

Med J Aust 2018; 208 (7): . || doi: 10.5694/mja17.00469
Published online: 16 April 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Respiratory tract diseases

Abstract

Objective: To determine the proportion of the national childhood asthma burden associated with exposure to dampness and gas stoves in Australian homes.

Design: Comparative risk assessment modelling study.

Setting, participants: Australian children aged 14 years or less, 2011.

Main outcome measures: The population attributable fractions (PAFs) and number of disability-adjusted life years (DALYs) for childhood asthma associated with exposure to damp housing and gas stoves.

Results: 26.1% of Australian homes have dampness problems and 38.2% have natural gas as the main energy source for cooktop stoves. The PAF for childhood asthma attributable to damp housing was 7.9% (95% CI, 3.2–12.6%), causing 1760 disability-adjusted life years (DALYs; 95% CI, 416–3104 DALYs), or 42 DALYs/100 000 children. The PAF associated with gas stoves was 12.3% (95% CI, 8.9–15.8%), corresponding to 2756 DALYs (95% CI, 1271–4242), or 67 DALYs/100 000 children. If all homes with gas stoves were fitted with high efficiency range hoods to vent gas combustion products outdoors, the PAF and burden estimates were reduced to 3.4% (95% CI, 2.2–4.6%) and 761 DALYs (95% CI, 322–1199).

Conclusions: Exposure to damp housing and gas stoves is common in Australia, and is associated with a considerable proportion of the childhood asthma burden. Strategies for reducing exposure to indoor dampness and gas combustion products should be communicated to parents of children with or at risk of asthma.

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1 University of Queensland, Brisbane, QLD
2 Woolcock Institute of Medical Research, Sydney, NSW
3 Liverpool Hospital, Sydney, NSW
4 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW

Correspondence: l.knibbs@uq.edu.au

Acknowledgements:

This work was supported by the National Health and Medical Research Council (Luke Knibbs: Early Career Fellowship [APP1036620]; Guy Marks: Centres of Research Excellence grant [APP1030259]), the Centre for Air Quality and Health Research and Evaluation (Luke Knibbs, Christine Cowie: postdoctoral fellowships), and the New South Wales Ministry of Health (funding to Christine Cowie and Guy Marks).

Competing interests:

No relevant disclosures.

