Objective:The Australian Capital Territory Health Directorate was notified of a food handler with hepatitis E virus (HEV) infection. To guide the public health response, a rapid risk assessment was undertaken to determine the risk of transmission of HEV from the infected food handler to restaurant patrons.Method:The literature on HEV was reviewed and expert advice sought from clinical and public health specialists. This was supplemented by results of a site investigation and a case interview. The risk rating was determined to be the product of the likelihood of transmission and the consequence of the infection.Results:The food handler was likely to have been infectious at the time he was working at the restaurant. He had handled high-risk foods, and the site inspection revealed potential opportunities for transmission. HEV is not common in Australia and it was assumed that the population was non-immune and hence susceptible to the disease. Therefore, there was a low but possible likelihood of transmission of HEV. If infected, HEV has the potential for major consequences in vulnerable populations especially among women who are pregnant. The overall level of risk was considered to be very high.Discussion:The general public and health practitioners were alerted to enable early identification of symptoms and prompt disease management. There were no secondary cases of HEV associated with this event. In the absence of published guidelines and limited evidence, a risk assessment framework was a useful tool to inform public health decision-making.

Introduction: Field epidemiology training programmes (FETPs) emphasize competency-based training and learning by doing. Supervision of FETP trainees is critical for programmes to achieve learning outcomes. We sought to address a knowledge gap regarding what constitutes effective FETP supervision. Methods: We investigated FETP supervision using a mixed-methods approach. Quantitative data were collected through a survey of FETP directors. Qualitative data included written feedback from the survey and a focus group discussion (FGD) conducted with FETP supervisors at the 8th South-East Asia and Western Pacific Bi-regional TEPHINET Conference. FGD questions focused on effective supervisory qualities and activities and challenges to effective supervision. We calculated descriptive statistics for quantitative data and analysed qualitative data using a deductive content analysis approach. Results: Eleven FETP directors responded to the survey and 23 participated in the FGD. Overall, supervision was seen as very important for trainee outcomes. Participants identified the different roles of academic and field supervisors but emphasized the importance of an enabling and supporting attitude towards trainees. Soft skills and interpersonal abilities were among the most important qualities identified for effective supervision. Key challenges identified included a lack of consistency in supervisors’ technical knowledge and the difficulty of finding candidate supervisors with sufficient interest, availability and motivation for supervision. Discussion Several practical recommendations arose from this study for supervision in FETPs, including recruiting and training supervisors with a more holistic range of skills. Our findings also provide key points for current FETP supervisors to consider to improve their own practice.

Objective: The Commonwealth of the Northern Mariana Islands (CNMI) is a remote Pacific island territory with a population of 47 329 that successfully prevented the significant introduction of coronavirus disease (COVID-19) until late 2021. This study documents how the response to the introduction of COVID-19 in CNMI in 2021 was conducted with limited resources without overwhelming local clinical capacity or compromising health service delivery for the population. Methods: Data from COVID-19 case investigations, contact tracing, the Commonwealth’s immunization registry and whole genome sequencing were collated and analysed as part of this study. Results: Between 26 March 2020 and 31 December 2021, 3281 cases and 14 deaths due to COVID-19 were reported in CNMI (case fatality rate, 0.4%). While notification rates were highest among younger age groups, hospitalization and mortality rates were disproportionately greater among those aged >50 years and among the unvaccinated. The first widespread community transmission in CNMI was detected in October 2021, with genomic epidemiology and contact tracing data indicating a single introduction event involving the AY.25 lineage and subsequent rapid community spread. Vaccination coverage was high before widespread transmission occurred in October 2021 and increased further over the study period. Discussion: Robust preparedness and strong leadership generated resilience within the public health sector such that COVID-19 did not overwhelm CNMI’s health system as it did in other jurisdictions and countries around the world. At no point was hospital capacity exceeded, and all patients received adequate care without the need for health-care rationing.