The Communicable Disease Branch works closely with public heath units in the prevention, surveillance and control of preventable communicable diseases. Key activities include the promotion and provision of immunisation services, the surveillance of notifiable diseases, and the investigation and control of outbreaks.

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Immunisation

Immunisation remains the backbone of communicable disease control. Most preschool immunisations (>85%), are provided by general practitioners and a small proportion are provided by community health and councils in NSW. Public health units and community health services provide high school based vaccination clinics. In 2013, NSW Health continued to facilitate high immunisation rates among children and adults through activities including:

  • The ‘Save the Date to Vaccinate’ awareness campaign (including television, radio, smartphone app and printed resources). The campaign evaluated well and there are plans to commence phase 2 of the campaign in 2014. See Save the Date to Vaccinate.
  • New legislation to strengthen the immunisation requirements for enrolment into childcare in NSW. This included the development and distribution of an immunisation enrolment toolkit, parent brochure and advice on the NSW Heath website. See Strengthening Vaccination Requirements for Child Care.
  • An improvement in immunisation rates in Aboriginal children at 12 months of age from 85.9% in 2012 to 86.4% in 2013. The immunisation rate for Aboriginal children at 60 months (93.9%) was higher than for the general population (92.0%) (Table 1 below)
  • The introduction of HPV vaccination for boys in Years 7 and 9. In the first year of this program, coverage for Year 7 males was only slightly below coverage in the established female vaccination program (Table 2 below)
  • The development of a single consent form for Year 7 vaccinations to improve the parents’ experience, record management and data collection
  • A new NSW Immunisation Schedule from 1 July 2013, including the introduction of two new vaccines (measles-mumps-rubella-varicella vaccine and Haemophilus influenza type b (Hib)-meningococcal C vaccine) into the schedule, and developed and distributed an Immunisation Provider Kit to explain the changes, see Immunisation Provider Kit.
  • Commencement of the Aboriginal Immunisation Health Worker Pilot with the employment of staff and completion of work plans aiming to identify and overcome barriers to immunisation in Aboriginal children
  • A new web-based vaccine ordering system, to provide greater efficiencies in the operations of the state vaccine centre, more reporting functionality for NSW Health and real-time feedback to immunisation providers when they place an order, see NSW Vaccine Centre.

Table 1. Proportion of Aboriginal children and all children fully immunised in NSW for three age groups, for the years 2012 and 2013

Age​ All children
​2012
All children
​2013
​Aboriginal children​
2012
​Aboriginal children​
2013
1 year old​ ​91.6% ​90.3% 85.9%​ 86.4%​
​2 years old ​92.4% ​91.9% ​92.0% ​90.8%
​5 years old ​90.8% ​92.0% ​90.1% ​93.9%

Source: Australian Childhood Immunisation Register

Note: from December 2013, the definition of fully immunised includes pneumococcal vaccine, which could account for a slight decrease in coverage at 12 months of age.

Table 2. Proportion of eligible students in Years 7 and 9 who received human papillomavirus (HPV), hepatitis B (Hep B), diphtheria-tetanus-pertussis (dTpa) and varicella (Vz) vaccine at school, NSW, 2012 and 2013.

Age and Gender Vaccine​ ​Dose 1
2012​
​Dose 1
2013
Dose 2​
2012​
Dose 2​
2013*
Dose 3​
2012​
Dose 3​
2013*
Year 7 boys & girls ​Hep B ​69% ​51%** ​63% ​46%** NA NA
Year 7 boys & girls ​dTpa ​81% ​81% NA NA ​NA ​NA
Year 7 boys & girls ​Vz*** ​50% ​53% NA NA NA NA
​Year 7 girls ​HPV ​86% ​86% ​83% 83%​ ​73% 73%​
​Year 7 boys ​HPV ​NA ​80% NA ​77% NA ​66%
​Year 9 boys ​HPV ​NA ​70% ​NA ​67% NA ​56%

Source: NSW School Immunisation Program

*HPV 2nd and 3rd dose data are preliminary as catch up vaccination will continue into 2014

**The large decrease in hepatitis B coverage between 2012 and 2013 was expected and reflects a cohort of children that previously received hepatitis B vaccination in infancy. 2013 was the final year of the school catch up program.