1. Australian Centre for Asthma Monitoring. Asthma in Australia 2011: with a focus chapter on chronic obstructive pulmonary disease (AIHW Cat. No. ACM 22; Asthma Series no. 4). Canberra: Australian Institute of Health and Welfare, 2011. https://www.aihw.gov.au/reports/asthma-other-chronic-respiratory-conditions/asthma-in-australia-2011-with-chapter-on-copd/contents/table-of-contents (viewed Apr 2017).
2. Institute of Medicine. Climate change, the indoor environment, and health. Washington (DC): The National Academies Press, 2011. https://www.nap.edu/catalog/13115/climate-change-the-indoor-environment-and-health (viewed Apr 2017).
3. Garrett MH, Hooper MA, Hooper BM, Abramson MJ. Respiratory symptoms in children and indoor exposure to nitrogen dioxide and gas stoves. Am J Resp Crit Care Med 1998; 158: 891-895.
4. Franklin P, Dingle P, Stick S. Raised exhaled nitric oxide in health children is associated with domestic formaldehyde levels. Am J Resp Crit Care Med 2000; 161: 1747-1749.
5. Ponsonby AL, Couper D, Dwyer T, et al. The relation between infant indoor environment and subsequent asthma. Epidemiology 2000; 11: 128-135.
6. Lin W, Brunekreef B, Gehring U. Meta-analysis of the effects of indoor nitrogen dioxide and gas cooking on asthma and wheeze in children. Int J Epidemiol 2013; 42: 1724-1737.
7. Quansah R, Jaakkola MS, Hugg TT, et al. Residential dampness and molds and the risk of developing asthma: a systematic review and meta-analysis. PLoS One 2012; 7: e47526.
8. Pilotto LS, Nitschke M, Smith BJ, et al. Randomized controlled trial of unflued gas heater replacement on respiratory health of asthmatic schoolchildren. Int J Epidemiol 2003; 33: 208-214.
9. Marks GB, Ezz W, Aust N, et al. Respiratory health effects of exposure to low-NOx unflued gas heaters in the classroom: a double-blind, cluster-randomized, crossover study. Environ Health Perspect 2010; 118: 1476-1482.
10. Hänninen O, Knol A (editors). European perspectives on environmental burden of disease: estimates for nine stressors in six European countries. Helsinki: National Institute for Health and Welfare, 2011. https://www.julkari.fi/bitstream/handle/10024/79910/b75f6999-e7c4-4550-a939-3bccb19e41c1.pdf (viewed Apr 2017).
11. Fisk WJ, Lei-Gomex Q, Mendell MJ. Meta-analyses of the associations of respiratory health effects with dampness and mould in homes. Indoor Air 2007; 17: 284-296.
12. Australian Bureau of Statistics. 4602.0.55.001. Energy use and conservation survey, 2011. Energy use and conservation additional tables (data cube). http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&4602055001do002_201103.xls&4602.0.55.001&Data%20Cubes&E32C173D338FE75FCA257953000EE41A&0&Mar%202011&28.11.2011&Previous (viewed Apr 2017).
13. Lunden MM, Delp WW, Singer BC. Capture efficiency of cooking-related fine and ultrafine particles by residential exhaust hoods. Indoor Air 2015; 25: 45-58.
14. Australian Bureau of Statistics 2013, 2011 Census community profiles. Basic community profile, table B04. http://www.censusdata.abs.gov.au/census_services/getproduct/census/2011/communityprofile/0 (viewed Feb 2018).
15. Australia Institute of Health and Welfare. Assessment of global burden of disease 2010 methods for the Australian context (Working paper no. 1). Canberra: AIHW, 2014. http://content.webarchive.nla.gov.au/gov/wayback/20170421063605/http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547710 (viewed Apr 2017).
16. Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 1998; 280: 1690-1691.
17. Tischer C, Chen C-M, Heinrich J. Association between domestic mould and mould components, and asthma and allergy in children: a systematic review. Eur Respir J 2011; 38: 812-824.
18. Tischer CG, Hohmann C, Thiering E, et al. Meta-analysis of mould and dampness exposure on asthma and allergy in eight European birth cohorts: an ENRIECO initiative. Allergy 2011; 66: 1570-1579.
19. Australian Institute for Health and Welfare. National drug household survey: detailed report 2013 (AIHW Cat. No. PHE 183; Drug Statistics Series No. 28). http://www.aihw.gov.au/publication-detail/?id=60129549469 (viewed Apr 2017).
20. Institute of Medicine. Damp indoor spaces and health. Washington (DC): The National Academies Press, 2004. https://www.nap.edu/catalog/11011/damp-indoor-spaces-and-health (viewed Apr 2017).
21. World Health Organization. WHO guidelines for indoor air quality: dampness and mould. Copenhagen: WHO Regional Office for Europe, 2009. http://www.who.int/indoorair/publications/7989289041683/en/ (viewed Apr 2017).
22. Heinrich J. Influence of indoor factors in dwellings on the development of childhood asthma. Int J Hyg Environ Health 2011; 214: 1-25.
23. Jarvis D, Chinn S, Sterne J, et al. The association of respiratory symptoms and lung function with the use of gas for cooking. Eur Respir J 1998; 11: 651-658.
24. Dharmage S, Bailey M, Raven J, et al. Prevalence and residential determinants of fungi within homes in Melbourne, Australia. Clin Exp Allergy 1999; 29: 1481-1489.
25. New South Wales Ministry of Health. Environmental health fact sheets [website]. Updated Sept 2017. http://www.health.nsw.gov.au/environment/factsheets/Pages/default.aspx (viewed Sept 2017).

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Editorials

Planetary health: what is it and what should doctors do?

Anthony G Capon, Nicholas J Talley AC and Richard C Horton

Med J Aust 2018; 208 (7): . || doi: 10.5694/mja18.00219
Published online: 16 April 2018

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Environment and public health

Planetary health is the business of the medical profession because the health of our patients is at risk

During the lifetime of many MJA readers, there have been remarkable improvements in human health. Since 1950, global average life expectancy has risen 25 years to its current level of 72 years, and global infant mortality rates have decreased substantially from around 210 per 1000 live births to just over 30 per 1000 now.1-3

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1 Professor of Planetary Health, University of Sydney, Sydney, NSW
2 Editor-in-Chief, Medical Journal of Australia, Sydney, NSW
3 Editor-in-Chief, Lancet, London, UK

Correspondence: tony.capon@sydney.edu.au

Competing interests:

Anthony Capon is a member of the Editorial Advisory Committee. Anthony Capon and Richard Horton are members of the Commission on Planetary Health.

1. Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the Anthropocene epoch: report of the Rockefeller Foundation-Lancet Commission on planetary health. Lancet 2015; 386: 1973-2028.
2. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. World population prospects: the 2017 revision. New York: United Nations, 2017. https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html (viewed Feb 2018).
3. Hug L, Shannon D, You D. Levels and trends in child mortality report 2017. New York: United Nations Inter-agency Group for Child Mortality Estimation; 2017. http://www.who.int/maternal_child_adolescent/documents/levels_trends_child_mortality_2017/en (viewed Feb 2018).
4. Steffen W, Broadgate W, Deutsch L, et al. The trajectory of the Anthropocene: the great acceleration. The Anthropocene Review 2015; 2: 81-98.
5. Hanna EG, McIver LJ. Climate change: a brief overview of the science and health impacts for Australia. Med J Aust 2018; 208: 311-315.
6. Knibbs LD, Woldeyohannes S, Marks GB, Cowie CT. Damp housing, gas stoves, and the burden of childhood asthma in Australia. Med J Aust 2018; 208: 299-302.
7. Horsley JA, Broome RA, Johnston FH, et al. Health burden associated with fire smoke in Sydney, 2001–2013. Med J Aust 2018; 208: 309-310.
8. van Nunen SA. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. Med J Aust 2018; 208: 316-321.
9. Pencheon D. Developing a sustainable health care system: the United Kingdom experience. Med J Aust 2018; 208: 284-285.
10. McMichael AJ, Dear KB. Climate change: heat, health, and longer horizons. Proc Natl Acad Sci U S A 2010; 107: 9483-9484.
11. Hussey R, Weatherup C. Lessons from Wales — how to embed sustainability and prevention in health care. Med J Aust 2016; 204: 102-103. <MJA full text>
12. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27-e35.
13. Hippocrates. On air, waters and places. In: The genuine works of Hippocrates. Translated with a commentary by Francis Adams. London: Sydenham Society, 1849.
14. Sveiby KE, Skuthorpe T. Treading lightly: the hidden wisdom of the world’s oldest people. Sydney: Allen and Unwin; 2006.

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Medical education

Preparing medical graduates for the health effects of climate change: an Australasian collaboration

Diana L Madden, Michelle McLean and Graeme L Horton

Med J Aust 2018; 208 (7): . || doi: 10.5694/mja17.01172
Published online: 16 April 2018

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Environment and public health

Medical education

Global health

Building a medical workforce that understands the impact of climate change on health and health services and will create change

The Lancet has described action to address climate change as the greatest public health opportunity before us.1 However, to grasp this opportunity, health professionals, including doctors, must understand the impact of climate change on health and be competent to take action and advocate for change. Otherwise it will be a missed opportunity when an urgent and scaled response to mitigate and adapt to climate change is required if society is to avoid the most harmful consequences. Medical degrees (primary medical programs) in Australia and New Zealand are responsible for preparing doctors for entry into clinical practice and to care for patients and their communities. In response to the health threats posed by climate change, Medical Deans of Australia and New Zealand (MDANZ) has formed a working group, representing medical schools and medical student associations across both countries, to work collaboratively to develop curricula and resources to address this within primary medical programs. This article summarises this initiative.

1 University of Notre Dame Australia, Sydney, NSW
2 Australasian Faculty of Public Health Medicine, Royal Australasian College of Physicians, Sydney, NSW
3 Bond University, Gold Coast, QLD
4 University of Newcastle, Newcastle, NSW

Correspondence: lynne.madden@nd.edu.au

Competing interests:

No relevant disclosures.

1. Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386: 1861-1914.
2. Watts N, Amann M, Ayeb-Karlsson S, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet 2018; 391: 581-630.
3. O’Shea K. The Lancet Countdown on health and climate change: Australia policy brief. 31 October 2017. http://www.lancetcountdown.org/media/1341/2017-lancet-countdown-australian-policy-brief.pdf (accessed Nov 2017).
4. World Health Organization. Second Global Conference on Health and Climate, Paris 7–8 July 2016. Conference conclusions and action agenda. http://www.who.int/globalchange/conference-conclusions-13July2016.pdf?ua=1 (viewed Feb 2018).
5. United Nations Framework Convention on Climate Change. The Paris Agreement. http://unfccc.int/paris_agreement/items/9485.php (viewed Nov 2017).
6. United Nations Educational, Scientific and Cultural Organization. Declaration of ethical principles in relation to climate change. Paris: UNESCO, 2017. http://unesdoc.unesco.org/images/0026/002601/260129e.pdf (viewed Nov 2017).
7. Thompson T, Walpole S, Braithwaite I, et al. Learning objectives for sustainable health care. Lancet 2014; 384: 1924-1925.
8. Walpole SC, Pearson D, Coad J, Barna S. What do tomorrow’s doctors need to learn about ecosystems? A BEME systematic review: BEME guide no. 36. Med Teach 2016; 38: 338-352.
9. Walpole SC, Vyas A, Maxwell J, et al. Building an environmentally accountable medical curriculum through international collaboration. Med Teach 2017; 39: 1040-1050.
10. Teherani A, Nishimua H, Apatria L, et al. Identification of core objectives for teaching sustainable healthcare education. Med Educ Online 2017; 22: doi:10.1080/10872981.2017.1386042.
11. Australian Medical Students’ Association. Code green: climate health short course. https://eliademy.com/catalog/catalog/product/view/sku/d0dd478153 (viewed Nov 2017).
12. International Federation of Medical Students’ Association. Training manual: climate and health. Enabling students and young professionals to understand and act upon climate change using a health narrative. IFMSA, 2016. https://ifmsa.org/wp-content/uploads/2017/03/Final-IFMSA-Climate-and-health-training-Manual-2016.pdf (viewed Nov 2017).
13. United Nations. Sustainable development goals: 17 goals to transform our world. http://www.un.org/sustainabledevelopment/sustainable-development-goals/ (viewed Nov 2017).
14. Shaman J, Knowlton K. The need for climate and health education. Am J Public Health 2017; doi:10.2105/AJPH.2017.304045 [Epub ahead of print].

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Perspectives

Tackling the worsening epidemic of Buruli ulcer in Australia in an information void: time for an urgent scientific response

Daniel P O'Brien, Eugene Athan, Kim Blasdell and Paul De Barro

Med J Aust 2018; 208 (7): . || doi: 10.5694/mja17.00879
Published online: 16 April 2018

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Infectious diseases

Environment and public health

Understanding risk factors is key to defining the source and transmission route of Mycobacterium ulcerans

Mycobacterium ulcerans causes an infectious disease known internationally as Buruli ulcer, and also as Bairnsdale ulcer or Daintree ulcer in Australia. It causes severe destructive lesions of skin and soft tissue, resulting in significant morbidity, in attributable mortality and often in long term disability and cosmetic deformity.1 All age groups, including young children, are affected, and the emotional and psychological impact on patients and their carers is substantial (Box 1). Although treatment effectiveness has improved in recent years, with cure rates approaching 100% using combination antibiotic regimens such as rifampicin and clarithromycin,2 these antibiotics are not covered by the Pharmaceutical Benefits Scheme for this condition and are, therefore, expensive to patients. Moreover, these antibiotics have severe side effects in up to one-quarter of patients,1 and many people also require reparative plastic surgery, sometimes with prolonged hospital admissions. The disease thus results in substantial costs, averaging $14 000 per patient including direct3 and indirect costs (eg, transport, lost productivity and dressings) — it had an estimated cost to Victoria in 2016 of $2 548 000 (Paul Mwebaze, Research Scientist, Adaptive Urban and Social Systems, Land and Water, CSIRO, Australia, personal communication, June 2017).

1 Barwon Health, Geelong, VIC
2 Geelong Centre for Emerging Infectious Diseases, Geelong, VIC
3 CSIRO, Brisbane, QLD

Correspondence: DanielO@BarwonHealth.org.au

Competing interests:

No relevant disclosures.

