* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Review of Notifiable Diseases in the South Metropolitan
Trichinosis wikipedia , lookup
Typhoid fever wikipedia , lookup
Henipavirus wikipedia , lookup
Gastroenteritis wikipedia , lookup
Oesophagostomum wikipedia , lookup
Schistosomiasis wikipedia , lookup
Sexually transmitted infection wikipedia , lookup
Hepatitis B wikipedia , lookup
Leptospirosis wikipedia , lookup
Meningococcal disease wikipedia , lookup
African trypanosomiasis wikipedia , lookup
Hepatitis C wikipedia , lookup
Hospital-acquired infection wikipedia , lookup
Neisseria meningitidis wikipedia , lookup
Marburg virus disease wikipedia , lookup
Coccidioidomycosis wikipedia , lookup
Neglected tropical diseases wikipedia , lookup
Middle East respiratory syndrome wikipedia , lookup
Review of notifiable diseases in the South Metropolitan Health Service – 2014 Disease Control Section South Metropolitan Population Health Unit July 2015 health.wa.gov.au health.wa.gov.au Review of notifiable diseases in the South Metropolitan Health Service – 2014. Disease Control Section - South Metropolitan Population Health Unit. For enquiries contact: Disease Control Section South Metropolitan Population Health Unit PO Box 546, Fremantle, Western Australia 6959 Phone: (08) 9431 0200 Email: [email protected] i Contents Summary iv Introduction 1 Background 1 Notifiable diseases 1 Childhood immunisation 1 Data sources and validity 2 Overview of notifiable diseases 3 Vaccine preventable diseases 6 Pertussis 6 Influenza 8 Hepatitis A 11 Measles 11 Invasive pneumococcal disease 12 Varicella zoster virus 13 Rotavirus 14 Rubella 14 Tetanus 14 Mumps 15 Immunisation rates 16 Vector borne diseases 20 Chikungunya 20 Dengue 20 Ross River virus and Barmah Forest virus 20 Other vector borne diseases 21 Sexually transmitted infections 22 Chlamydia 22 Gonorrhoea 23 Syphilis 24 Blood borne viruses 25 Hepatitis C 25 Hepatitis B 25 Enteric diseases 26 Campylobacterosis 26 Salmonellosis 26 ii Other enteric diseases 27 Gastroenteritis outbreaks in residential care facilities 27 Other diseases 28 Invasive meningococcal infection 28 Legionellosis 29 Tuberculosis 29 Rabies post-exposure prophylaxis 29 References 30 iii Summary There were 11,694 communicable diseases notified in the South Metropolitan Health Service (SMHS) in 2014. This was an increase of 8.0% from 2013 (10,826 cases) which was primarily due to an increase in influenza and campylobacteriosis notifications. Chlamydia was the most commonly notified disease with 4,120 notifications, followed by influenza with 1,673 cases, and varicella zoster with 1,066 notifications. Despite relatively high vaccination coverage, pertussis notification rates have increased in Australia in recent years. The last pertussis epidemic in the SMHS and Western Australia (WA) peaked in 2011, but a new, higher non-epidemic baseline now seems to have been reached with 676 cases notified in 2014 in the SMHS, compared to 60 in the pre-epidemic year of 2007, suggesting there is ongoing transmission of pertussis in the community. There were 1,673 influenza cases notified in 2014, which was nearly double the number of cases notified in 2013 (n=856), but similar to the 2012 season (n=1,742). There were 17 cases of measles notified in the SMHS in 2014 compared with 6 in 2013. This was part of an Australia wide increase in notifications due to imported measles from Asia, which was linked to an outbreak in the Philippines. Over three quarters (76%) of SMHS cases acquired measles overseas and the remaining cases acquired in Australia were all contacts of a confirmed case who had acquired the disease overseas. This highlights that measles is essentially a traveller’s disease imported from high prevalence countries. In 2014 there was one notification of tetanus in an elderly person which was the first case notified in the SMHS since 1998. Tetanus is an acute, often fatal vaccine preventable disease, caused by toxin from the organism Clostridium tetani resulting in severe muscle spasms, often requiring prolonged ventilation. There was a fall in the proportion of Australian Childhood Immunisation Register (ACIR) coverage for two year olds who were fully immunised in the September quarter of 2014 in the SMHS, WA and Australia. This was due to the addition of meningococcal C vaccine, varicella vaccine and dose 2 of measles, mumps, rubella (MMR) vaccine (replacing dose 1 of MMR vaccine) to the fully vaccinated calculation for this age cohort. There has been a steady increase in gonorrhoea notifications in the SMHS since 2010 (n=207). In 2014 there were 589 cases of gonorrhoea notified in the SMHS, an increase of 35% from 2013 (n=438). Non-Aboriginal males were responsible for most of this increase and, to a lesser degree, non-Aboriginal females. In Australia, rabies post-exposure prophylaxis (PEP) is indicated in people who have had mammalian animal bites or scratches in a geographic location where rabies is known to be endemic in animal populations (not in Australia), and for people who have been bitten or scratched by bats in Australia or overseas. The majority of exposures were from mammalian animals (mostly monkeys but including dogs) during holidays in Bali. There has been an increase in Australian bat lyssavirus (ABLV) detection in sick and injured bats in the Kimberley region of WA. In 2014, 11 bats tested positive for ABLV, compared with only one case in WA in the previous decade. iv Introduction This report provides a summary of notifiable diseases in the South Metropolitan Health Service (SMHS) of Western Australia (WA) in 2014 and compares these to recent years. It also includes a report of childhood immunisation rates. The purpose of this report is to improve the prevention and early detection of notifiable diseases by informing health-care providers about important local notifiable disease trends. Background Notifiable diseases Under the Western Australian Health Act of 1911, any medical practitioner or nurse practitioner attending a patient who is known, or suspected, to have a notifiable disease has a legal obligation to report it to the WA Department of Health (DoH). All notifiable diseases require notification by a medical practitioner and are entered into the Western Australian Notifiable Infectious Diseases Database (WANIDD) and cross-checked for duplication. Some diseases, including suspected meningococcal disease and measles, require the practitioner to notify the DoH urgently by telephone and these are marked with a on the notification form. In addition, laboratory notification is mandatory for all notifiable diseases. A new (green) notification form was produced in August 2014, with some changes to the notifiable infectious diseases listed. Communicable disease notifications are used to inform public health interventions and enhance the prevention and control of these diseases. A full list of current notifiable diseases in WA, along with case definitions, fact sheets and more, are available at: http://ww2.health.wa.gov.au under Health Professionals, alerts and notifications. In the SMHS, notifiable diseases are reported to the South Metropolitan Population Health Unit (SMPHU) disease control team who are responsible for following up notified cases, as required by national and state directives, protocols and guidelines. The purpose of notifiable disease follow up is enhanced surveillance and public health case management and contact tracing, including provision of prophylaxis to high risk contacts as required for some notifiable diseases. The aim is to prevent or reduce further cases of notifiable diseases in the population. Information to support this process is gathered with the assistance of general practice, hospital staff, pathology department staff and the patient. Childhood immunisation The Australian Childhood Immunisation Register (ACIR) was established in 1996 to record details of vaccinations given to Australian children aged less than seven years. Children are included on the register at birth, when enrolled with Medicare. Immunisation coverage is reported quarterly by ACIR for children fully vaccinated in each age group, based on their age calculated at the end of March, June, September and December each year. The data is a sample of children from each of three age cohorts, reflecting approximately one quarter of all children in that one year period. 1 The data reported is as follows: 12 to <15 month report (sample of one year olds): The percentage of children who have received their scheduled immunisations at 6 months of age. 24 to <27 month report (sample of two year olds): The percentage of children who have received their scheduled immunisations at 6, 12 and 18 months of age. 60 to <63 month report (sample of five year olds): The percentage of children who have received their scheduled immunisations at 48 months (4 years) of age. All prior doses are presumed given. Data sources and validity Childhood immunisation data were obtained from the following ACIR reports: State Summary Coverage, State Summary Aboriginal Coverage, Public Health Unit for WA, Public Health Unit Aboriginal for WA, Local Government Area for WA and Local Government Area Aboriginal for WA. The SMHS and WA notification data for 2014 were obtained from the WANIDD, held by the Communicable Disease Control Directorate (CDCD), WA DoH. The estimated 2014 population of the SMHS (945,057 people) and WA (2,532,956 people) were obtained using the Rates Calculator1 and used to calculate notification rates, which are expressed per 100,000 population. National notification rates for 2014 were obtained from the National Notifiable Diseases Surveillance System (NNDSS) (Commonwealth DoHA, 2014). The SMHS notifiable disease data presented in this report were extracted from the WANIDD on 31 March 2015 and are subject to revision. Most data were retrieved from the WANIDD on the basis of the earliest available date reflecting the date of onset of disease (i.e. the ‘optimal date of onset’ or ODO). The