Wendy A. Page

Description:We measured the nuclear-recoil ionization yield in silicon with a cryogenic phonon-sensitive gram-scale detector. Neutrons from a monoenergetic beam scatter off of the silicon nuclei at angles corresponding to energy depositions from 4 keV down to 100 eV, the lowest energy probed so far. The results show no sign of an ionization production threshold above 100 eV. These results call for further investigation of the ionization yield theory and a comprehensive determination of the detector response function at energies below the keV scale.

Description:Background: Strongyloidiasis is endemic in many remote Indigenous communities in Australia. Early diagnosis, treatment, and follow-up of chronic strongyloidiasis can prevent life-threatening clinical complications and decrease transmission in these endemic communities. The aim of this paper is to evaluate the effectiveness and sustainability of a primary healthcare strategy designed to measure and reduce the prevalence of strongyloidiasis in four remote communities in northeast Arnhem Land. Methods: The primary healthcare strategy was a prospective, longitudinal, health-systems intervention designed to integrate serological testing for chronic strongyloidiasis into the Indigenous preventive adult health assessment utilising the electronic health-record systems in four Aboriginal health services. Positive cases were recalled for treatment, and opportunistic follow-up serology after six months. Results were tracked using Strongyloides reports generated by the electronic health-record system. This paper describes the changes in prevalence, effectiveness of treatment, and reinfection during the implementation phase, 2012-2016. An improved Strongyloides electronic report was developed to evaluate the effectiveness and sustainability of the intervention to the end of 2020. Results: During the entire period 2012-2020, 84% (2390/2843) of the resident adults in the four communities were tested for strongyloidiasis at least once. Prevalence was reduced from 44% (1056/2390) ever-positive to 10% (232/2390) positive on their last test. Of positive, treated cases with a follow-up serology test, the last test was negative in 85% (824/967) of individuals. Point prevalence continued to decrease in each community four years after the end of the implementation phase. Conclusions: The results provided practice-based evidence of a significant decrease in the prevalence of strongyloidiasis attributable to the strategy which could be replicated in other health services utilising electronic health-record systems. The final evaluation demonstrated the sustainability and ongoing benefits for endemically infected communities, and the key role that health services can play in strongyloidiasis prevention and control programs.

Description:Strongyloidiasis, an infection caused by the soil-transmitted helminth Strongyloides stercoralis, can lead immunocompromised people to a life-threatening syndrome. We highlight here current and emerging pharmacotherapeutic strategies for strongyloidiasis and discuss treatment protocols according to patient cohort. We searched PubMed and Embase for papers published on this topic between 1990 and May 2022. Ivermectin is the first-line drug, with an estimated efficacy of about 86% and excellent tolerability. Albendazole has a lower efficacy, with usage advised when ivermectin is not available or not recommended. Moxidectin might be a valid alternative to ivermectin, with the advantage of being a dose-independent formulation. The standard dose of ivermectin is 200 µg/kg single dose orally, but multiple doses might be needed in immunosuppressed patients. In the case of hyperinfection, repeated doses are recommended up to 2 weeks after clearance of larvae from biological fluids, with close monitoring and further dosing based on review. Subcutaneous ivermectin is used where there is impaired intestinal absorption/paralytic ileus. In pregnant or lactating women, studies have not identified increased risk with ivermectin use. However, with limited available data, a risk-benefit assessment should be considered for each case.

Description:•Neglected tropical diseases (NTDs) represent a threat to the health, wellbeing and economic prosperity of billions of people worldwide, often causing serious disease or death. •Commonly considered diseases of low and middle-income nations, the presence of NTDs in high income countries such as Australia is often overlooked. •Seven of the 20 recognised NTDs are endemic in Australia: scabies, soil-transmitted helminths and strongyloidiasis, echinococcosis, Buruli ulcer, leprosy, trachoma, and snakebite envenoming. •Dengue, while not currently endemic, poses a risk of establishment in Australia. There are occasional outbreaks of dengue fever, with local transmission, due to introductions in travellers from endemic regions. •Similarly, the risk of introduction of other NTDs from neighbouring countries is a concern. Many NTDs are only seen in Australia in individuals travelling from endemic areas, but they need to be recognised in health settings as the potential consequences of infection can be severe. •In this review, we consider the status of NTDs in Australia, explore the risk of introducing and contracting these infections, and emphasise the negative impact they have on the health of Australians, especially Aboriginal and Torres Strait Islander peoples.

Description:Strongyloidiasis and HTLV-I (human T-lymphotropic virus-1) are important infections that are endemic in many countries around the world with an estimated 370 million infected with Strongyloides stercoralis alone, and 5-10 million with HTVL-I. Co-infections with these pathogens are associated with significant morbidity and can be fatal. HTLV-I infects T-cells thus causing dysregulation of the immune system which has been linked to dissemination and hyperinfection of S. stercoralis leading to bacterial sepsis which can result in death. Both of these pathogens are endemic in Australia primarily in remote communities in Queensland, the Northern Territory, and Western Australia. Other cases in Australia have occurred in immigrants and refugees, returned travellers, and Australian Defence Force personnel. HTLV-I infection is lifelong with no known cure. Strongyloidiasis is a long-term chronic disease that can remain latent for decades, as shown by infections diagnosed in prisoners of war from World War II and the Vietnam War testing positive decades after they returned from these conflicts. This review aims to shed light on concomitant infections of HTLV-I with S. stercoralis primarily in Australia but in the global context as well.