1. O’Brien DP, Friedman ND, Cowan R, et al. Mycobacterium ulcerans in the elderly: more severe disease and suboptimal outcomes. PLoS Negl Trop Dis 2015; 9: e0004253.
2. Friedman ND, Athan E, Walton AL, O’Brien DP. Increasing experience with primary oral medical therapy for Mycobacterium ulcerans disease in an Australian cohort. Antimicrob Agents Chemother 2016; 60: 2692-2695.
3. Pak J, O’Brien DP, Quek TY, Athan E. Treatment costs of Mycobacterium ulcerans in the antibiotic era. Int Health 2012; 4: 123-127.
4. World Health Organization. Buruli ulcer — number of new cases of Buruli ulcer reported: 2016 [website]. http://apps.who.int/neglected_diseases/ntddata/buruli/buruli.html (viewed Nov 2017).
5. Steffen CM, Freeborn H. Mycobacterium ulcerans in the Daintree 2009–2015 and the mini-epidemic of 2011. ANZ J Surg 2016.
6. Centers for Disease Control and Prevention. Lesson 6: investigating an outbreak [website]. Atlanta: CDC; 2016. https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson6/section2.html (viewed Nov 2017).
7. Tai A, Athan E, Friedman ND, et al. Increased severity and spread of Mycobacterium ulcerans, southeastern Australia. Emerg Infect Dis 2018. doi:10.3201/eid2401.171070. [Epub ahead of print].
8. Williamson HR, Benbow ME, Nguyen KD, et al. Distribution of Mycobacterium ulcerans in Buruli ulcer endemic and non-endemic aquatic sites in Ghana. PLoS Negl Trop Dis 2008; 2: e205.
9. Veitch MG, Johnson PD, Flood PE, et al. A large localized outbreak of Mycobacterium ulcerans infection on a temperate southern Australian island. Epidemiol Infect 1997; 119: 313-318.
10. Quek TYJ, Athan E, Henry MJ, et al. Risk factors for Mycobacterium ulcerans infection, southeastern Australia. Emerg Infect Dis 2007; 13: 1661-1666.
11. Portaels F, Elsen P, Guimaraes-Peres A, et al. Insects in the transmission of Mycobacterium ulcerans infection. Lancet 1999; 353: 986.
12. Wallace JR, Mangas KM, Porter JL, et al. Mycobacterium ulcerans low infectious dose and mechanical transmission support insect bites and puncturing injuries in the spread of Buruli ulcer. PLoS Negl Trop Dis 2017; 11: e0005553.
13. Fyfe JAM, Lavender CJ, Handasyde KA, et al. A major role for mammals in the ecology of Mycobacterium ulcerans. PLoS Negl Trop Dis 2010; 4: e791.
14. Yerramilli A, Tay EL, Stewardson AJ, et al. The location of Australian Buruli ulcer lesions — implications for unravelling disease transmission. PLoS Negl Trop Dis 2017; 11: e0005800.
15. O’Brien DP, Wynne JW, Buultjens AH, et al. Exposure risk for infection and lack of human-to-human transmission of Mycobacterium ulcerans disease, Australia. Emerg Infect Dis 2017; 23: 837-840.

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Perspectives

The Lancet Countdown down under: tracking progress on health and climate change in Australia

Ying Zhang and Paul J Beggs

Med J Aust 2018; 208 (7): . || doi: 10.5694/mja17.01245
Published online: 16 April 2018

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Topics

Environment and public health

Australia is set to join a global initiative to track progress on health and climate change

When it comes to climate change and human health, Australia has, in many respects, an impressive track record. The late Professor Tony McMichael led the international community in research and advocacy on this issue.1,2 In 2016, the Royal Australasian College of Physicians Climate Change and Health Working Party released position statements on climate change and health and the health benefits of mitigating climate change.3,4 Scientific articles on Australian health and climate change have been published since the mid-1990s, including in the MJA.5

1 University of Sydney, Sydney, NSW
2 Macquarie University, Sydney, NSW

Correspondence: ying.zhang@sydney.edu.au

Acknowledgements:

We acknowledge the current team members who are developing the Australian countdown report.

Competing interests:

No relevant disclosures.

