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IJE Advance Access published online on December 2, 2005
International Journal of Epidemiology, doi:10.1093/ije/dyi271
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2005; all rights reserved.
Accepted October 24, 2005

Original paper

Extreme weather events and environmental contamination are associated with case-clusters of melioidosis in the Northern Territory of Australia

Allen C. Cheng 1 *, Susan P. Jacups 1, Daniel Gal 2, Mark Mayo 2, and Bart J. Currie 1

1 Tropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Charles Darwin University, Australia; Northern Territory Clinical School, Flinders University, Darwin, NT, Australia
2 Tropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Charles Darwin University, Australia

* To whom correspondence should be addressed.
Allen C. Cheng, E-mail: allenc{at}menzies.edu.au


  Abstract

Background Melioidosis, the infection due to the environmental organism Burkholderia pseudomallei, is endemic to northern Australia and South East Asia. It is associated with exposure to mud and pooled surface water, but environmental determinants of this disease are poorly understood. We defined case-clusters in northern Australia, determined their contribution to the observed rate of melioidosis, and explored clinical features and associated environmental factors.

Methods Using geographical information systems data, we examined clustering of melioidosis cases in time and geographical space in the Top End of the Northern Territory of Australia between 1990 and 2002 using a scan statistic. DNA macrorestriction analysis, resolved by pulsed field gel electrophoresis, was performed on isolates from patients.

Results We defined five case-clusters involving 27 patients that occurred within 7-28 days and/or a radius of 100-300 km. Clustered cases were associated with extreme weather events or environmental contamination; no difference in the clinical pattern of disease was noted from other patients not involved in clusters. Isolates from patients linked to environmental contamination were caused by isolates with similar DNA macrorestriction patterns, but isolates from patients linked to severe weather events had more diverse DNA macrorestriction patterns.

Conclusion Case-clusters of melioidosis where isolates exhibit diverse DNA macrorestriction patterns in our region are linked to extreme weather events and outbreaks where isolates are predominantly of the same DNA macrorestriction pattern are linked with contamination of an environmental source.

Keywords: Melioidosis; Burkholderia pseudomallei; outbreaks; natural disasters; environmental microbiology.
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