non-Aboriginal Patients Research Articles

The rate at which Aboriginal injecting drug users with HIV infections initiate antiretroviral therapy (ART) is slower than that of non-Aboriginal patients,

The rate at which Aboriginal injecting drug users with HIV infections initiate antiretroviral therapy (ART) is slower than that of non-Aboriginal patients,

Aboriginal versus non‐Aboriginal ophthalmic disease: admission characteristics at the Royal Adelaide Hospital

The purpose of the study is to compare characteristics of Aboriginal patient hospital admissions with non-Aboriginal admissions to the Ophthalmology Unit of the Royal Adelaide Hospital. A retrospective review of separation data was undertaken of hospital inpatient and day surgery admissions to the Royal Adelaide Hospital Ophthalmology Unit for the period July 1997 to January 2005. There were 11 944 admissions to the Ophthalmology Unit (including inpatients and day surgery cases), of which 273 (2.29%) were Aboriginal patients. Of the total, 2779 (23.3%) patients were admitted for at least 24 h (inpatients), and 9165 (76.7%) stayed less than 24 h (mostly day surgery cases). Aboriginal patients comprised 6.8% of inpatient admissions, and 0.9% of admissions less than 24 h. The average age of Aboriginal patients (52.9 years) was significantly less than non-Aboriginal patients (62.6 years; P < 0.0001). The median length of stay for Aboriginal patients was 5 days compared with 3 days in non-Aboriginal patients. Aboriginal patients were more likely to be from interstate (RR 10.3 P < 0.0001), more likely to have diabetes mellitus (RR 2.7 P < 0.0001), and more likely to be admitted for cataract surgery (RR 4.18 P < 0.0001) and lid disorders (RR 6.04 P < 0.0001) than non-Aboriginal patients. Aboriginal patients admitted to the Ophthalmology Unit were younger in age, more frequently from interstate, and had longer admissions than non-Aboriginal patients. These results have important implications for ophthalmic health-care planning.

Revascularization for peripheral vascular disease in Aboriginal and non-Aboriginal patients

Canadian Aboriginal subjects have a higher prevalence of diabetes, renal disease, and lower extremity amputation than non-Aboriginal subjects. However, limited information is available about patient outcomes for arterial bypass surgery in Canadian Aboriginal compared with non-Aboriginal subjects. A retrospective study of all patients undergoing revascularization for peripheral vascular disease at a tertiary care referral center was performed. A total of 828 procedures were performed on 678 patients between 1995 and 2002: 108 (13%) procedures on 84 (12%) Aboriginal patients and 720 (87%) procedures on 594 (88%) non-Aboriginal patients. Aboriginal patients had a higher prevalence of diabetes, chronic renal failure, and end-stage renal disease than non-Aboriginal patients. Aboriginal patients presented with more serious complications (gangrene [Aboriginal, 63 [58%] of 108 patients; non-Aboriginal, 112 [16%] of 720 patients; P < .0001] and nonhealing ulcer [Aboriginal, 29 [27%] of 108 patients; non-Aboriginal, 131 [18%] of 720 patients; P < .05]) and required urgent or emergency revascularization (Aboriginal, 47 [49%] of 95 patients; non-Aboriginal, 228 [36%] of 634 patients; P < .02) more frequently than non-Aboriginal patients. The 60-month patient mortality was similar for both groups (Aboriginal, 20 [24%] of 84 patients; non-Aboriginal, 160 [27%] of 594 patients; not significant), but Aboriginal patients had loss of limb more frequently (Aboriginal, 19 [18%] of 108 patients; non-Aboriginal, 62 [9%] of 720 patients; P < .0001) and had loss of primary graft patency more frequently (Aboriginal, 39 [36%] of 108 patients; non-Aboriginal, 155 [22%] of 720 patients; P < .0001) than non-Aboriginal patients. Canadian Aboriginal subjects had worse outcomes with revascularization than non-Aboriginal subjects, but ethnicity and diabetes were not independent risk factors for poor outcome. Multivariate analysis showed that the poor outcomes in mortality, limb salvage, and primary graft patency among Aboriginal patients undergoing revascularization may be attributed to renal disease and a more advanced mode of presentation of peripheral vascular disease complications at the time of intervention.