exceptions were diseases where there may have been considerable delay between disease onset and diagnosis date. These diseases (non-infectious syphilis, tuberculosis, leprosy, Creutzfeldt-Jakob disease and unspecified hepatitis B and C) were retrieved by date of receipt of notification (DOR). It is important to identify and record Aboriginal2 status for notifiable diseases as Aboriginal people experience a greater burden of infectious diseases than other Australians. This allows specific programs introduced to address this, such as targeted immunisation programs, to be monitored and evaluated. The ethnicity variable on the WANIDD can be recorded as Aboriginal or Torres Strait Islander, other or unknown. Ethnicity was recorded as unknown in 8.7% (1,014) of all cases in 2014, although this was lower for diseases that require public health follow-up and enhanced surveillance of individual cases, such as gonorrhoea (0.5%) and invasive pneumococcal disease (1.5%). In this report, cases with unknown ethnicity were assumed to be nonAboriginal. This will underestimate the Aboriginal notification rate if some of those with unknown status were Aboriginal. 1 The Rates Calculator was created by Dr Jim Codde and is maintained by the Epidemiology Branch, Department of Health WA. The projection feature of the program was used to obtain 2014 population estimates. 2 The use of the term ‘Aboriginal’ within this document refers to both Aboriginal and Torres Strait Islander people. 2 Overview of notifiable diseases There were 11,694 communicable diseases notified in the SMHS in 2014. This was an increase of 8.0% from 2013 (10,826 cases) which was primarily due to an increase in influenza and campylobacteriosis notifications. The number of influenza notifications nearly doubled, from 856 cases in 2013 to 1,673 cases in 2014, and campylobacteriosis notifications increased by 61%, from 649 cases in 2013 to 1,045 cases in 2014. Travellers returning from Bali continue to feature prominently in disease notifications in the SMHS. The main notifiable infectious disease risks for travellers to Bali are from mosquitoborne (e.g. dengue fever), gastrointestinal (e.g. Salmonella infection) and sexually transmitted infections (e.g. chlamydia) (CDCD, 2013a). Figure 1 shows changes in notification rates for selected diseases, by displaying the ratio of the 2014 notification rate to the average notification rate from the previous five years (2009 to 2013). Measles had the highest rate ratio (RR=3.9) between the 2014 notification rate and the five-year average rate, followed by gonorrhoea and legionellosis (RR=1.7 for both). The total number of notifications for each disease notified in the SMHS between 2010 and 2014 are presented in Table 1. Only notifiable diseases recorded in the SMHS during that period have been included. The 2014 crude notification rates for each disease are also presented and compared to crude state and national rates (where available). 3 Figure 1: Rate ratios comparing the 2014 notification rate for selected diseases to the mean rate over the period 2009-2013, SMHS Notes: [1] Diseases with rate ratios <1 had lower notification rates in 2014 than the average rate from 2009-2013, and diseases with rate ratios >1 had higher notification rates in 2014 than the average rate. [2] Diseases with <10 cases notified in the year are not shown (except for meningococcal disease and newly acquired hepatitis B). [3] Infectious and non-infectious syphilis are not shown due to changes in data cleaning during this period. [4] Barmah Forest virus is compared against the average rate from 2009-12 because of false positive reporting by laboratories in 2013. [5] * indicates diseases for which data were extracted based on date of receipt of notification (DOR). 4 Table 1: Number of notifications SMHS 2010-2014 & 2014 SMHS, WA & national rates Number of notifications/year 2010 2011 2012 2013 Blood borne diseases Hepatitis B (newly acquired) Hepatitis B (unspecified)* Hepatitis C (newly acquired) Hepatitis C (unspecified)* Hepatitis D Enteric diseases Campylobacteriosis Cholera Cryptosporidiosis Hepatitis E Listeriosis Paratyphoid fever Salmonellosis Shiga/Vero-toxin-prod E. coli Shigellosis Typhoid fever Vibrio parahaemolyticus Yersiniosis Sexually transmitted infections Chlamydia Gonorrhoea Syphilis (infectious) Syphilis (non-infectious)* Vector borne diseases Arboviral encephalitis Barmah Forest virus Chikungunya Dengue Malaria Typhus (rickettsial disease) Ross River virus Schistosomiasis Vaccine preventable diseases Hepatitis A Influenza Measles Mumps Pertussis Pneumococcal disease (invasive) Rotavirus Rubella Tetanus Varicella zoster virus Zoonotic diseases Leptospirosis Psittacosis (Ornithosis) Q fever Other diseases Acute rheumatic fever Creutzfeldt-Jakob disease* Legionellosis Leprosy* Melioidosis Meningococcal disease (invasive) Tuberculosis* 2014 2014 notification rate/100,000# SMHS WA National 16 239 22 350 0 9 216 42 347 1 13 227 40 362 1 15 251 46 384 1 9 277 51 