The health outcomes in this report are measured mainly through routine surveillance data, derived from notifications of selected diseases from doctors, hospitals and laboratories to public health units under the NSW Public Health Act 2010.
Tables 1–6 show disease-specific data on notifiable conditions reported by: year of onset of illness; month of onset of illness; local health district of residence; and age group and sex. Note that the degree to which notification data reflect the true incidence of disease varies and is subject to a range of caveats.
In 2014 we saw:
- an upward trend in pertussis notifications from mid-2014, mainly across the 0-14 year age group
- three clusters of measles involving secondary transmission within NSW, the largest involving the importation of two cases from Philippines and the subsequent transmission to eleven persons
- hepatitis B and hepatitis C notifications remain similar to previous years
- an increase in notifications of chlamydia, gonorrhoea and infectious syphilis compared to previous years and a decrease in notifications of Lymphogranuloma venereum
- an increase in notifications for salmonellosis and giardiasis of around 25% compared the annual average for the previous five years. Rotavirus and cryptosporidiosis notifications were decreased compared to previous years
- thirty-one notifications of Shiga toxin producing Escherichia coli (STEC) the highest number of notifications on record and an increase of 99% compared to the annual average for the previous five years. One of the causes for this increase was an outbreak linked to a kebab shop.
- an increase in hepatitis E notifications of 131% compared with the annual average for the previous five years. This increase was due to the locally acquired cluster linked to pork pate and the recognition that hepatitis E can be acquired in Australia from pork products.
- 43 foodborne or probable foodborne disease outbreaks affecting at least 468 people, as well as 575 viral or probable viral gastroenteritis outbreaks in institutions affecting 8,467 residents
- one of the most severe winter influenza seasons in recent years with high rates of admission to critical care units. A new strain of influenza A (H3N2) predominated which was not well matched to the 2014 vaccine (but which is well-matched to the 2015 vaccine). Notifications of Legionnaires’ disease in 2014 were down by about one third from the previous year
- tuberculosis notifications remain stable, with five cases of multi-drug resistant tuberculosis (MDR-TB) compared to eight and three cases reported in 2013 and 2012 respectively
- a continuation of the upward trend in dengue notifications seen over the past few years. All cases were acquired overseas with Fiji a more common source of infection than in previous years. Indonesia, and particularly Bali, continued to be the most common location where dengue was acquired.
- four of five reported cases of ‘Flavivirus – unspecified’ were able to be further identified as due to Zika virus infection; all were in travellers recently returned from Cook Islands
- numbers of zoonotic infections remain similar to previous years. There were 220 reports of exposure to either a bat in Australia or a mammal overseas. Forty six per cent were exposed within Australia, 32% in Indonesia, 13% in Thailand and 8% in another overseas country. Where an exposure occurred in Australia, 73% were from a megabat (including flying foxes) and 27% from microbats. Where an exposure occurred overseas, 63% were from a monkey, 25% from a dog and 12% from another animal.
- the number of newly diagnosed HIV infection remained similar to the previous 5 years, with 79% reporting to be men who have sex with men (MSM), 14% reporting acquiring HIV through heterosexual sex, and 2% reporting acquiring HIV through injecting drugs (PWID).
Progress on work plan priorities
- Improve the timeliness of vaccinations of children and adolescents
- Contain all importations of measles
- Rapidly investigate and help control disease outbreaks
- Prevent the transmission of HIV through improved clinical interventions
- Reduce the transmission of tuberculosis in Aboriginal communities
- Establish electronic notification of diseases by laboratories
Improve the timeliness of vaccinations of children and adolescents
In the context of recurring outbreaks of vaccine preventable diseases, in particular pertussis and measles, timeliness of vaccination is important to protect vulnerable children. There continues to be a higher percentage of Aboriginal children who receive their vaccines late. The latest data show that for the cohort of children born in 2012, 27.9% of Aboriginal children received the third dose of diphtheria-tetanus-pertussis (DTPa) vaccine (due at 6 months of age) up to 6 months late, compared with 15.4% of non-Aboriginal children. For the second dose of measles, mumps and rubella (MMR) vaccine (due at 18 months), 31.5% of Aboriginal children received the second dose of up to 6 months late, compared with 23.9% of non-Aboriginal children.