***Varicella vaccine is provided for students who do not have a history of chickenpox infection or vaccination.

NA: not applicable

Vaccine-preventable diseases

In 2013 there were:

  • Nine invasive Haemophilus influenzae type b notifications, of which five were in children aged less than five years
  • 2338 pertussis notifications, the lowest since 2007 when a highly sensitive test became widely used. There were no infant pertussis deaths
  • 34 measles notifications, of which 16 were imported from overseas, eight were linked to imported cases, and one case was acquired in Victoria. Nine locally acquired measles cases were reported with no known source of infection. Eight cases were notified from the Sydney Local Health District. The largest single outbreak, of six cases, was in Northern NSW Local Health District associated with an imported case at a school
  • 46 meningococcal disease notifications, a dramatic decrease from 65 in 2012. Of these, 26 were due to serogroup B (57%), eight were due to serogroup Y (17%), six were due to serogroup W135 (13%), three were due to serogroup C (7%), and three were of an unknown serogroup (7%). Of the three cases of meningococcal C disease, two were in adults aged over 50 years, and one was reported in a teenager who was vaccinated against meningococcal C disease (the 3rd vaccine failure identified in NSW since vaccine introduction in 2003)
  • 90 mumps notifications, a decrease from the 105 reported in 2012. The highest notifications were in metropolitan areas and in under-vaccinated persons aged 15–19 years (n = 15), followed by those aged 30–34 years (n = 12)
  • 12 rubella notifications, including a cluster in the North Coast Local Health District (n = 6)
  • 469 invasive pneumococcal disease notifications, a marked decrease compared with 581 in 2012. In children less than five years, 65% of notifications were due to non-vaccine related serotypes; serotype 19A was the predominant vaccine related serotype in this age group

Long term trend in notifications are seen in the charts below.

Note: Surveillance for vaccine preventable diseases occurs through notification to public health units of patients with these infections by doctors, hospitals, laboratories and child care operators. This information allows public health units to initiate control measures and monitor the success of the vaccination program. There may be variation in the likelihood of notification of some vaccine preventable conditions. For example, the vast majority of patients diagnosed with invasive Haemophilus influenzae type b and meningococcal disease and measles are likely notified to public health unit, however, only patients with laboratory confirmed mumps and rubella and invasive pneumococcal disease require notification meaning that people diagnosed by clinical symptoms only will not be notified. Many pertussis infections are likely to be undiagnosed.

Notifications of patients with selected vaccine preventable diseases, NSW, 2003-2013: Measles, Meningococcal disease, Mumps, Rubella and H. influenzae type b infection 

Notifications of patients with selected vaccine preventable diseases, NSW, 2003-2013: Pertussis and Pneumococcal disease (invasive) 

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Bloodborne viruses

In 2013 there were:

 