1. McMichael AJ, Ando M, Carcavallo R, et al. Human population health. In: Watson RT, Zinyowera MC, Moss RH, Dokken DJ, editors. Climate change 1995: impacts, adaptations and mitigation of climate change: scientific-technical analyses. Contribution of Working Group II to the Second Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press, 1996.
2. McMichael A, Githeko A, Akhtar R, et al. Human health. In: McCarthy JJ, Canziani OF, Leary NA, et al, editors. Climate change 2001: impacts, adaptation, and vulnerability. Contribution of Working Group II to the Third Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press, 2001.
3. Royal Australasian College of Physicians. Climate change and health: position statement. Sydney: RACP, 2016.
4. Royal Australasian College of Physicians. The health benefits of mitigating climate change: position statement. Sydney: RACP, 2016.
5. Jackson EK. Climate change and global infectious disease threats. Med J Aust 1995; 163: 570-574.
6. Beggs PJ, editor. Impacts of climate change on allergens and allergic diseases. Cambridge: Cambridge University Press, 2016.
7. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009; 373: 1693-1733.
8. Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386: 1861-1914.
9. Watts N, Amann M, Ayeb-Karlsson S, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. Lancet 2018; 391: 581-630.
10. United Nations Framework Convention on Climate Change. The Paris Agreement. http://unfccc.int/paris_agreement/items/9485.php (viewed Dec 2017).
11. International Energy Agency. IEA Atlas of Energy: CO2 Emissions from Fuel Combustion. http://energyatlas.iea.org/#!/tellmap/1378539487/4 (viewed Feb 2018).

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Perspectives

Whole genome sequencing provides better diagnostic yield and future value than whole exome sequencing

John S Mattick, Marcel Dinger, Nicole Schonrock and Mark Cowley

Med J Aust 2018; 209 (5): . || doi: 10.5694/mja17.01176
Published online: 9 April 2018

ARTICLE
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Topics

Medical genetics

The integration of genome sequencing with clinical records and data from the internet of things will transform health care

There is a great deal of optimism about the potential of genomics to transform medicine and health care. That optimism is justified. Indeed, it is hard to imagine a future where personal genomic information is not consulted routinely at the point of care. Every one of us is different, with personal genetic idiosyncrasies and risks — of cancer, cardiac arrest, blood clots, emphysema, diabetes, arthritis or toxic reactions to medications, among many others; the list will only continue to grow. Knowledge of individual genetic variation will change medicine from the art of crisis response to the science of health management, with huge benefits, both individually and systemically. It will also create new enterprises at a time of rapid change in the largest and fastest growing industry in the world.

1 Garvan Institute of Medical Research, Sydney, NSW
2 St Vincent's Clinical School, UNSW Sydney, Sydney, NSW
3 Kinghorn Centre of Clinical Genomics, Garvan Institute of Medical Research, Sydney, NSW

Correspondence: j.mattick@garvan.org.au

Acknowledgements:

We thank Howard Jacob for his comments on the manuscript. This work was supported by funding from the Kinghorn Foundation, the New South Wales State Government and the National Health and Medical Research Council of Australia.

Competing interests:

The Garvan Institute of Medical Research is the owner of Genome.One, which is clinically accredited (ISO15189) to provide whole human genome sequencing and analysis.