388 0 1.0 29.3 5.4 41.1 0.0 0.9 24.9 6.3 39.9 0.1 0.8 28.4 1.7 44.6 0.3 759 0 37 1 1 3 412 2 20 5 0 0 734 1 99 4 2 7 410 0 16 5 4 0 643 0 49 0 5 3 386 0 19 10 5 2 649 0 108 1 1 7 406 0 28 6 6 3 1,045 0 112 0 2 5 393 0 12 6 6 1 110.6 0.0 11.9 0.0 0.2 0.5 41.6 0.0 1.3 0.6 0.6 0.1 117.8 0.0 12.3 0.0 0.2 0.4 50.1 0.1 2.7 0.6 0.6 0.2 126.7 0.0 10.4 0.2 0.3 NA 70.8 0.5 4.6 0.5 NN NN 3,686 207 19 23 4,418 340 34 27 4,283 415 22 31 4,317 438 15 31 4,120 589 21 20 436.0 62.3 2.2 2.1 451.2 87.4 3.8 2.5 372.1 67.9 8.7 8.5 0 34 6 179 22 5 173 79 2 50 2 135 22 20 247 26 0 90 3 211 15 12 515 15 1 551^ 31 168 20 7 516 12 0 17 14 171 18 3 584 41 0.0 1.8 1.5 18.1 1.9 0.3 61.8 4.3 0.0 2.2 1.0 17.8 1.9 0.6 62.9 7.0 0.0 3.2 0.5 6.8 1.4 NN 23.1 NN 10 584 4 7 431 48 209 3 0 731 3 645 5 6 1,498 54 52 7 0 882 6 1,742 2 13 1,212 58 112 1 0 838 5 856 6 13 554 54 99 1 0 1,116 5 1,673 17 11 676 65 148 1 1 1,066 0.5 177.0 1.8 1.2 71.5 6.9 15.7 0.1 0.1 112.8 0.8 209.1 1.7 0.9 69.1 8.3 16.5 0.0 0.0 121.3 1.0 293.3 1.5 0.8 51.3 6.8 NN 0.1 0.0 79.6 3 2 1 0 3 2 1 1 2 1 1 0 1 0 0 0.1 0.0 0.0 0.1 0.1 0.2 0.4 0.2 2.0 0 1 23 0 0 8 46 2 1 27 0 0 2 48 2 0 28 0 2 6 63 1 0 40 1 5 7 47 1 1 46 1 0 7 69 0.1 0.1 4.9 0.1 0.0 0.7 7.3 1.0 0.0 4.8 0.2 0.2 0.7 5.6 NN NA 1.9 0.0 NN 0.7 5.8 * Data retrieved from WANIDD based on date of receipt of notification (DOR). ^Due to laboratory false positives. NN = Not notifiable; NA = Data not available at time of reporting 5 Vaccine preventable diseases There were 3,663 vaccine preventable diseases (VPD) notified in the SMHS in 2014, which was an increase of 36% from 2013 (n=2,704). This was largely due to a 95% increase in the number of influenza notifications (from 856 in 2013 to 1,673 in 2014), and a 22% increase in pertussis notifications (from 554 in 2013 to 676 in 2014). Pertussis Pertussis (whooping cough) is a highly contagious, vaccine-preventable respiratory illness characterised by a paroxysmal cough that can last for many weeks. Infants who are not fully immunised are most vulnerable to severe disease, which can be complicated by pneumonia and hypoxic encephalopathy and can occasionally result in death (CDCD, 2011). The National Immunisation Program provides pertussis containing vaccinations for children at two, four and six months of age, with booster doses at four years of age and in adolescence. Despite relatively high vaccination coverage, pertussis notification rates have increased in Australia in recent years (CDCD, 2012; Pillsbury et al., 2014). Several reasons have been proposed for this including: The acellular pertussis vaccine (introduced in Australia in 1999) may be less effective than the whole cell vaccine which was previously used (Sheridan et al., 2012). Selection of non-vaccine strains of Bordetella pertussis (Octavia et al., 2012). Greater availability of more sensitive polymerase chain reaction (PCR) testing (Kaczmarek et al., 2013). Greater physician and patient awareness leading to increased testing (CDCD, 2012). Infants usually acquire pertussis from household contacts, particularly parents (Chuk et al., 2008; Bisgard et al., 2004) and siblings (Bertilone et al., 2014). To prevent newborns from acquiring pertussis infection, since early 2015 vaccination has been recommended and is funded by the WA DoH for pregnant women during their third trimester (from 28 weeks) of every pregnancy. Parents, grandparents and carers of babies should also consider being immunised against pertussis (this is not funded). In the past, pertussis epidemics tended to occur every three or four years (CDCD, 2012). The last pertussis epidemic in the SMHS and WA peaked in 2011, however a new higher nonepidemic baseline now seems to have been reached, with 554 cases notified in 2013 and 676 cases in 2014, compared to 60 in the pre-epidemic year of 2007 (Figure 2). This suggests there is ongoing transmission of pertussis in the community. 6 Figure 2: Number of pertussis notifications by quarter, SMHS, 2007 to 2014 900 Number of notifications 800 700 600 500 400 300 200 100 Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec 0 2007 2008 2009 2010 2011 2012 2013 2014 There were nine cases of pertussis in infants aged less than one year. Of these: Two were aged less than two months, so were unvaccinated as expected with the current vaccination schedule. Three were aged between two and six months. Of these, one was age-appropriately vaccinated and two were partially vaccinated for age. Four were aged between six and 12 months. Of these, three were fully vaccinated and one was partially vaccinated. Five were hospitalised. In 2014, the highest pertussis notification rates were in adults aged 50 to 84 years, with the peak occurring among those aged 75 to 79 years (115 per 100,000; n=24). A secondary peak occurred in children aged 10 to 14 years (94 per 100,000; n=51) (Figure 3). There were 17 notifications of pertussis among Aboriginal people, and nearly half of those (n=8) were children under 15 years of age. 7 Figure 3: Rates of pertussis