Download NSW Health testing denominator data – uses for public health

NSW Health testing denominator
data – uses for public health
Sheena Adamson, Nick Rose, Paula Spokes, Vicky Sheppeard
Health Protection NSW
October 2016
Why notify to public health
 NSW Public Health Act 2010
– notifiable conditions
– laboratory notification of positive results to PHU
– doctors and hospitals clinical notification to PHU
 NSW Public Health
– reporting timeframe (telephone or electronic, fax, mail)
– laboratory results interpreted per NSW Control Guidelines
aligned with CDNA National Surveillance Case Definition (based on PHLN
Laboratory Case Definition)
– PHU enters notification into NCIMS
 National Health Security Act 2007
– national collation of notifications from jurisdictions
What is notifiable to public health in NSW
 There are 60 infectious diseases notifiable to public health
by laboratories
 In 2015, over 100,000 infectious disease reports were
received by public health in NSW
 99.5% were notified by laboratories
Laboratory notifiable infectious diseases in NSW (L)
Some also notifiable by Medical Practitioners (MP), Hospitals (H), School/Child Care Centre (SC)
Anthrax [L]
Arboviral infection [L] including:
Barmah Forest virus; Chikungunya virus; Dengue virus; Ross River
virus; Japanese encephaliitiis virus; Kunjin virus; Murray Valley
encephalitis virus; Yellow Fever (tel); Zika virus; Other
Avian Influenza [MP/H/L] (tel)
Botulism [H/L] (tel)
Brucellosis [L]
Chancroid [L]
Chlamydia [L]
Cholera [H/L] (tel)
Creutzfeldt-Jacob disease (CJD or vCJD) [MP/H/L] (tel)
Cryptosporidiosis [L]
Diphtheria [H/L/SC] (tel)
Donovanosis [L]
Giardiasis [L]
Gonorrhoea [L]
Haemophilus influenzae type b invasive infections [H/L] (tel)
Hendra virus infection [L] (tel)
Hepatitis A [L] (tel)
Hepatitis B [L]
Hepatitis C [L]
Hepatitis D (Delta) [L]
Hepatitis E [L] (tel)
HIV [L] [see HIV Notification Form]
Influenza [L]
Invasive pneumococcal infection [L]
Legionella infection [H/L] (tel)
Leptospirosis [L]
Listeriosis [L] (tel)
Lymphogranuloma venereum (LGV) [L]
Lyssavirus [H/L] (tel)
Malaria [L]
Measles [MP/H/L/SC] (tel)
Meningococcal infection [H/L] (tel)
MERS-CoV [L] (tel)
Mumps [L/SC]
Paratyphoid [H/L] (tel)
Pertussis [MP/H/L/SC]
Plague [H/L] (tel)
Poliomyelitis [H/L] (tel)
Psittacosis [L]
Q Fever [L]
Rabies [H/L] (tel)
Rotavirus infection [L]
Rubella [L/SC]
Salmonellosis [L]
Severe Acute Respiratory Syndrome (SARS) [MP/H/L] (tel)
Shigellosis [L]
Smallpox [MP/H/L (tel)]
Syphilis [MP/H/L]
Tetanus [H]
Tuberculosis [MP/H/L]
Tularaemia (tel)
Typhoid [H/L] (tel)
Typhus (epidemic) [H/L] (tel)
VTEC/STEC [L] (tel)
Viral haemorrhagic fevers [H/L] (tel)
What testing is important for Public Health
 Pathogen - known, emerging, re-emerging
 Direct detection
– microscopy, isolation, antigen, nucleic acid
 Indirect - immune response
– recent infection (IgM, NT), immunity (IgG, HI)
 Antimicrobial susceptibility
 Donor testing
 Routine testing vs outbreak response
Public Health review of laboratory notifications
 Monitor notifications (passive surveillance) to detect:
– cluster/outbreak of specified diseases for urgent action
eg significant risk to public health, rapid transmission
– increased rate of infection of endemic diseases
denominator data useful
 Interpretation of laboratory results
– based on national guidelines (SoNGs), NSW Control Guidelines
 Follow-up testing may be requested by PHU eg typing
 Confirming a case may also require stipulated
clinical/epidemiological evidence
– consultation with clinicians, healthcare facilities, other agencies
Public health actions may include:
•
Outbreak investigation
- identify clusters (geomapping)
- detect novel pathogens/transmission eg zoonoses
•
Contact tracing
•
Active surveillance
- targeted testing for cases and contacts
- identify transmission links (phenotypic/genotypic testing)
•
Management of cases and contacts
-
containment (isolation, quarantine)
- treatment, prophylaxis
•
Monitor trends for control and management programs
- alerts, advice, policies and procedures
Epidemiological analysis - geomapping
Average annual measles notification rates in NSW,
by Local Health District (per 100,000), 2006-15
Testing denominator data
 Aggregated monthly data for selected notifiable infectious
diseases from 15 NSW laboratories since Jan 2012
for: BBVs (HIV, HBV, HCV); STIs (Chlamydia, gonorrhoea);
arboviruses (RRV, BFV); respiratory pathogens (pertussis; influenza);
enteric pathogens (Salmonella, Shigella, Giardia, Cryptosporidium)
 Useful to indicate trends in rates of testing
assists interpretation of notification rates (eg increased cases due to increased
testing/detection not disease incidence), impact of public health programs
 Limitations of data
possible duplication if >1 test per condition (eg pertussis)
or >1 specimen per episode (eg gonorrhoea)
 Enhancements
requestor and patient demographics would be useful to indicate patient group
tested, patient location, age, sex
Notification – HIV
Notification – HBV, HCV
Hepatitis B
Hepatitis C
Notification – Chlamydia, Gonorrhoea
Chlamydia
Gonorrhoea
Notification - pertussis
Notification – Influenza
Notification – RRV, BFV
Ross River
Virus
Barmah Forest
Virus
Notification – Salmonella, Shigella
Salmonella
Shigella
Notification – Cryptosporidium, Giardia
Cryptosporidium
Giardia
Public health reporting
 Weekly CDB report on-line, emailed to laboratories
highlights the previous week’s activities
 Monthly, quarterly and annual reports for public health
surveillance on-line
eg influenza, STI, HIV Hepatitis B and C reports
 Publications
eg outbreak investigations
Summary
 Notifiable infectious disease testing data
– legally required, data defined & collated by NSW Public Health
– used for case/outbreak control & management, public health
programs
– benefits public health
 Denominator data
assists interpretation of notifications, assessment of impact of public
health programs
 Further information: www.health.nsw.gov.au
Infectious Diseases website includes:
Communicable Disease Weekly Report, Disease Notification, other reports
A-Z of Infectious Diseases (Data, Control Guidelines)