Wait-Listing for Kidney Transplantation Among Aboriginal Hemodialysis Patients

Although there has been rapid growth in the global prevalence of Aboriginal patients with end-stage renal disease (ESRD), these individuals have markedly lower rates of kidney transplantation for reasons that are unclear. We investigated barriers to kidney transplantation for Aboriginal patients treated with hemodialysis for ESRD in Canada. All consenting adults in the province of Alberta, Canada, who had been established on hemodialysis therapy for 6 months or longer were interviewed by a physician. Data for transplantation referral, waiting list status, and the assessment process were determined from the regional transplant programs, with race defined by patient self-report. For purposes of this analysis, race was dichotomized as either Aboriginal or non-Aboriginal. Of 835 subjects, 100 (12%) were Aboriginal. Aboriginal patients were significantly younger and more likely to have diabetes mellitus as the cause of ESRD than non-Aboriginal patients. Although a greater proportion of Aboriginal patients were referred for transplantation assessment (60.6% versus 46.0%; P < 0.01), after adjustment, the likelihood of referral was similar for both racial groups (hazard ratio associated with Aboriginal race, 0.80; 95% confidence interval, 0.59 to 1.08). Aboriginal patients also were significantly less likely to be active on the transplant wait list than non-Aboriginal patients (adjusted hazard ratio, 0.46; 95% confidence interval, 0.27 to 0.78). Aboriginal subjects who had been referred for assessment were significantly more likely than non-Aboriginals to be in the process of completing the transplantation workup (69.6% versus 26.9%; P < 0.01) as opposed to being temporarily or permanently unsuitable for transplantation (30.4% versus 73.3%; P < 0.01). Although not statistically significant, median duration of the workup in progress in referred, but nonlisted, participants appeared longer in Aboriginal participants (954 versus 596 days; P = 0.07). The likelihood of referral for transplantation was similar between Aboriginal and non-Aboriginal people. However, Aboriginal people were approximately half as likely to be successfully activated to the transplant waiting list compared with non-Aboriginal people. These data suggest that the major barrier to transplantation in Aboriginal patients occurs after referral, but early in the course of evaluation for eligibility.

Quality of Care among Aboriginal Hemodialysis Patients

Registry data report racial differences in hemodialysis (HD) care, with ethnic minorities at a disadvantage. However, little information is available regarding Aboriginal HD patients specifically. This study sought to compare the quality of HD care between Aboriginal and non-Aboriginal patients in Canada. All adults who were established on HD for > or = 6 mo in a single Canadian province were included. Clinical information was obtained by patient interview and chart review, with race determined by self-report. Quality of HD care was assessed by small solute clearance, BP control, mineral metabolism, and anemia management. Of the 835 patients, 95 (11.4%) were Aboriginal. Aboriginal patients were significantly younger, were more likely to have diabetes as the cause of ESRD, and had a higher degree of comorbidity than non-Aboriginal patients. There were no differences between Aboriginal and non-Aboriginal patients for small solute clearance, anemia management, or use of permanent vascular access. Aboriginal patients, however, were less likely to achieve a target predialysis systolic BP of < 140 mmHg (29.5 versus 44.9%; P = 0.004), a target phosphate level of < 1.8 mmol/L (40.0 versus 67.3%; P < 0.0001), and a calcium-phosphate product < 4.4 mmol2/L2 (52.6 versus 72.7%; P < 0.001). Quality of care was found to be similar for Aboriginal compared with non-Aboriginal HD patients except for differences in predialysis systolic BP and mineral metabolism, which may be influenced by individual and cultural factors. Explanations for these differences and their impact on morbidity and mortality warrant further investigation.

Many hands, one dream: Healthy Aboriginal children and young people

Many hands, one dream: Healthy Aboriginal children and young people

Higher rate and earlier peritonitis in Aboriginal patients compared to non‐Aboriginal patients with end‐stage renal failure maintained on peritoneal dialysis in Australia: Analysis of ANZDATA