notifications by age group, SMHS, 2014 120 100 80 60 40 20 85+ 80-84y 75-79y 70-74y 65-69y 60-64y 55-59y 50-54y 45-49y 40-44y 35-39y 30-34y 25-29y 20-24y 15-19y 10-14y 05-09y 0 00-04y Notification rate per 100,000 140 Age group Influenza Influenza is a vaccine preventable disease, and an influenza vaccine is manufactured each year to cover the likely circulating influenza virus strains (as determined by the World Health Organisation). Influenza vaccine is funded by the WA DoH for all children aged from six months to less than 5 years of age. The National Immunisation Program funds influenza vaccine for: Persons aged 65 years or older. Aboriginal people aged six months to less than 5 years of age (from 2015), or 15 years and older. Individuals aged six months and over with medical risk factors. Pregnant women in any trimester. There were 1,673 influenza cases notified in 2014, which was nearly double the number of cases notified in 2013 (n=856), but similar to the 2012 season (n=1742) and 2009 season (n=1902) when the influenza A H1N1 pandemic strain was circulating (Figure 4). Figure 4: Number of influenza notifications by year, SMHS, 2005 - 2014 2,000 Number of notifications 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 8 Influenza is a winter disease, usually peaking in July or August in WA. The pattern of influenza notifications in 2014 featured a steep rise in notifications, similar to that seen in the 2012 season where notification numbers were also high. In contrast, in 2010, 2011 and 2013 notifications were lower, with a slower rise in notifications prior to the peak (Figure 5). Figure 5: Number of notifications of influenza by month and year, SMHS, 2010-2014 800 700 Number of notifications 600 500 400 300 200 100 0 2014 2013 2012 2011 2010 In 2014, the rate of influenza notifications in the SMHS was 177 per 100,000, which was lower than both the state rate and the national rate (209 and 293 per 100,000 respectively). In the SMHS, the highest rate of influenza notifications was among those aged 75 years and older (284 per 100,000) (Figure 6). Rates remain high for the 0 to 4 year age cohort (243 per 100,000) despite a funded vaccine program for children aged 6 months to less than 5 years of age. 9 Figure 6: Rate of influenza notifications by age group and year, SMHS, 2014 350 Notification rate per 100,000 300 250 200 150 100 50 0 In 2014, unspecified influenza A accounted for 36% of notifications, followed by A/H1N1 (33%), A/H3 (16%) and unspecified influenza B (15%) (Figure 7). The majority of influenza notifications in people aged 75 years and over were due to unspecified influenza A (40%) or A/H3 (35%). Figure 7: Percentage of influenza notifications by genotype, SMHS, 2014 15% 36% 16% 33% A (UNSPECIFIED) A/H1N1(2009) A/H3 B (UNSPECIFIED) 10 Public / Population Health Units are responsible for following up influenza outbreaks in residential care facilities (RCF). Their role is to provide education and infection control advice to RCFs, to facilitate access to antiviral medication where required, and to monitor the outbreak through daily line listings of cases notified. In 2014, SMPHU followed up four respiratory outbreaks in RCFs, one of which was confirmed to be due to influenza. This was a significant decrease from 2013, when 16 outbreaks were investigated of which nine were due to influenza. The frequency of RCF outbreaks vary each year, depending on the circulating strain of influenza virus and the susceptibly of the elderly population to these strains. Hepatitis A In the 1990s hepatitis A was responsible for outbreaks among people who inject drugs, communities of men who have sex with men, residential facilities for disabled people, child care centres and preschools, Aboriginal communities, and people who had ingested certain foodstuffs (NHMRC, 2013). In recent years, the number of hepatitis A notifications has fallen to low levels, and travellers returning from countries with endemic hepatitis A are responsible for the majority of infections in Australia (NHMRC, 2013; CDCD, 2010a). The National Immunisation Program provides hepatitis vaccination for Aboriginal children at twelve and eighteen months of age. There were five cases of hepatitis A notified in the SMHS in 2014, the same number as in 2013. One case was a child aged five years and the other four were adults. Three cases acquired the infection overseas – one in India, one in Somalia and the other in the Philippines. Two cases were acquired in WA with an unidentified source of infection. All of the cases were unvaccinated and none of the cases were Aboriginal, which was similar to previous years. Measles Measles is highly infectious and a case of measles requires intensive contact tracing and postexposure intervention, which can include immunoglobulin, vaccine, isolation and education. Many contacts may be immune to measles because of past measles infection or immunisation with measles containing vaccine (MMR vaccine). People who are regarded as not immune to measles