The spread to a new geographic area of Victoria of a severe tissue-destroying ulcer once rare in Australia has caused health authorities to issue a state-wide health alert to doctors.
The Buruli ulcer occurs in very specific areas of Victoria and Queensland, and those who don’t enter an endemic area don’t get the disease. In Victoria, transmission of the disease has until now been confined to the Bellarine and Mornington peninsulas.
But on Thursday Victoria’s chief health officer Dr Brett Sutton issued an alert saying Aireys Inlet, a coastal town along the Great Ocean Road, and the Geelong suburb of Belmont, had been newly identified as transmission areas.
In the health advisory, Sutton urged doctors across the state to be aware of the warning signs of the disease and said laboratory testing for Buruli ulcer was now free for patients, although a handling fee may be charged by private pathology companies.
There can be a delay of several months between infection and symptoms, and given the coastal towns were popular tourist destinations people were often far away from the transmission site by the time of diagnosis.
Though risk of transmission is low due to the confined areas where the ulcer occurs, the spread is nonetheless a cause for concern since it can be difficult to detect and treat. Despite being recognised in Victoria since 1948, efforts to control the disease have been severely hampered because the mode of transmission to humans is unknown.
The first sign of infection is usually a painless lump on the skin often dismissed as an insect bite. The slow-moving infection then burrows into a layer of fat located between the skin and the lining that covers muscles. It is in this fatty layer that the infection takes hold, spreading sideways and through the body, destroying tissue along the way, before eventually erupting back through the skin in the form of an ulcer. Those with the infection often have no idea the infection has taken hold until the ulcer appears. But when the ulcer does erupt, the pain can be extreme.
Anyone is susceptible. While the infection responds to a roughly eight-week course of antibiotics, in rare cases surgery to remove skin or even amputation is needed, making early detection critical.
“There have been a total 240 cases notified so far in 2019,” Sutton said.
There is growing evidence that mosquitoes play an important role in transmitting the infection though it’s not yet known exactly how infections occur or where in the environment the bacteria prefer to live. It is not thought to be spread person to person.
Those travelling to transmission areas have been urged to avoid insect bites, protect cuts and abrasions, and see a doctor if any persistent skin lesions occur.
It follows concern from doctors earlier in October that the disease had also spread in Queensland. There, it has moved from the Douglas Shire to the Atherton Tablelands, south of its usual catchment area in the far north.