  • 357 cases of newly diagnosed HIV infection, a 13% decrease compared with 2012 (n = 409). Of these 357 cases, 278 (78%) were reported as men who have sex with men (MSM). This compares with 330 MSM related new diagnoses in 2012, a 16% decrease in the notifications in this major risk group. 40% of patients newly diagnosed with HIV infection in 2013 had evidence of early stage infection, a lesser proportion than that reported for new diagnoses in 2012 (47%) and 2011 (50%). Overall HIV testing increased by 6% in 2013 compared to 2012, with almost 450,000 tests performed
  • 2,478 notifications of unspecified hepatitis B, an 8% increase compared with 2012 (n = 2288) and about the same as the average of the previous five years (n=2,458). 54% of cases were males. Hepatitis B is notified as “unspecified” when the time of infection is unknown (most notifications) or is known to be longer than two years prior to diagnosis
  • 34 newly acquired hepatitis B case notifications, an increase of 17% compared with 2012 (n = 29), but similar to the average of the previous five years (n=35). 65% of cases were males. Newly acquired hepatitis B is notified when there is evidence that the infection was acquired within two years of diagnosis
  • 3,462 notifications of unspecified hepatitis C, 7% higher than in 2012 (n = 3245) but 2% lower than the average of the previous five years (n=3519). Sixty-six per cent of cases were males
  • 44 newly acquired hepatitis C case notifications, 14% lower than in 2012 (n = 51) but 10% higher than the average of the previous five years (n=40). 55% of cases were males and 50% were aged between 15 and 29 years. Newly acquired hepatitis C is notified when there is evidence that the infection was acquired within two years of diagnosis

Long term trend in notifications are seen in the chart below.

Note: Notifications of hepatitis B and hepatitis C provide only very limited information that can be used for assessing the epidemiological patterns of these infections. This is because many infections are asymptomatic, and so people who are infected may never be diagnosed, or only diagnosed many years after infection. Single positive tests do not reliably indicate the time of infection, and apart from the small number of people who have evidence of a previous recent negative test, it is difficult to identify acute infections. Variations in notifications may reflect changes in testing patterns rather than changes in the incidence of infection.

Notifications of patients with blood borne virus infections, NSW, 2003-2013: Hepatitis B - acute; Hepatitis B - other; Hepatitis C - Acute; Hepatitis C - Other; and HIV infection 

In 2013, NSW Health:

  • Developed the NSW HIV Support Program (HSP) to provide advice and support for doctors when they have newly diagnosed a patient with HIV infection, see HIV Support Program. By assisting doctors provide 5 Key Support Services to a newly diagnosed person, the person is supported to manage their infection and avoid transmitting HIV to another person. The 5 Key Support Services are:
    • Appropriate clinical management
    • Psychosocial support
    • Counselling about HIV treatment and prevention of transmission of HIV to others
    • Contact tracing assistance
    • Linkage to relevant specialist, community and peer support services.

    The HSP commenced on 9 May 2013 and by 31 December 2013 more than 100 doctors inexperienced in HIV had been supported. The program was well received with most doctors indicating they found the support valuable. The HSP is continuing to evolve as Local Health Districts share experiences on models of implementation and resources and tools are developed. A formal evaluation of the HSP will commence in 2014.

  • Commenced quarterly reporting on key HIV statistics, 6 weeks after the close of each quarter for monitoring the implementation of the HIV Strategy, see Resources and Data
  • Strengthened surveillance of HIV infection by collecting information on viral load and HIV treatment uptake at the time of diagnosis. For the first time, information was available on HIV treatment coverage among people newly diagnosed with HIV in NSW. This is critical for tracking progress towards the goals set out in the NSW HIV Strategy 2012-2015. Of 355 NSW residents newly diagnosed with HIV in 2013, 140 (39%) had commended HIV antiretroviral treatment around the time of diagnosis.

Sexually transmissible infections

In 2013 there were:

  • 20,821 chlamydia case notifications, a decrease of 2% compared with 2012 (n = 21 305). 55% of cases were females and 56% were aged between 15 and 24 years
  • 4,243 gonorrhoea case notifications, an increase of 3% compared with 2012 (n = 4127). 82% of cases were males and 42% were aged between 20 and 29 years
  • 624 infectious syphilis case notifications, a 21% increase compared with 2012 (n = 514). Almost all cases (95%) were men. The most commonly affected age groups were between 30 and 39 years (30%) and 40 and 49 years (29%)
  • 27 lymphogranuloma venereum (LGV) case notifications, a decline from 29 in 2012. All cases were men. Almost half of the cases (48%) were aged between 25 and 34 years, and a further 44% were between 35 and 44 years. The number of LGV notifications has decreased each year since 2010 following an outbreak early in that year

Long term trend in notifications are seen in the charts below.

