Objective To describe an outbreak of meningococcal meningitis and the impact of rifampicin chemoprophylaxis on secondary attack rates among Aboriginal people in central Australia. Design Prospective study of patients admitted to hospital between September 1987 and May 1991. Setting The Alice Springs Health Region of the Northern Territory and the Anangu Pitjantjatjara Lands of South Australia, covering a population of 13 228 Aboriginal people. Subjects Patients admitted to the Alice Springs Hospital with clinical signs or autopsy findings of meningococcal disease. Rifampicin chemoprophylaxis was given to close contacts of all cases. Mencevax AC vaccine was offered to children aged 1 to 15 years In the Region. Main outcome measures Blood or cerebrospinal fluid (CSF) with Neisseria meningitidis, or a positive result of latex agglutination testing on CSF. Positive Isolates were serogrouped. Results Seventy‐seven cases of meningococcal disease were diagnosed in Aboriginal people over four years compared with one to two cases per year previously; of these, 60 were definite, 7 probable and 10 suspected cases. Seventy‐six subjects had meningitis, of whom one also had the clinical features of meningococcal septicaemia; one other subject had positive blood cultures with a mild febrile illness without features of meningitis. The annual attack rate of meningococcal disease in the Aboriginal population was 1.6/1000. The relative risk for secondary cases was estimated to be between 0.3 (95% confidence Interval [Cl], 0.09–0.92) and 0.5 (95% Cl, 0.15–1.53). The annual attack rate In the non‐Aboriginal population was 0.04/1000. Conclusions The epidemic closely resembled those In sub‐Saharan Africa, and in socloeconomlcally marginalised groups in developed countries. The relative risk for secondary cases was lower than generally reported, and was attributed to chemoprophylaxis for close contacts and the mass vaccination program for children. Until there are major improvements in living conditions, infectious diseases such as those transmitted by airborne droplets will continue to occur In Aboriginal communities.

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Introduction Venous thromboembolism (VTE) remains a major public health issue around the world. Ethnicity is known to alter the incidence of VTE. To our knowledge, there are no reports in the literature investigating the incidence of VTE in British Indians. The aim of this study was to investigate the rates of symptomatic VTE in British Indian patients in the UK. Methods Patients referred to our institution between January 2011 and August 2013 with clinically suspected VTE were eligible for inclusion in the study. Those not of British Indian or Caucasian ethnicity were excluded. A retrospective review of these two cohorts was conducted. Results Overall, 15,529 cases were referred to our institution for suspected VTE. This included 1,498 individuals of British Indian ethnicity. Of these, 182 (12%) had confirmed VTE episodes. A further 13,159 of the patients with suspected VTE were coded as Caucasian, including 2,412 (16%) who had confirmed VTE events. VTE rates were a third lower in British Indians with clinically suspected VTE than in the equivalent Caucasian group. The British Indian cohort presented with VTE at a much earlier age than Caucasians (mean 57.0 vs 68.0 years). Conclusions This study suggests that British Indian patients have a lower incidence of VTE and are more likely to present at an earlier age than Caucasians. There was no significant difference in VTE type (deep vein thrombosis vs pulmonary embolism) among the ethnic groups. Clinicians should be aware of variations within ethnicities but should continue to adhere to existing VTE prevention guidance.

Objectives: To determine the effectiveness of measles vaccine during a measles outbreak, and to assess whether age at vaccination was a risk factor for measles vaccine failure. Design: A matched case‐control study. Setting: The five primary schools in western Sydney with the largest number of measles cases during the June to December 1993 outbreak. Subjects: Seventy‐nine children aged 5–9 years with an illness consistent with a clinical definition for measles. Two controls per case were selected from children in the same classroom. Main outcome measures: Estimated measles vaccine effectiveness by age of the child at vaccination and vaccination status: “unvaccinated”; “parental recall” (parents stated the child was vaccinated but no record could be found); and “record” (record including date of vaccination available). Results: The estimated vaccine effectiveness was 94% (95% confidence interval [CI], 83%–98%) in the “record” group, and 81% (95% CI, 46%–93%) in the “parental recall” group. Vaccine effectiveness did not differ significantly with age at vaccination (under 12 months of age 96% [64%–99%]; 12–14 months 95% [81%–99%]; and 15 months and over 93% [80%–98%]). Conclusion: Vaccination records should be used to calculate a vaccine's effectiveness as parental recall may not be sufficiently accurate. The high vaccine effectiveness in the “record” group (94%) makes it unlikely that low vaccine effectiveness was the cause of the outbreak. More effort is needed to increase vaccine coverage to at least 95% in all population subgroups.