Aboriginal patients maintained on peritoneal dialysis (PD) have a higher rate of technique failure than any other racial group in Australia. Peritonitis accounts for the bulk of these technique failures, but it is uncertain whether the increased risk of peritonitis in Aboriginal patients was independent of associated comorbid conditions, such as diabetes mellitus. Using data collected by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), peritonitis rates and time to first peritonitis were compared between Aboriginal (n = 238) and non-Aboriginal patients (n = 2924) commencing PD in Australia between 1 April 1999 and 31 March 2003. Aboriginal PD patients were younger, and had a higher incidence of diabetes than their non-Aboriginal counterparts. Mean peritonitis rates were significantly higher among Aboriginal (1.15 episodes/year; 95% confidence interval (CI): 1.03-1.28) than non-Aboriginal patients (0.60 episodes/year; 95% CI: 0.57-0.62, P < 0.05). Using multivariate negative binomial regression, independent predictors of higher peritonitis rates include Aboriginal racial origin (adjusted odds ratio 1.78; 95% CI: 1.45-2.19), obesity, age and absence of a recorded dialysate : plasma creatinine ratio (D/P creatinine) measurement. Aboriginal racial origin was also associated with a shorter median time to first peritonitis (9.9 vs 19.3 months, P < 0.05), which remained statistically significant in a multivariate Cox proportional hazards model (adjusted hazard ratio 1.76; 95% CI: 1.47-2.11, P < 0.05). Aboriginal and obese PD patients have a higher rate of peritonitis and a shorter time to first peritonitis, independent of demographic and comorbid factors. Further investigation of the causes of increased peritonitis risk in Aboriginal patients is needed.

Hospital to home: An integrated approach to discharge planning in a rural South Australian town

To produce safer and more integrated hospital discharge planning practices for older people living in rural and remote settings. Plan-Do-Study-Act framework using case-note audit and focus groups. Central Yorke Peninsula Hospital in South Australia. All patients aged 65 years or older admitted between October 2001 and June 2002. Range of communication strategies designed to improve discharge planning practices. Percentage of patients with documented discharge plan, Percentage of patients risk screened, Percentage of community health service provider referrals, Percentage of patients followed up within 10 days of discharge. There was a significant increase in the proportion of patients with a documented discharge plan for both non-Aboriginal (23%) and Aboriginal patients (52%). There was also a significant increase in the proportion of patients who received timely and informative risk screening (41% for non-Aboriginal and 58% for Aboriginal patients). Referrals to community health service providers also increased significantly from baseline to the intervention period (14% for non-Aboriginal and 33% for Aboriginal patients). The project also resulted in improved communication processes between hospital staff and community health service providers. This National Demonstration Hospitals Program project has impacted on both hospital discharge planning and the hospital-community interface. Flow-on effects to other initiatives within the region are likely.

Is there a role for peritoneal dialysis in remote aboriginal patients with end‐stage renal disease in Australia?

Peritoneal dialysis (PD) is often the preferred treatment modality of many Aboriginal patients with end-stage renal disease (ESRD) due to their remote locations and the scarcity of remote satellite haemodialysis units. Infectious complications remain an important cause of morbidity in Aboriginal patients maintained on PD in Australia. Analysis of the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) has revealed that Aboriginal PD patients are more likely to have earlier and a higher rate of peritonitis, higher risk of PD technique failure, and higher mortality compared to non-Aboriginal PD patients independent of other factors. However, the finding of Aboriginality as a risk factor for PD-related complications is at least partly attributable to socioeconomic factors, such as poor housing and hygiene. As PD will remain a necessary first-line therapy in this group of isolated and disadvantaged patients, implementing aggressive preventive strategies and targeting modifiable socioeconomic risk factors may reduce morbidity and preserve their independence and way of life.

Barriers to Effective Perioperative Communication in Indigenous Australians: An Audit of Progress since 1996

This prospective study was designed to elucidate barriers limiting effective perioperative communication between indigenous Australians and anaesthetists, and to identify strategies for improving communication. A questionnaire was used to collect data on 1040 consecutive patients undergoing anaesthesia at Royal Darwin Hospital between February and March 2003. 27.1% of these patients described themselves as Aboriginal. Aboriginal patients were more likely to undergo emergency surgery and were more likely to be classified as ASA 3, 4 or 5 than non-indigenous patients. Communication difficulties were identified in 28.7% of all Aboriginal patients, which was 31 times higher than those in non-Aboriginal patients. The most common reason identified for this was difficulty in speaking English. Only 17.7% of Aboriginal patients presenting to the operating theatre spoke English as their first language. Unfortunately, the anaesthetic team utilized the Aboriginal interpreter service in only a minority of cases. Communication difficulty in indigenous Australians is pervasive and often goes unrecognized. The results suggest that heath care providers may need staff training in cross-cultural communication and that protocols need to be developed within the health care system so that interpreters are called upon automatically early in the admission process.