Note: sexually transmissible infections are often asymptomatic, and so people who are infected may never be diagnosed. Variations in notifications may reflect changes in testing patterns rather than changes in the incidence of infection.

Notifications of patients with slected sexually transmissible infections, NSW, 2003-2013 - Chlamydia, Gonorrhoea, LGV and Infectious Syphilis

In 2013, Health Protection NSW piloted a system to collect enhanced data on notifications of gonorrhoea to provide better information on the Aboriginal status and risk exposure of people diagnosed with gonorrhoea in NSW. Subject to the outcomes of the evaluation, new follow up procedures will be implemented.

Enteric diseases

In 2013 there were:

  • 7,598 enteric disease case notifications, a 9% increase compared with the average annual count for the previous five years, but 1% lower than the total enteric disease notifications for 2012
  • 3,438 salmonellosis case notifications, a 16% increase compared with 2012 and 13% higher than the average annual count for the previous five years
  • 39 outbreaks of probable foodborne disease affecting 417 people, a decrease compared with 61 outbreaks affecting 662 people in 2012
  • 687 outbreaks of probable viral gastroenteritis in institutions affecting 10,069 people, a decrease compared with 803 notifications affecting 13,842 people in 2012
  • 9 point-source outbreaks of Salmonella Typhimurium infection affecting 109 people, most likely associated with the consumption of sauces, smoothies, and desserts prepared with raw eggs
  • 29 listeriosis cases. There was a cluster of three listeriosis cases in NSW public hospitals in April 2013 associated with consumption of chocolate profiteroles. One patient died and a further two cases recovered after serious illness. Following this incident Health Protection NSW, worked closely with the Camperdown PHU, the NSW Food Authority, and NSW Health Service Support, (providers of food services to NSW public hospitals), to tighten requirements about Listeria control in foods served to patients and to improve communication protocols

Long term trend in notifications are seen in the charts below.

Note: Surveillance of enteric infections depends on notifications of outbreaks by clinicians, or laboratory confirmation of specific organisms, which are likely to reflect only a small proportion of all enteric infections.
Notifications of patients with selected enteric infections, NSW, 2003-2013 - Cryptospiridiosis; Foodbourne Illness; Giardiasis; Rotavirus; and Salmonella infection.

Notifications of patients with selected enteric infections, NSW, 2003-2013 - Hepatitis A; Hepatitis E; Listeriosis; Shigellosis; and Typhoid
Notifications of patients with selected enteric infections, NSW, 2003-2013 - Botulism; Cholera; HAemolytics Uraemic Syndrome; and Verotoxin-producing Escherichia Coli infections

NSW Health continues to work closely with the NSW Food Authority to investigate reports of potential food borne infection.

Salmonella Online Survey

In early 2013 a Salmonella Online Survey (SOS) was trialled to:

  • explore online surveys as a tool for rapid collection of salmonellosis risk factors;
  • assess the suitability of using an online survey for disease follow up; and
  • reduce the time interval between onset of illness and public health follow-up.

More than 300 people were invited to participate via a letter including a link to an online survey. A response rate of 22% was achieved. The survey responses frequently revealed foods or meals that were a likely source of the salmonellosis so advice could be given on safer alternatives, e.g. informing a case that smoothies containing raw egg are a particularly risky practice for salmonellosis. An evaluation found the SOS to be both a useful and acceptable form of public health follow up for salmonellosis cases and HPNSW aims to refine the methodology of the SOS and trial it again in 2014.

Enterovirus Outbreak Surveillance

Although most enterovirus infections cause mild or no symptoms, they are also associated with a wide range of clinical diseases from hand-foot-and-mouth (HFM) disease to aseptic meningitis and acute flaccid paralysis. Transmission of enteroviruses, which includes the poliomyelitis virus, may occur directly via the faecal-oral route, contaminated environmental sources, or respiratory droplet transmission. Enterovirus infections (apart from poliomyelitis) are not notifiable in NSW.

