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Strongyloides stercoralis is a soil-transmitted helminth (STH) endemic to tropical and subtropical areas. We reviewed the temporal detection trends in patients with S. stercoralis larvae present in faecal samples, in Northern Territory (NT) Government Health facilities, between 2002 and 2012. This was a retrospective observational study of consecutive patients with microbiologically confirmed detection of S. stercoralis in faeces. The presence of anaemia, eosinophilia, polyparasitism, and geographic and demographic data, were included in the assessment. S. stercoralis larvae were present in 389 of 22,892 faecal samples (1.7%) collected across the NT over 11 years, examined by microscopy after formol ethyl acetate concentration. 97.7% of detections were in Indigenous patients. Detections, by number, occurred in a biphasic age distribution. Detections per number of faecal samples collected, were highest in the 0–5 year age group. Anaemia was present in 44.8%, and eosinophilia in 49.9% of patients. Eosinophilia was present in 65.5% of the ≤5 age group, compared to 40.8% of >5 year age (p < 0.0001). Polyparasitism was present in 31.4% of patients. There was an overall downward trend in larvae detections from 2.64% to 0.99% detections/number of faecal samples year between 2002 and 2012, consistent with the trends observed for other local STHs. S. stercoralis remains an important NT-wide pathogen.

To observe the prevalence, disease associations, and temporal trends in Trichuris trichiura (whipworm) infection in the Northern Territory between 2002 and 2012. Retrospective observational analysis of consecutive microbiologically confirmed cases of T. trichiura infection among members of the NT population from whom a faecal sample was obtained for testing by NT Government health care facilities between 1 January 2002 and 31 December 2012. Annual prevalence of T. trichiura infection; age, sex, Indigenous status and place of residence of infected patients; percentage of infected patients with anaemia (haemoglobin level, ≤ 110 g/L) and eosinophilia (eosinophil count, ≥ 0.5 × 10(9)/L). 417 episodes of T. trichiura infection were identified over the 11 years from 63 668 faecal samples. The median age of patients was 8 years (interquartile range [IQR], 3-36 years). Patients were predominantly Indigenous (95.3%; P = 0.001) and from three main geographical areas (Victoria Daly, East Arnhem Land and West Arnhem Land). Infections were associated with anaemia (40.2%) and eosinophilia (51.6%). There was a downward trend in the prevalence of T. trichiura infection diagnosed at NT Government health care facilities, from 123.1 cases (95% CI, 94.8-151.3 cases) per 100,000 Indigenous population in 2002 to 35.8 cases (95% CI, 21.8-49.9 cases) per 100,000 Indigenous population in 2011. T. trichiura is the most frequently identified soil-transmitted helminth infecting patients in NT Government health care facilities. Cases are identified predominantly in Indigenous patients in remote communities. We have observed a declining prevalence of whipworm infection in the NT.

BACKGROUND: COVID-19 has affected many healthcare workers (HCWs) globally. We performed state-wide SARS-CoV-2 genomic epidemiological investigations to identify HCW transmission dynamics and provide recommendations to optimise healthcare system preparedness for future outbreaks. METHODS: Genome sequencing was attempted on all COVID-19 cases in Victoria, Australia. We combined genomic and epidemiologic data to investigate the source of HCW infections across multiple healthcare facilities (HCFs) in the state. Phylogenetic analysis and fine-scale hierarchical clustering were performed for the entire dataset including community and healthcare cases. Facilities provided standardised epidemiological data and putative transmission links. FINDINGS: Between March-October 2020, approximately 1,240 HCW COVID-19 infection cases were identified; 765 are included here, requested for hospital investigations. Genomic sequencing was successful for 612 (80%) cases. Thirty-six investigations were undertaken across 12 HCFs. Genomic analysis revealed that multiple introductions of COVID-19 into facilities (31/36) were more common than single introductions (5/36). Major contributors to HCW acquisitions included mobility of staff and patients between wards and facilities, and characteristics and behaviours of patients that generated numerous secondary infections. Key limitations at the HCF level were identified. INTERPRETATION: Genomic epidemiological analyses enhanced understanding of HCW infections, revealing unsuspected clusters and transmission networks. Combined analysis of all HCWs and patients in a HCF should be conducted, supported by high rates of sequencing coverage for all cases in the population. Established systems for integrated genomic epidemiological investigations in healthcare settings will improve HCW safety in future pandemics. FUNDING: The Victorian Government, the National Health and Medical Research Council Australia, and the Medical Research Future Fund.