NSW Health has implemented a number of strategies to address timeliness of vaccination, including the “Save the Date to Vaccinate” campaign, funding of Aboriginal Immunisation Health Workers in all public health units, reminder letters (sent through the Australian Childhood Immunisation Register) to all new parents, and implementation of strengthened vaccination requirements for enrolment into childcare. Timeliness of vaccination for Aboriginal children improved from 86.2% fully vaccinated at one year of age in 2013 to 89.2% in 2014.
2014 Measles Control Program
In response to on-going measles transmission in NSW and an immunity gap in adolescents and young adults, a measles expert group was convened and the NSW Measles High-school Catch-up Program 2014 was rolled out to students in Years 7-12 in 145 high schools during terms 3 and 4. Schools and student years targeted were determined by each public health unit based on a set of principles to prioritise groups most likely to require vaccination.
A total of 11,185 students were vaccinated during the program, representing 57% of students whose parents had provided consent for vaccination. The consent form asked parents to indicate how many previous doses of measles-mumps-rubella (MMR) vaccine the student had received (0, 1 or 2). For 43% of students where a parent had indicated 0 or 1 dose, Australian Childhood Immunisation Register (ACIR) records showed that the student was fully vaccinated (had already received 2 doses). This suggests that parental records of vaccinations may not be accurate.
Building on the success of this program, a measles vaccination program in Years 11 and 12 is being rolled out in all schools during 2015.
Contain all importations of measles
In 2014, 28 out of 67 cases of measles notified to NSW Health were acquired outside of Australia. Secondary transmission was observed with three clusters reported in NSW. The majority of importations were linked to the Philippines which was experiencing a prolonged measles outbreak following Cyclone Yasi.
A range of control measures were initiated alongside public health unit follow up, including: multiple media alerts, measles alert posters, travel advice and school based measles vaccination catch up programs.
Rapidly investigate and help control disease outbreaks
STEC infection associated with a take away food store
A PHU was notified of 5 STEC cases serotype O157-H (Stx genes 1 & 2 positive), from the same local health district. One further symptomatic case was reported by a doctor but no stool specimen was taken. Interviews with the cases revealed a common take away food premises that sold kebabs and pide. Foods were consumed between 4 and 17 January 2014 and included a mix of items and no one common ingredient. The kebab shop was closed on 17 January 2014 by the NSW Food Authority (NSWFA) and food and environmental samples were taken. The results of the samples were negative, but numerous hygiene and process breaches were noted on the inspection that could have led to cross-contamination of foods that did not undergo a final kill step. The business was closed until it could satisfy the requirements of improvement notices regarding the proper handling and cooking of shaved rotisserie meat, ensuring meat handling utensils are not a source of cross-contamination risk and are routinely cleaned and sanitised, ensuring adequate temperature controls are in place, and that repair and maintenance work was undertaken.
Hepatitis E infection associated with a restaurant
In April 2014, a case of hepatitis E (HEV) was notified to public health. The interview revealed that the case’s work colleague from Victoria also had HEV and the only common exposure for both cases was dinner with seven other people from the same work place at a restaurant on 11 March 2014. Further investigations included interviewing and serological testing of co-dining work colleagues, which revealed a further three cases. Case interviews revealed that pork pâté was the only food consumed by all the cases. An additional 10 infected individuals, unrelated to the work group, were also investigated as part of this cluster. Of the 10 individuals, four had symptoms and were identified through routine surveillance, five were asymptomatic cases identified through screening co-diners and one symptomatic case was identified through retrospective testing of stored sera. All cases reported consuming pork pâté at the same restaurant on different dates to the work group (13 March, 15 March, 3 May and 15 May). The NSWFA inspected the restaurant on two occasions on 15 and 21 May 2014 and witnessed the preparation and cooking of the pork pâté. The restaurant was found to be very well-run with no issues identified in food handling, cooking or cleaning. The pork pâté was made with pork livers and included only one short cooking step. Pork samples from the restaurant were tested for HEV. All samples were negative. Trace back of the pork livers revealed that a single pig farm supplied the livers that were served as pork pâté on the days the cases reported eating at the restaurant. Pork liver pâté is no longer sold at the restaurant. Investigations are ongoing.
In addition to the HEV cases above, three notifications of locally acquired HEV from 2013 with no known source of infection were re-investigated. Interviews revealed that two cases had also eaten pork pâté at the same restaurant during their incubation period (the third case was thought to be person to person transmission). An additional case from October 2013, identified on retrospective testing of stored sera was also linked to the cluster. The viruses from 11 out of the 18 cases linked to the restaurant (three from 2013 and eight from 2014) were genetically sequenced and were found to be closely related, suggesting a common source. Undercooked pork has been associated with cases of food borne hepatitis E overseas. NSW Health convened a hepatitis E expert panel and it was concluded there was no ongoing public health risk associated with the restaurant.