In early March 2013, paediatricians from the Northern Beaches area of Sydney alerted the Northern Sydney Local Health District Public Health Unit to an increase in the number of young children presenting with severe neurological manifestations of enterovirus infection. The Sydney Children’s Hospital Randwick confirmed human enterovirus 71 (EV71) in some of these cases and suspected infection in others.

Human enterovirus 71 (or EV71) is a major cause of HFM disease worldwide, and in the last 15 years has caused large outbreaks in South East Asia associated with severe neurological disease and deaths. Large outbreaks have been rare in Australia but have been reported from Victoria, Western Australia, and in Sydney in 2000-01.

NSW Health alerted clinicians and issued alerts to the community locally and statewide. The Sydney Children’s Hospital Network circulated advice to clinical staff on the diagnosis and management of patients with suspected neurological complications of enterovirus infection. Enhanced surveillance for current and recent cases of severe enterovirus infections in young children was implemented at both of Sydney’s Children’s Hospitals, and through the public hospital real-time emergency department surveillance system (PHREDSS) which demonstrated a gradual community spread of the infection to other parts of Sydney and outside Sydney. More than 100 suspected cases were identified, which were found to be due to either EV71 or one of a number of other enteroviruses. The outbreak peaked in March and had declined by June 2013. While the enhanced hospital case surveillance was stopped in June, emergency department surveillance through PHREDSS continued.

In November 2013 paediatricians at Children’s Hospital Westmead reported an increase in presentations of very young infants with fever, rash, and irritability. Testing showed that the infants were infected with parechovirus genotype 3, which has been recognised as causing similar outbreaks amongst infants in Europe, North America and Asia, but had not previously been recognised in Australia. In collaboration with public health units and clinical staff in the three tertiary paediatric hospitals active surveillance was established and alerts were disseminated to paediatricians and emergency departments. Overall, in the period from October 2013 to February 2014, 183 cases were confirmed in infants, from all parts of the state. PHREDSS surveillance was found to be a sensitive tool to track the outbreak, and the indicator (admission of infants presenting with fever/unspecified) continues to be monitored.

 

Respiratory disease

In 2013 there were:

  • 101 Legionnaires’ disease case notifications compared with 102 cases in 2012. A total of 54 cases were due to Legionella pneumophila infection, compared with 64 cases in 2012. Public health investigations did not identify any common sources for these L. pneumophila cases and they were evenly spread throughout the year. Notifications due to L. longbeacheae infection increased slightly (36 compared with 29 cases in 2012)
  • 8,401 notifications of patients with laboratory confirmed influenza, a slight increase compared with 7,993 notifications in 2012. Both influenza A and B activity was highest in late August. Approximately 64% of laboratory-confirmed influenza was influenza A, with the influenza A(H1N1)pdm09 strain predominating. The number of influenza B notifications was higher than for any of the previous five years and accounted for 36% of laboratory confirmed influenza cases overall. Laboratory-confirmed influenza notifications represent only a small proportion of cases in the community. There was a large increase in the number of people presenting to emergency departments with influenza-like illness from June to September, with a peak in presentations in late August. There were fewer reported outbreaks of respiratory illness in aged-care and other residential care facilities in 2013 compared to previous years, and the rate of deaths attributed to influenza and pneumonia was low (a pattern seen previously influenza A(H1N1)pdm09 predominates)
  • Continued influenza prevention campaigns that focused on three key respiratory disease prevention messages: Cover your face when you cough or sneeze; Wash your hands; and Stay at home if you're sick so you don't infect others. The campaign also included distribution of The Spread of Flu is Up to You campaign posters, vaccination & pregnancy brochures, and infection control signage to health care facilities, aged care facilities and a range of other sectors.
  • 430 notifications of tuberculosis, a steady decrease from the 451 and 511 cases reported in 2012 and 2011, respectively
  • 8 cases of multi-drug resistant tuberculosis (MDR-TB). Eight cases were reported in 2010, 2011 and 2012 combined
  • In collaboration with an expert sub-committee of the NSW Tuberculosis Advisory Committee, continued activities to strengthen tuberculosis prevention and control in Aboriginal communities in northern NSW, through a range of measures to increase screening, and increase early diagnosis.

