Dr. Steph Williams

But they also are very keen to point out that the evidence is just about the bug and needs the human factors, the clinical and the epidemiological information to draw conclusions.

linkage.

And I think just that question about how this started really has to draw us back to what is this bacteria and why are we seeing it now?

Because diphtheria as the bacteria is with us, whether or not it causes disease or especially toxin-producing disease,

is the question.

But I think we need to do a bit more study about mapping the spread of this outbreak in order to be able to get to a good answer to your question, or in fact, come to say that probably we'll never really know.

What is interesting is that of these young adult cases, a very high proportion of both the cutaneous and the respiratory cases have received in the past at least three valid vaccine doses.

And we know that, you know, the immunity wanes with time with this vaccine.

So it's not unusual.

And that's why there's a recommendation for booster doses for adults at most risk of severe disease.

And at the same time, it looks to continue to be providing at least partial protection.

So we're not seeing the most severe forms of disease in this outbreak.

And I think

whilst the outbreak is not a good news story, the fact that we are not seeing the most severe form of respiratory diphtheria is something that is worth noting.

The outbreak response is vaccination with case and contact management, including treatment with antibiotics to manage the bacteria and in some cases eliminate the carriage.

So that's the kind of biomedical treatment and prevention.

And certainly those efforts have been being mobilised in communities for many weeks now, both by the Northern Territory and WA governments.

So the individual and public health management is well underway to get on top of this particular outbreak.

I think we're talking and it's the end of Reconciliation Week and I think we need to

absolutely acknowledge that the social determinants and the conditions in which our Aboriginal Torres Strait Islander peoples live in Australia is contributing to the ongoing risk of outbreaks, especially for bacterial infections that can spread easily in crowded living conditions, as an example.