Demographic patterns of emergency presentations to Northern Territory public hospitals

This study investigates demographic patterns of emergency presentations to Northern Territory (NT) public hospitals over the past five years with respect to population changes, Aboriginality and age of patients. Retrospective analysis was undertaken on the 1996-2001 data extracted from the NT Module of Caresys and the Hospital Morbidity Data System. There was a 4.6% decrease in total presentations to the five public hospitals but a 9.4% growth in the population during the study period. Substantial differences in emergency presentation patterns were found between Aboriginal and non-Aboriginal patients. There were more Aboriginal presentations than non-Aboriginal presentations for all age groups except for 5 to 19 years and 70 to 74 years. Analysis based on the national triage scale showed the higher needs of older adults with the 60 or over age group accounting for the majority of presentations, and Aboriginal presentation rates exceeded the non-Aboriginal presentation rates in most triage categories. Re-attendance within seven days at the emergency departments occurred predominantly among Aboriginal patients regardless of age group. The analysis has highlighted several emerging demographic patterns. The issue of non-urgent visits by Aboriginal patients occupying a large portion of the emergency department utilisation also needs to be addressed.

A 12-Month Review of Peritoneal Dialysis-Related Peritonitis in Western Australia: Is Empiric Vancomycin Still Indicated for Some Patients?

The International Society for Peritoneal Dialysis (ISPD) guidelines recommend empiric therapy with cefazolin and ceftazidime for peritoneal dialysis (PD)-related peritonitis. Empiric cefazolin therapy may have diminishing efficacy because of emerging methicillin resistance in gram-positive bacteria (GPB). Western Australia also has large numbers of Aboriginal and isolated regional patients, where giving these antimicrobials can be impractical. To evaluate, based on local antimicrobial resistance patterns, the feasibility of following ISPD guidelines in Western Australia and to identify any subgroups of PD peritonitis patients that may benefit from alternative empiric intraperitoneal antibiotics (e.g., vancomycin). Retrospective study of all PD peritonitis episodes in Western Australia from 1 February 2000 to 31 January 2001. Three adult tertiary referral university hospitals and their PD patients in metropolitan Perth and regional Western Australia. All adults on PD in Western Australia. Isolates and antibiograms were analyzed versus patient characteristics, including race and patient demographics. 293 patients (28% Aborigines, 32% regional patients) received PD. 145 episodes of PD peritonitis occurred during the study. The overall PD peritonitis rate was 1 episode/16 patient months, with Aborigines having 1 episode/10.5 patient months versus non-Aborigines having 1 episode/17 patient months (p < 0.001). 36% of isolates from PD peritonitis episodes were resistant to cefazolin or ceftazidime. 22% were methicillin-resistant GPB (MR-GPB) [18% coagulase-negative staphylococci (CoNS), 1.6% MR Staphylococcus aureus]; 2.5% were multidrug-resistant gram-negative bacteria (MDR-GNB); 5.7% were polymicrobial (MR-GPB and/or MDR-GNB); and 5.7% were fungal. 63% of CoNS were methicillin resistant. Non-Aboriginal patients yielded MR-GPB in 22% of isolates versus 23% in Aborigines (p = 0.9). Six of seven cases of fungal peritonitis occurred in Aboriginal patients (p < 0.001). In our study population the ISPD guidelines were appropriate for 64% of patients with PD peritonitis. We could not identify specific patient subgroups where empiric cefazolin use could be more effective. High proportions of MR-GPB PD peritonitis episodes, along with local factors, make empiric cefazolin unsuitable for many regional PD patients in Western Australia.

Critical illness and its impact on the Aboriginal people of the top end of the Northern Territory, Australia.

The Royal Darwin Hospital (RDH) services a relatively large and geographically remote Aboriginal population who account for 45% of intensive care unit admissions. Critical illness in the Aboriginal population is different from the non-Aboriginal population of the "Top End" of the Northern Territory. The critically ill Aboriginal patient is younger, has more chronic health problems and a higher severity of illness at presentation. The city and the hospital environment are foreign to many Aboriginal patients retrieved from remote communities and this adds to the stress of the critical illness. English is a second, third or fourth language for many Aboriginal people from remote communities and strategies must be put in place to ensure informed consent and effective communication are achieved. Despite the increased severity of illness and complexity, the Royal Darwin Hospital ICU achieves the same survival rates for both Aboriginal and non-Aboriginal patients.