are those born since 1965 who have not received two doses of measles containing vaccine. The National Immunisation Program provides measles containing vaccination for children at twelve and eighteen months of age. All health care workers born since 1965 should show immunity to measles – either proof that they have received two doses of measles-containing vaccine or serological proof of immunity. Travellers to endemic countries should receive measles containing vaccine prior to travel. If a suspected measles case presents to a health service, it is important that appropriate testing is arranged, infection control and isolation procedures are implemented, and that the WA DoH is immediately notified by phone. There were 17 cases of measles notified in the SMHS in 2014, compared with 6 in 2013. This was part of an Australia wide increase in measles notifications, with the national rate increasing from 0.7 per 100,000 (n=158) in 2013 to 1.5 per 100,000 (n=340) in 2014. This outbreak was due to imported measles from Asia, which has been linked to an outbreak in the Philippines (CDCD, 2014). Of the 17 cases in 2014, 71% (n=12) were males and 76% (n=13) were acquired measles overseas – six in the Philippines, six in Indonesia (five in Bali), and one in India. The four cases acquired in Australia were all contacts of a confirmed case where disease acquisition had been 11 from overseas. There were no cases with unknown local transmission, highlighting that measles is essentially a travellers’ disease brought in from high prevalence countries. Fourteen cases had no record of measles containing vaccine or an unknown vaccination status (including two infants less than one year old who were not old enough to be vaccinated), two were partially vaccinated with one dose of vaccine and only one was fully vaccinated with two doses of vaccine. Invasive pneumococcal disease In 2014 there were 65 cases of invasive pneumococcal disease (IPD) notified in the SMHS. Thirty eight cases (59%) were male. Notifications peaked in winter (June to August), with 29 cases (45%) occurring during this period. There were ten notifications of IPD among Aboriginal people in 2014. The notification rate for Aboriginal people (62 per 100,000) was over ten times higher than that for non-Aboriginal people (5.9 per 100,000). From 2007 to 2010, there was a steady increase in the notification rate for children aged four years and under, which may reflect serotype replacement with non-vaccine strains. On 1st July 2011, Prevenar 13® (13vPCV) replaced Prevenar 7® (7vPCV) on the WA Vaccination Schedule, providing coverage against an extra six serotypes. Since that time, the notification rate for this age cohort has fallen, and in 2013 it was 8.0 per 100,000, the lowest since data became available in 2001. However, in 2014 the rate increased to 20 per 100,000 (Figure 8). Figure 8: Notification rates of invasive pneumococcal disease in children aged 4 years and under, SMHS, 2006-2014 13vPCV replaces 7vPCV 12 The 23-valent pneumococcal polysaccharide vaccine is funded for all adults aged 65 years and older. In this age group, people aged 85 years and over had the highest notification rate for IPD (33 per 100,000) in 2014 – a 4.7 times higher risk of infection than the general population (6.9 per 100,000). Varicella zoster virus Varicella zoster virus (VZV) has been a notifiable disease in WA since July 2006. This followed the addition of a live attenuated varicella vaccine to the National Immunisation Program in November 2005 for children aged 18 months, and a catch up program for school children in year seven from 2006. In 2014, there were 1,066 notifications of VZV in the SMHS, similar to 2013 (n=1,116). The rate for VZV in the SMHS was 113 per 100,000, which was 1.4 times higher than the national rate of 80 per 100,000. Of the 1,066 notifications in the SMHS, 11% were chickenpox (n=122), 43% were shingles (n=454), and 46% (n=490) were unspecified varicella. Unspecified varicella means the disease was laboratory confirmed in the absence of clinical information, which makes it hard to interpret trends in chicken pox and shingles over time. Notifications will underestimate the true incidence of VZV infection since the majority of infections will be clinically diagnosed by the doctor and may never be notified (Roche et al., 2002). Chickenpox affects mainly younger people, and in 2014 the highest notification rate was among children aged 5 to 9 years (66 per 100,000; n=37). Only one case of chicken pox occurred in a person over the age of 64 years. In contrast, shingles notifications increased with age, with the highest notification rate in those aged 80 to 84 years (150 per 100,000; n=26). Similarly, notification rates for unspecified VZV increased with age, with people aged 70 years and above having the highest rates (Figure 9). 