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. 2018 Nov;24(11):1988-1997.
doi: 10.3201/eid2411.171593.

Epidemiology of Buruli Ulcer Infections, Victoria, Australia, 2011-2016

Michael J Loftus, Ee Laine Tay, Maria Globan, Caroline J Lavender, Simon R Crouch, Paul D R Johnson, Janet A M Fyfe

Epidemiology of Buruli Ulcer Infections, Victoria, Australia, 2011-2016

Michael J Loftus et al. Emerg Infect Dis. 2018 Nov.

Abstract

Buruli ulcer (BU) is a destructive soft-tissue infection caused by the environmental pathogen Mycobacterium ulcerans. In response to rising BU notifications in the state of Victoria, Australia, we reviewed all cases that occurred during 2011-2016 to precisely map the time and likely place of M. ulcerans acquisition. We found that 600 cases of BU had been notified; just over half were in residents and the remainder in visitors to defined BU-endemic areas. During the study period, notifications increased almost 3-fold, from 66 in 2013 to 182 in 2016. We identified 4 BU-endemic areas: Bellarine Peninsula, Mornington Peninsula, Frankston region, and the southeastern Bayside suburbs of Melbourne. We observed a decline in cases on the Bellarine Peninsula but a progressive increase elsewhere. Acquisitions peaked in late summer. The appearance of new BU-endemic areas and the decline in established areas probably correlate with changes in the level of local environmental contamination with M. ulcerans.

Keywords: Australia; Buruli ulcer; Mycobacterium ulcerans; epidemiology; skin ulcer; tuberculosis and other mycobacteria.

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Figures

Figure 1
Figure 1
Melbourne, Victoria, Australia, and surrounding areas, showing population density and outlines of the 4 geographic regions used in study of the epidemiology of Buruli ulcer infections in Victoria, Australia, 2011–2016. Population density calculated as residents per square kilometer, according to the Australian Bureau of Statistics 2013 estimated resident population data at the level of Statistical Area Level 1 (18). Inset shows location of Melbourne in Australia. CBD, central business district.
Figure 2
Figure 2
Number of Buruli ulcer cases and incidence rate (no. cases/100,000 persons), by year and resident status, Victoria, Australia, 2011–2016.
Figure 3
Figure 3
Mycobacterium ulcerans likely exposure locations, by region and year (definite cases only), Victoria, Australia, 2011–2016. BP, Bellarine Peninsula; MP, Mornington Peninsula; SEBS, southeastern Bayside suburbs.
Figure 4
Figure 4
Heat maps of Mycobacterium ulcerans likely exposure locations (definite cases only), by 2-year period, Victoria, Australia, 2011–2016.
Figure 5
Figure 5
Timing of A) symptom onset, B) first visit to a healthcare worker, and C) diagnosis of Buruli ulcer for patients with Mycobacterium ulcerans infection, Victoria, Australia, 2011–2016.
See this image and copyright information in PMC

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