End-stage renal disease in the Northern Territory: current and future treatment costs.

To compare hospital costs of Aboriginal and non-Aboriginal patients having haemodialysis treatment and forecast the future treatment cost. The costs of patients with HD in the "Top End" of Australia's Northern Territory were estimated for the financial years 1996/97 and 1997/98 using a hospital costing model. We used an Autoregression Integrated Moving Average model to predict future demand. 165 patients (101 Aboriginal and 64 non-Aboriginal) were treated at a total cost of $12.4 million in this two-year period. These 165 patients represented 0.7% of inpatients, 8.8% of total inpatient costs and 31.6% of total inpatient episodes of care in the Top End region. $9.5 million (77%) was spent on routine haemodialysis treatment and $2.9m (23%) on other hospitalisations. The average cost per routine haemodialysis treatment over the two-year period was $527, or $78 600 per patient treatment year. Hospitalisations for comorbidities occurred in 86% of Aboriginal and 39% of non-Aboriginal patients. Average cost per patient, number of admissions and length of hospital stays were all significantly greater for Aboriginals. We predict an average increase in the number of treatments of 12% each year over the next five years and a five-year cost of $49.8m. A multipronged strategy designed to reduce the prevalence and costs of renal failure is required.

Pancreatitis in remote Australia: an indigenous perspective.

In Australia, pancreatitis has been associated with gallstones in approximately 35% of cases and alcohol in approximately 25% of cases. The present study was performed to analyse the aetiology of pancreatitis in patients admitted to a remote Australian hospital that has a population base comprising both indigenous and non-indigenous people. A retrospective study was conducted of all cases of pancreatitis admitted to the Alice Springs Hospital from August 1993 to August 1999. One hundred and two patient records were examined, and 77% of these patients were Aboriginal. Alcohol was the most common aetiological factor (64%), with gallstone disease being the next most common. Aboriginal patients with pancreatitis were younger than non-Aboriginal patients ( P = 0.0304) and were also more likely to have alcohol as their cause of pancreatitis ( P = 0.035), especially if they were male. In males, alcohol was implicated in at least 70% of cases. In females, the causes were gallstone disease (41%) and alcohol (49%). Patients with gallstone disease were significantly older than patients with other causes of pancreatitis ( P = 0.000). There was an overall 30% increase in admission rate per year, which was primarily due to an increase in the number of Aboriginal admissions (36% per year) ( P = 0.000). The present study highlights a difference in the aetiology of pancreatitis in Aboriginal and non-Aboriginal people from a remote Australian population.

Aboriginals with multiple sclerosis: HLA types and predominance of neuromyelitis optica.

MS is common in people of northern European ethnicity who live in northern geographic areas; however, MS is rarely identified among aboriginal peoples living in the same areas. To determine the prevalence, clinical features, HLA type, and viral infections associated with MS among aboriginals in Manitoba, Canada. A retrospective study was performed in which the clinical features of all aboriginal patients with MS together with HLA type and human herpesvirus-6, HIV-1, human T-cell lymphotropic virus-1, and endogenous retrovirus associated with MS (MSRV) infections were analyzed and compared with results from nonaboriginal patients with MS. Seven aboriginals with MS were identified with a period prevalence among aboriginals of 40:100,000. Clinical features included relapsing-remitting (n = 6) or primary progressive (n = 1) phenotypes with aggressive disease courses and frequent involvement of optic nerves and spinal cord (n = 5) compared with nonaboriginal patients. Autopsy of one patient showed necrosis and eosinophil infiltrates in a cervical spinal cord lesion and a demyelinated optic nerve. Analysis of HLA alleles at the DRB1 and DQB1 loci indicated that the HLA types detected were common in aboriginals, but there were no HLA alleles previously associated with the development of MS. Analysis of the copy number of MSRV did not show differences among aboriginals and nonaboriginals with or without MS. Aboriginals of Algonkian background are at increased risk for an aggressive type of MS, resembling neuromyelitis optica, which is resistant to conventional MS treatments and occurs independently of HLA alleles previously associated with MS.

End-stage renal disease in aboriginals in New South Wales: a very different picture to the Northern Territory.