Salmonella Typhimurium infection associated with Vietnamese rolls
A PHU was notified of two people who had gastrointestinal illness after eating Vietnamese rolls from a cafe on 24 January 2014. The PHU conducted case finding via emergency department presentations and of Salmonella notifications and identified 24 people (16 Salmonella Typhimurium MLVA 3-17-10-11-523 cases and another eight symptomatic cases) with gastrointestinal illness after eating at this cafe on either 23 or 24 January 2014. Nine (38%) of the symptomatic cases were hospitalised. The NSWFA inspected the premises on 29 January 2014 with most procedures satisfactory and commercial mayonnaise in use, however sanitiser was not in use for utensils and equipment. Food samples were taken and the pâté was positive for Salmonella Typhimurium MLVA 3-17-10-11-523. The pâté was made on site and it is possible the chicken liver was not cooked to a temperature necessary to kill any Salmonella present, so may have been the source of the salmonellosis.
Prevent the transmission of HIV through improved clinical interventions
The NSW HIV Support Program (HSP) provides expert advice and support for doctors when they diagnose someone with HIV to ensure the newly diagnosed person has access to the five key support services: appropriate clinical management including access to treatment; psychosocial support; counselling about HIV treatment and prevention of transmission of HIV to others; confirmation of contact tracing; and linkage to specialist, community and peer support services.
From its commencement on 9 May 2013 to 31 December 2014 the HSP supported 212 HIV-inexperienced doctors at the time they newly diagnosed a person with HIV infection, as well as a further 24 medical doctors whose patient had been previously diagnosed; a total of 236 doctors. HSP Coordinators submitted 131 of 212 (62%) evaluation forms for the interventions they conducted with HIV-inexperienced doctors. One hundred and seventeen (89%) of these doctors reported they wanted some form of assistance or support through the HSP, indicating there was a need among doctors for support. For 66 (50%) doctors it was the first time they had made an HIV diagnosis and in 66 (50%) cases the patient was not a regular patient of the doctor. While 89 (68%) doctors were aware of their contact tracing responsibilities only 64 (49%) were aware of methods for contact tracing.
For people newly diagnosed with HIV since 1 January 2013, information has been collected from doctors about HIV antiretroviral therapy (ART) initiation at the time of notification and at a time at least six months after diagnosis. At the end of 2014, of 534 NSW residents newly diagnosed with HIV infection from 1 January 2013 to 30 June 2014, 292 (55%) had commenced ART within six months of diagnosis, 189 (35%) had not commenced ART within this time frame and 53 (10%) were of unknown ART status at six months after diagnosis.
Reduce the transmission of tuberculosis in Aboriginal communities
There is an ongoing gap between the incidence of TB in Aboriginal and Torres Strait Islander and Australian born non-indigenous Australians, with TB incidence being approximately five times higher in Aboriginal and Torres Strait Islander Australians. In NSW the gap in TB incidence between Aboriginal and non-indigenous people is driven primarily by an ongoing cluster of TB, focused around Northern NSW. Five new cases were reported in 2014, bringing the total number of NSW cases in the cluster since 2000 to 36 at the end of 2014.
The NSW TB Program continues to work towards reducing TB transmission in Aboriginal communities. This is done by engaging with communities to understand barriers to early diagnosis and uptake of preventive treatment, raising awareness of TB within communities and amongst healthcare providers, and working with Aboriginal Medical Services to offer more opportunities for TB screening.
Establish electronic notification of diseases by laboratories
Electronic laboratory reporting (ELR) is the electronic transmission of laboratory results for notifiable conditions to the Notifiable Conditions Information Management System (NCIMS). ELR has many benefits, including improved timeliness, reduction of manual data entry errors, and reports that are more complete.
Four laboratories commenced ELR in 2013. An additional laboratory commenced in 2014, bringing the total labs that report using ELR to 5. This represents around 60% of all notifications in NSW.
- Guides and caveats for interpreting infectious diseases data (NSW Data)
- Bareja C, Waring J, Stapledon R, Toms C, Douglas P. Tuberculosis notifications in Australia, 2011. Commun Dis Intell Q Rep 2014; 38(4): E356-68.