13 Figure 9: Notification rates for varicella zoster by disease type and age group, SMHS, 2014 160 Notification rate per 100,000 140 120 100 80 60 40 20 VZV Unspecified Chickenpox 85+ 80-84y 75-79y 70-74y 65-69y 60-64y 55-59y 50-54y 45-49y 40-44y 35-39y 30-34y 25-29y 20-24y 15-19y 10-14y 05-09y 00-04y 0 Shingles Rotavirus Rotavirus has been notifiable in WA since July 2006, but is not notifiable nationally. Rotavirus vaccine was introduced for infants in 2007. There were 148 rotavirus cases in the SMHS in 2014, representing a 50% increase in notifications from 2013 (n=99). Over half of the notifications in 2014 occurred in children under five years of age (55%; n=81). Rubella The National Immunisation Program provides rubella containing vaccination for children at twelve and eighteen months of age. There was one case of rubella notified in the SMHS in 2014. This was acquired in Indonesia by an adult female whose vaccination status was unknown. Tetanus Tetanus is an acute, often fatal vaccine preventable disease, caused by toxin from the organism Clostridium tetani. It is a rare disease in Australia most common in the elderly due to this age cohort having a high rate of no prior vaccination or waning immunity from vaccination in the remote past (NHMRC, 2013). The National Immunisation Program provides tetanus-containing vaccination as a three dose primary infant schedule, a booster dose for four year olds and another in adolescence. A booster dose is also recommended, but not funded for those aged 50 years of age. 14 The main presenting symptom is severe muscle spasms. Tetanus is one of the few diseases that, with a clinically compatible illness, does not require laboratory confirmation to meet the NNDS case definition (CDCD, 2013). In 2014 there was one notification of tetanus in an elderly person in the SMHS which was the first case notified in the SMHS since 1998.Exposure was from a wound sustained during gardening and they had no known record of a tetanus containing vaccine. They presented to hospital with classic tetanus symptoms of severe muscle spasms and required prolonged admission to intensive care and ventilation. Mumps In 2012 there was a Perth wide outbreak of mumps which peaked in the first quarter of 2013 (Figure 10). There were 11 cases of mumps notified in the SMHS in 2014, similar to 2013 (n=13). Figure 10: Number of mumps notifications by quarter, SMHS, 2011-2014 The notification rate for mumps in the SMHS in 2014 was 1.2 per 100,000, which was higher than both the WA and the national rate (0.9 and 0.8 per 100,000 respectively). In 2014, 64% (n=7) of mumps cases were male, and all were non-Aboriginal adults (age range 18 to 63 years). In 2014, three cases acquired mumps overseas (two in Sri Lanka and one in Burma). Of the eight cases acquired in WA, only one was a confirmed contact of a known case. For the remaining cases, the source of infection was unknown. The National Immunisation Program provides mumps-containing vaccination for children at twelve and eighteen months of age. Only one mumps case could confirm being fully vaccinated with two doses of mumps-containing vaccine, and two cases had received one dose of vaccine. 15 Immunisation rates There have been recent changes to the fully vaccinated calculation for the ACIR. In the 12 to <15 month age cohort, pneumococcal vaccine was added to the fully vaccinated calculation for the end of September 2013 (date calculated) ACIR quarterly report onwards. In the 24 to <27 month age cohort, meningococcal C vaccine and varicella vaccine has been added to the fully vaccinated calculation for the end of September 2014 (date calculated) ACIR quarterly report onwards. In addition, for this report and onwards, the cohort calculation has also been amended to calculate dose 2 of MMR vaccine instead of dose 1. Table 2 shows the percentage of children fully immunised in each age cohort for each quarter of 2014. The data is presented by Local Government Area (LGA), and grouped by Medicare Locals and Child and Adolescent Community Health (CACH) zones. The final column shows the number of children in the December cohort. LGAs with small numbers of children, such as East Fremantle and Waroona, will show greater variability in percentages between years. Table 3 shows immunisation rates per quarter for 2014 by Medicare Locals, SMHS, WA and Australia for Aboriginal children and all children. In a three month age cohort at a Medicare Local level, the number of Aboriginal children may be small so there will be greater variability in immunisation rates. 