To compare the incidence of end-stage renal disease (ESRD) among Aboriginals in New South Wales with the incidence among Aboriginals in the Northern Territory, and to compare the patterns of ESRD among Aboriginals and non-Aboriginals in NSW. Secondary data analysis of information from unpublished and published Australia and New Zealand Dialysis and Transplant Registry reports. Average annual incidence of ESRD (persons per million); form of renal replacement therapy; mortality at 31 March 1998; patient and graft survival one and five years after transplant. Each year in NSW, 5-17 new Aboriginal patients are treated for ESRD. There was no increase in the average annual incidence of ESRD among NSW Aboriginals (118 per million in 1988-1989 and 111 per million in 1996-1997), whereas incidence in the NT increased from 255 per million to 800 per million. In NSW, ESRD was attributed to diabetes in 32% of Aboriginal patients, compared with 13% of non-Aboriginal patients (P < 0.001). In NSW, Aboriginal patients were younger and more likely to be female, a pattern similar to that in the NT. The outcome of ESRD treatment is not significantly different between Aboriginals and non-Aboriginals in NSW. There is a different pattern of incidence of ESRD and of outcomes with treatment among Aboriginals in NSW compared with those in the NT. A possible explanation is that the lower incidence in NSW reflects less profound socioeconomic disadvantage and better access to primary and specialist care.

Patient Satisfaction: A Gynaecological Surgery Audit

Objective: to assess patient satisfaction after major gynaecological surgery. In addition, complication rates and two-year cure rates between Aboriginal and non-Aboriginal patients are compared.Design: observational audit with telephone interviews at six months and two years post-surgery.Setting: Stanton Regional Hospital, Yellowknife, which provides specialist services and supports primary health care services for Western Arctic communities.Results: our audit showed a high degree of patient satisfaction. There was a lack of regret about having undergone surgery and reports that expectations had been met. Two years later, 94 percent of contacted patients felt better than they had prior to surgery. Our results, although obtained in a unique northern context, support other studies which suggest that appropriately selected and managed surgery, for common non-malignant gynaecological conditions, provides effective symptom relief and patient satisfaction. Complication rates and two-year cure rates for urinary stress incontinence are consistent with rates reported elsewhere.Conclusions: an audit of patient satisfaction following surgical procedures has the potential to improve care and the provision of consumer education. Although the results were reassuring and no lapses or needed improvements were revealed, the process of audit itself was perceived by the patients to improve their overall treatment and contributed to their positive outcomes . Such audits should be carried out as part of provision of care and continuous quality improvement.

Diagnosis of schizophrenia in a matched sample of Australian aborigines

Cross-cultural phenomenology is one method of studying mental disorders such as schizophrenia. There are few data of this nature available on Australian aborigines. Using a retrospective medical record review of 39 matched pairs of aboriginal and nonaboriginal patients discharged as schizophrenic from a psychiatric hospital, this study investigated whether any phenomenological differences, using DSM-III-R criteria, existed between the two groups. Of all criteria, bizarre delusions, social deterioration, illness duration and organic exclusion were statistically significant, with fewer aboriginal subjects having documentation for each of these variables. Possible explanations for these findings, including intergroup phenomenological differences and assessment variation, are discussed.

Australian encephalitis in Western Australia, 1978-1991.

To review the various clinical manifestations of Murray Valley encephalitis (MVE) or Kunjin virus encephalitis in patients in Western Australia. Review of clinical records, 1978 to 1991. Of 26 reported cases of Australian encephalitis, four were excluded from study because the patient's symptoms were not definitely associated with MVE virus or Kunjin virus infection. Two further cases of MVE were not reviewed as case records were not available. Of the remaining 20 patients, 18 had MVE and two had Kunjin virus encephalitis. Sixteen cases were in the Kimberley, a tropical region where the viruses are endemic. Four were in the subtropical Pilbara and Gascoyne regions. Thirteen of the 20 cases were in Aborigines, of whom 11 were children. The seven non-Aboriginal patients were adults. Seventeen of 20 cases were in males. The range of neurological disease and outcome was similar to that in previously reported cases, with convulsions, brainstem disease or respiratory failure in severe and fatal cases, and involvement of the spinal cord, cranial nerve or cerebellum in the moderate cases. One mild cases without neurological involvement was caused by Kunjin virus. The poor outcome in young Aboriginal children indicated that disease resulting from exposure early in life was more likely to be severe. The disease in adults, irrespective of facial background, was similar to that in cases reported previously from south-eastern Australia, but generally milder.