1. Mattick JS. The central role of RNA in human development and cognition. FEBS Lett 2011; 585: 1600-1616.
2. Freedman ML, Monteiro AN, Gayther SA, et al. Principles for the post-GWAS functional characterization of cancer risk loci. Nat Genet 2011; 43: 513-518.
3. Noll AC, Miller NA, Smith LD, et al. Clinical detection of deletion structural variants in whole-genome sequences. NPJ Genom Med 2016; 1: 16026.
4. Mallawaarachchi AC, Hort Y, Cowley MJ, et al. Whole-genome sequencing overcomes pseudogene homology to diagnose autosomal dominant polycystic kidney disease. Eur J Hum Genet 2016; 24: 1584-1590.
5. Hannan AJ. Tandem repeats mediating genetic plasticity in health and disease. Nat Rev Genet 2018; 19: 286-298.
6. Belkadi A, Bolze A, Itan Y, et al. Whole-genome sequencing is more powerful than whole-exome sequencing for detecting exome variants. Proc Natl Acad Sci USA 2015; 112: 5473-5478.
7. Mercer TR, Gerhardt DJ, Dinger ME, et al. Targeted RNA sequencing reveals the deep complexity of the human transcriptome. Nat Biotechnol 2012; 30: 99-104.
8. Deveson IW, Brunck ME, Blackburn J, et al. Universal alternative splicing of noncoding exons. Cell Syst 2018.
9. Gilissen C, Hehir-Kwa JY, Thung DT, et al. Genome sequencing identifies major causes of severe intellectual disability. Nature 2014; 511: 344-347.
10. Rauch A, Wieczorek D, Graf E, et al. Range of genetic mutations associated with severe non-syndromic sporadic intellectual disability: an exome sequencing study. Lancet 2012; 380: 1674-1682.
11. de Ligt J, Willemsen MH, van Bon BW, et al. Diagnostic exome sequencing in persons with severe intellectual disability. N Engl J Med 2012; 367: 1921-1929.
12. Yang Y, Muzny DM, Reid JG, et al. Clinical whole-exome sequencing for the diagnosis of mendelian disorders. N Engl J Med 2013; 369: 1502-1511.
13. Lee H, Deignan JL, Dorrani N, et al. Clinical exome sequencing for genetic identification of rare Mendelian disorders. JAMA 2014; 312: 1880-1887.
14. Yang Y, Muzny DM, Xia F, et al. Molecular findings among patients referred for clinical whole-exome sequencing. JAMA 2014; 312: 1870-1879.
15. Hamdan FF, Srour M, Capo-Chichi JM, et al. De novo mutations in moderate or severe intellectual disability. PLoS Genet 2014; 10: e1004772.
16. Srivastava S, Cohen JS, Vernon H, et al. Clinical whole exome sequencing in child neurology practice. Ann Neurol 2014; 76: 473-483.
17. Farwell KD, Shahmirzadi L, El-Khechen D, et al. Enhanced utility of family-centered diagnostic exome sequencing with inheritance model-based analysis: results from 500 unselected families with undiagnosed genetic conditions. Genet Med 2015; 17: 578-586.
18. Wright CF, Fitzgerald TW, Jones WD, et al. Genetic diagnosis of developmental disorders in the DDD study: a scalable analysis of genome-wide research data. Lancet 2015; 385: 1305-1314.
19. Todd EJ, Yau KS, Ong R, et al. Next generation sequencing in a large cohort of patients presenting with neuromuscular disease before or at birth. Orphanet J Rare Dis 2015; 10: 148.
20. Lazaridis KN, Schahl KA, Cousin MA, et al. Outcome of whole exome sequencing for diagnostic odyssey cases of an individualized medicine clinic: The Mayo Clinic Experience. Mayo Clin Proc 2016; 91: 297-307.
21. Parsons DW, Roy A, Yang Y, et al. Diagnostic yield of clinical tumor and germline whole-exome sequencing for children with solid tumors. JAMA Oncol 2016; 2: 616-624.
22. Posey JE, Rosenfeld JA, James RA, et al. Molecular diagnostic experience of whole-exome sequencing in adult patients. Genet Med 2016; 18: 678-685.
23. Stark Z, Tan TY, Chong B, et al. A prospective evaluation of whole-exome sequencing as a first-tier molecular test in infants with suspected monogenic disorders. Genet Med 2016; 18: 1090-1096.
24. Retterer K, Juusola J, Cho MT, et al. Clinical application of whole-exome sequencing across clinical indications. Genet Med 2016; 18: 696-704.
25. Nolan D, Carlson M. Whole exome sequencing in pediatric neurology patients: clinical implications and estimated cost analysis. J Child Neurol 2016; 31: 887-894.
26. Sawyer SL, Hartley T, Dyment DA, et al. Utility of whole-exome sequencing for those near the end of the diagnostic odyssey: time to address gaps in care. Clin Genet 2016; 89: 275-284.
27. Kuperberg M, Lev D, Blumkin L, et al. Utility of whole exome sequencing for genetic diagnosis of previously undiagnosed pediatric neurology patients. J Child Neurol 2016; 31: 1534-1539.
28. Monroe GR, Frederix GW, Savelberg SM, et al. Effectiveness of whole-exome sequencing and costs of the traditional diagnostic trajectory in children with intellectual disability. Genet Med 2016; 18: 949-956.
29. Trujillano D, Bertoli-Avella AM, Kumar Kandaswamy K, et al. Clinical exome sequencing: results from 2819 samples reflecting 1000 families. Eur J Hum Genet 2017; 25: 176-182.
30. Harris E, Topf A, Barresi R, et al. Exome sequences versus sequential gene testing in the UK highly specialised Service for Limb Girdle Muscular Dystrophy. Orphanet J Rare Dis 2017; 12: 151.
31. Vissers L, van Nimwegen KJM, Schieving JH, et al. A clinical utility study of exome sequencing versus conventional genetic testing in pediatric neurology. Genet Med 2017; 19: 1055-1063.
32. Evers C, Staufner C, Granzow M, et al. Impact of clinical exomes in neurodevelopmental and neurometabolic disorders. Mol Genet Metab 2017; 121: 297-307.
33. Fu F, Li R, Li Y, et al. Whole exome sequencing as a diagnostic adjunct to clinical testing in a tertiary referral cohort of 3988 fetuses with structural abnormalities. Ultrasound Obstet Gynecol 2018; 51: 493-502.
34. Tan TY, Dillon OJ, Stark Z, et al. Diagnostic impact and cost-effectiveness of whole-exome sequencing for ambulant children with suspected monogenic conditions. JAMA Pediatr 2017; 171: 855-862.
35. Long PA, Evans JM, Olson TM. Diagnostic yield of whole exome sequencing in pediatric dilated cardiomyopathy. J Cardiovasc Dev Dis 2017; 4.
36. Lata S, Marasa M, Li Y, et al. Whole-exome sequencing in adults with chronic kidney disease: a pilot study. Ann Intern Med 2018; 168: 100-109.
37. Cordoba M, Rodriguez-Quiroga SA, Vega PA, et al. Whole exome sequencing in neurogenetic odysseys: an effective, cost- and time-saving diagnostic approach. PLoS ONE 2018; 13: e0191228.
38. Soden SE, Saunders CJ, Willig LK, et al. Effectiveness of exome and genome sequencing guided by acuity of illness for diagnosis of neurodevelopmental disorders. Sci Transl Med 2014; 6: 265ra168.
39. Yuen RK, Thiruvahindrapuram B, Merico D, et al. Whole-genome sequencing of quartet families with autism spectrum disorder. Nat Med 2015; 21: 185-191.
40. Willig LK, Petrikin JE, Smith LD, et al. Whole-genome sequencing for identification of Mendelian disorders in critically ill infants: a retrospective analysis of diagnostic and clinical findings. Lancet Respir Med 2015; 3: 377-387.
41. Ellingford JM, Barton S, Bhaskar S, et al. Whole genome sequencing increases molecular diagnostic yield compared with current diagnostic testing for inherited retinal disease. Ophthalmology 2016; 123: 1143-1150.
42. Bick D, Fraser PC, Gutzeit MF, et al. Successful application of whole genome sequencing in a medical genetics clinic. J Pediatr Genet 2017; 6: 61-76.
43. Lionel AC, Costain G, Monfared N, et al. Improved diagnostic yield compared with targeted gene sequencing panels suggests a role for whole-genome sequencing as a first-tier genetic test. Genet Med 2018; 20: 435-443.
44. Cirino AL, Lakdawala NK, McDonough B, et al. A comparison of whole genome sequencing to multigene panel testing in hypertrophic cardiomyopathy patients. Circ Cardiovasc Genet 2017; 10: e001768.