Long term trend in notifications are seen in the charts below.

Note: Notifications of laboratory legionnaires disease and tuberculosis are likely to approximate diagnoses, however only a tiny proportion of influenza cases are ever diagnosed and notified.

Notifications of patients with Tuberculosis and Legionellosis, NSW, 2003-2013 

Vector borne diseases

In 2013 there were:

  • 503 Ross River virus infection (RRV) notifications, a decrease from 604 in 2012. While the largest number of RRV cases was reported in the Hunter New England LHD (130 cases), Northern NSW LHD had the highest rate of notifications by population, followed by the Mid North Coast LHD
  • 431 Barmah Forest virus infection notifications, a 21% increase compared with the 357 notifications in 2012. This increase should be interpreted with caution as the use of a less specific serological test in 2013 is thought to have resulted in some false positive notifications. The geographical distribution of cases was similar to RRV, with the highest number of cases reported from residents of the Northern NSW, Mid North Coast and Hunter New England LHDs
  • 298 dengue fever case notifications, a small increase compared with the 289 notifications in 2012. The majority of the cases in 2013 were linked to international travel: Indonesia was the most commonly reported exposure site (40%), followed by Thailand (20%), India (6%) and the Philippines (6%). One case was acquired in NSW through exposure to the dengue virus in a research laboratory
  • No notifications of Kunjin virus, Murray Valley encephalitis virus, or other non-dengue flavivirus infections
  • 24 Chikungunya virus infection notifications, a marked increase over the two cases reported in 2012. All were acquired overseas with 13 cases acquired in Indonesia and five acquired in India
  • 87 malaria notifications, compared with 70 cases in 2012. All were acquired overseas. Travel to India was again the most commonly reported exposure site (26%), followed by Nigeria (11%)

Long term trend in notifications are seen in the charts below.

Note: Only laboratory confirmed diagnosed vector borne infections are notified in NSW. Many arbovirus infections are likely to remain undiagnosed.

Notifications of patients with selected vector borne diseases, NSW, 2003-2013 - Barmah Forest Virus; Dengue; Malaria and Ross River Virus
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Zoonotic diseases

In 2013 there:

  • Was an increase in Q fever case notifications (168 compared with 123 in 2012). Q fever was the most commonly notified zoonotic disease in 2013
  • Was a decrease in leptospirosis notifications (12 compared with 22 in 2012)
  • Was a slight decrease in brucellosis notifications (3 compared with 6 in 2012). 2 cases were overseas-acquired and 2 infections were in feral pig hunters in Northern NSW
  • Was an outbreak of Hendra virus (HeV) infection in horses on the north coast of NSW in June and July 2013. the outbreak affected four separate properties including four horses and one dog. See Notes from the Field for more detail Add link
  • Were two outbreaks of highly pathogenic H7N2 avian influenza (AI) in animals on poultry farms near Young in October 2013. See Notes from the Field for more detail (add link)
  • Was continued close work with the NSW Department of Primary Industries to manage zoonoses including developing and releasing joint factsheets on HeV and Australian Bat Lyssavirus and revising HeV quarantine procedures to include provision for companion animals.

Long term trend in notifications are seen in the charts below.

Note: Only laboratory confirmed diagnosed of zoonoses are notified in NSW, and mild cases may remain undiagnosed.

Notifications of patients with selected zoonoses, NSW, 2003-2013 - Brucellosis; Leptospirosis and Q Fever 

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Page Updated: Wednesday 25 June 2014
Contact page owner: Health Protection NSW