In This Issue

Progression of a pandemic: influenza (H1N1) 2009 in the MJA

As the human swine flu pandemic unfolds, the MJA will continue to publish the latest peer-reviewed information and opinion on our website (http://www.mja.com.au). Now, in print, we bring you a set of articles first released online, including a summary of guidelines for treatment and prevention with antiviral agents (Cheng et al, “Summary of the Australasian Society for Infectious Diseases and the Thoracic Society of Australia and New Zealand guidelines: treatment and prevention of H1N1 influenza 09 (human swine influenza) with antiviral agents”), perspectives about Australia’s influenza pandemic policy (McCaw et al, “Understanding Australia’s influenza pandemic policy on the strategic use of the antiviral drug stockpile”; Grayson and Johnson, “Australia’s influenza containment plan and the swine flu epidemic in Victoria ”; and Eizenberg, “The general practice experience of the swine flu epidemic in Victoria — lessons from the front line .”) and updates about the epidemiology of pandemic influenza (H1N1) 2009 compared with that of seasonal influenza infection (Kelly et al, “Epidemiological characteristics of pandemic influenza H1N1 2009 and seasonal influenza infection”; and Senanayake, “Swine flu update: bringing home the bacon”).

Bitten by which snake?

Snakebite victims whose bites test positive for tiger snake venom using a standard venom detection kit may actually have been bitten by another type of snake, including the rough-scaled snake (Tropidechis carinatus). After searching the Australian Snakebite Project database for eligible cases and using a specific enzyme immunoassay, Gan and colleagues were able to confirm that 24 of 697 cases over a 5-year period were due to rough-scaled snake envenoming. Nearly all had occurred in coastal areas between northern New South Wales and south-eastern Queensland; in this area, most envenoming was due to rough-scaled rather than tiger snakes. Clinically, rough-scaled snake envenoming was characterised by venom-induced consumption coagulopathy. Tiger snake antivenom was effective in binding all rough-scaled snake venom (→ Envenoming by the rough-scaled snake (Tropidechis carinatus): a series of confirmed cases).

Beware the bitter lupin

Eating sweet lupins can provide health benefits for humans, including increased satiety; however, bitter lupins can cause harm if not appropriately pretreated, warn Pingault and colleagues. They report that two patients presented with anticholinergic syndrome after eating scones or pancakes made with bitter lupin flour. Bitter varieties of lupin need to undergo a debittering process to remove potent alkaloids before consumption. This involves soaking lupin beans in repeated changes of water (→ Two cases of anticholinergic syndrome associated with consumption of bitter lupin flour).

Rapid rotavirus downturn

Rotavirus gastroenteritis is recognised as the most frequent cause of severe childhood gastroenteritis worldwide. In July 2007, a national, publicly funded, universal infant rotavirus vaccine program commenced in Australia. In this issue, Lambert and colleagues present early evidence of the effects of this program in Queensland, reporting a fall in rotavirus notifications, not only in the very young, but in all age groups (→ Early evidence for direct and indirect effects of the infant rotavirus vaccine program in Queensland). In an accompanying editorial, Macartney and Burgess say the study’s findings suggest a herd immunity effect, as already observed in preliminary data from the United States (→ Rapid impact of rotavirus vaccination in the United States: implications for Australia).

Reaping smoking status

Although Australia has reportedly been labelled as “one of the darkest markets in the world” by British American Tobacco, tobacco smoking remains the largest single cause of preventable mortality and morbidity in this country. In For Debate, Sitas and colleagues say that by continuing to rely on indirect, rather than direct, measures of tobacco’s impact on our health, we are using yesterday’s tools to shape today’s policy on tobacco control. They argue that it is time for Australia to follow other countries in seeking a direct estimate of this impact, and suggest questions about smoking status be added to all death notification forms (→ Smoking questions on the Australian death notification form: adopting international best practice?).

APHRODITE and libido

Transdermal testosterone may be useful in managing hypoactive sexual desire disorder (HSDD) in postmenopausal women, according to an Australian expert. Davis led the international APHRODITE Study Team that compared the effects of a testosterone patch, administered at two different daily doses, with a placebo patch in 814 women with HSDD who were not using systemic oestrogen therapy. Women treated with the higher-dose (300 μg) testosterone patch reported enjoying nearly all of their sexual encounters. In an editorial, Davis highlights this and other results from the trial recently published in the New England Journal of Medicine (→ Testosterone for low libido in postmenopausal women not using systemic oestrogen therapy).

It’s all about strengths

Recognising a community’s strengths or assets sets the platform for possibilities, writes Chelsea Bond in her submission to this year’s Dr Ross Ingram Memorial Essay Competition (→ Starting at strengths . . . an Indigenous early years intervention). Her personal experience as a parent influenced the development of an Indigenous early years intervention that achieved a wide range of positive outcomes within just 12 months. Bond’s essay is a runner-up to this year’s winning essay by Beverley Spiers, published in our 18 May Indigenous Health issue. This prize, and the MJA/Wyeth Prize for best research report, were recently presented at this year’s Australian Medical Association national conference (→ Clean hands, caring hands: MJA Awards Ceremony 2009).

Another time . . . another place

Tobacco, coffee, alcohol, hashish, prussic acid, strychnine, are weak dilutions: the surest poison is time.