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Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010–2014

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Tick-induced allergies: mammalian meat allergy and tick anaphylaxis

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Damp housing, gas stoves, and the burden of childhood asthma in Australia

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Planetary health: what is it and what should doctors do?

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Preparing medical graduates for the health effects of climate change: an Australasian collaboration

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Tackling the worsening epidemic of Buruli ulcer in Australia in an information void: time for an urgent scientific response

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The Lancet Countdown down under: tracking progress on health and climate change in Australia

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Whole genome sequencing provides better diagnostic yield and future value than whole exome sequencing

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Primary care management of non-specific low back pain: key messages from recent clinical guidelines

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Drowning deaths in Australia caused by hypoxic blackout, 2002–2015

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Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010–2014

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Abstract

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Tick-induced allergies: mammalian meat allergy and tick anaphylaxis

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Summary

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Comment

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Damp housing, gas stoves, and the burden of childhood asthma in Australia

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Abstract

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Comment

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Planetary health: what is it and what should doctors do?

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Preparing medical graduates for the health effects of climate change: an Australasian collaboration

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Tackling the worsening epidemic of Buruli ulcer in Australia in an information void: time for an urgent scientific response

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Comment

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The Lancet Countdown down under: tracking progress on health and climate change in Australia

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Whole genome sequencing provides better diagnostic yield and future value than whole exome sequencing

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Primary care management of non-specific low back pain: key messages from recent clinical guidelines

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Drowning deaths in Australia caused by hypoxic blackout, 2002–2015

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