16 Table 2: Percentage of children fully immunised in each age cohort by LGA & quarter, SMHS, 2014 % fully immunised Local Age 31-Mar30-Jun30-SepGovernment group 2014 2014 2014 Area (LGA) (months) FREMANTLE MEDICARE LOCAL South Cockburn 12-<15 92.9 90.9 92.2 Coastal 24-<27 91.2 92.6 85.5 Zone 60-<63 91.0 91.5 90.6 East Fremantle 12-<15 83.3 83.3 66.7 24-<27 76.0 66.7 66.7 60-<63 94.4 84.9 95.5 Fremantle 12-<15 84.0 83.5 81.6 24-<27 90.7 86.3 81.0 60-<63 91.0 80.8 84.7 Melville 12-<15 88.4 91.1 90.2 24-<27 88.9 92.2 81.4 60-<63 87.4 91.0 89.4 PERTH SOUTH COASTAL MEDICARE LOCAL South Mandurah 12-<15 91.1 91.4 92.9 Coastal 24-<27 91.7 92.1 86.6 Zone 60-<63 92.2 90.5 92.8 Murray 12-<15 87.5 89.4 89.2 24-<27 92.8 92.4 86.4 60-<63 93.0 94.0 95.8 Waroona 12-<15 92.9 90.9 83.3 24-<27 71.4 88.9 85.7 60-<63 100.0 84.6 100.0 Rockingham 12-<15 90.9 92.8 90.7 24-<27 86.6 92.3 86.2 60-<63 89.7 88.9 91.5 Kwinana 12-<15 93.8 90.7 90.4 24-<27 91.9 93.4 91.5 60-<63 88.2 89.4 91.8 BENTLEY ARMADALE MEDICARE LOCAL South Armadale 12-<15 90.4 88.5 88.9 Coastal 24-<27 93.0 91.3 84.0 Zone 60-<63 91.2 88.9 90.6 Serpentine / 12-<15 96.1 93.9 93.4 Jarrahdale 24-<27 93.1 94.1 84.0 60-<63 93.5 93.8 94.7 Inland Belmont 12-<15 90.7 86.7 92.2 Zone 24-<27 90.7 90.3 76.8 60-<63 91.3 83.6 88.0 Canning 12-<15 89.2 89.3 90.1 24-<27 91.1 90.2 81.5 60-<63 89.6 88.3 90.6 Gosnells 12-<15 88.8 91.9 90.0 24-<27 90.1 92.9 86.0 60-<63 89.4 89.6 87.3 South Perth 12-<15 84.0 91.8 91.2 24-<27 91.8 89.9 88.3 60-<63 85.7 91.2 94.3 Victoria Park 12-<15 93.3 89.8 91.6 24-<27 92.7 88.6 84.9 60-<63 88.7 90.2 90.3 * CACH Child and Adolescent Community Health CACH Zone 31-Dec2014 Number in cohort 31-Dec-14 92.8 87.4 90.5 90.0 65.0 88.9 86.5 80.5 90.7 90.4 88.3 89.2 375 414 379 10 20 9 89 82 75 272 291 316 88.6 82.9 89.0 89.7 81.1 93.5 90.0 90.0 73.7 92.9 87.0 91.4 87.9 88.5 91.3 210 199 200 68 74 77 10 10 19 493 523 525 141 165 149 90.4 86.4 93.7 96.2 90.1 93.3 90.6 88.4 87.9 90.1 86.0 88.3 87.7 86.4 90.2 87.2 84.0 86.8 87.3 80.0 88.0 345 331 299 78 71 90 159 146 107 342 379 324 446 469 428 117 106 106 134 105 100 17 For all children living in the SMHS, the immunisation rates were lower across all age groups compared with WA and Australia (Table 3). The drop in coverage in the 24 to <27 month age cohort, due to the addition of vaccines to the fully vaccinated calculation, can be seen in the September quarter across the SMHS, WA and Australia (Table 3 and Figure 11). Table 3: Percentage of Aboriginal and total children fully immunised in each age cohort by quarter, Medicare Local, SMHS, WA & Australia, 2014 Area Age group months 31-Mar-2014 % Total* % 30-Jun-2014 Aborig.^ % Total* % 30-Sep-2014 Aborig.^ % Total* 31-Dec-2014 % % % Aborig.^ Total* Aborig.^ Fremantle 12-<15 90.3 75.0 89.9 84.2 89.8 77.3 91.2 87.5 Medicare Local 24-<27 89.9 82.6 91.2 94.4 83.2 60.0 86.5 64.7 60-<63 89.7 100.0 90.1 90.9 89.7 92.3 90.0 86.2 Perth South 12-<15 91.4 100.0 91.8 77.3 90.9 75.8 90.9 67.6 Coastal 24-<27 88.9 93.9 92.7 93.5 87.2 95.5 86.0 82.8 Medicare Local 60-<63 90.4 91.3 89.7 92.3 92.2 87.5 90.7 86.5 Bentley 12-<15 89.7 75.0 90.2 70.2 90.4 71.7 89.4 76.7 Armadale 24-<27 91.4 88.0 91.3 86.4 83.7 61.8 86.1 79.3 Medicare Local 60-<63 89.9 87.9 89.0 89.1 89.8 84.8 90.1 84.3 SMHS 12-<15 90.4 79.8 90.6 75.0 90.4 73.9 90.2 74.8 24-<27 90.3 88.6 91.6 89.2 84.6 68.1 86.2 77.9 60-<63 90.1 90.7 89.5 90.3 90.5 85.9 90.3 85.5 12-<15 90.7 83.7 91.7 84.9 90.7 84.9 91.2 82.4 24-<27 91.5 92.4 92.0 92.2 85.1 75.1 86.6 81.9 60-<63 90.3 92.8 90.1 92.2 90.6 91.6 91.0 92.6 12-<15 90.9 86.2 91.5 88.0 90.6 87.4 91.0 87.0 24-<27 92.6 93.2 92.8 92.9 87.3 83.9 87.6 84.4 93.2 93.5 60-<63 91.9 92.2 *Includes both Aboriginal and non-Aboriginal children. 92.2 93.1 92.3 93.7 WA AUST ^Aboriginal 18 Figure 11: Percentage of children fully immunised in each age cohort by quarter, SMHS, 2013-2014 Table 4 shows that for SMHS children, immunisation rates improved for the 60 to <63 months age cohort, from 87.9% in 2012, to 88.6% in 2013 and 90.1% in 2014. A similar trend was seen in WA and Australia. Similarly, the Aboriginal coverage rates for the 60 to <63 months age cohort increased in the SMHS, WA and Australia. There was a significant difference in Aboriginal coverage rates in the SMHS compared with the total childhood population, particularly in the 12 to <15 month age cohort (Table 4). The drop in coverage for the 24 to <27 month age cohort in 2014 was due to the addition of vaccines to the fully vaccinated calculation for the September quarter onwards as discussed above. Table 4: Percentage of Aboriginal and total children fully immunised in each age cohort, SMHS, WA and Australia, 2012-2014 Region SMHS WA AUSTRALIA Age group % total fully immunised % Aboriginal fully immunised (months) 2012 2013 2014 2012 2013 2014 12-<15 89.4 89.1 90.4 75.5 76.3 75.8 24-<27 90.0 89.5 88.2 85.1 87.0 81.6 60-<63 87.9 88.6 90.1 82.5 87.3 88.1 12-<15 90.2 89.9 91.1 78.9 82.5 84.0 24-<27 90.5 90.7 88.8 89.4 90.4 85.7 60-<63 88.9 89.6 90.5 86.9 90.3 92.3 12-<15 91.7 90.3 91.0 86.5 85.7 87.1 24-<27 92.5 92.2 90.1 92.1 91.7 88.7 60-<63 91.2 91.9 92.2 91.0 93.0 93.4 19 Vector borne diseases There were 848 cases of vector borne diseases notified in the SMHS in 2014, which was a decrease of 35% from 2013 (n=1,306). The high numbers of Barmah Forest virus reported in 2013 was due to false positive reporting by laboratories. Chikungunya Chikungunya is a member of the Alphavirus group, which also includes Ross River virus and Barmah Forest virus and is a mosquito-borne acute illness. It is endemic in many tropical regions of the world, reflecting the distribution of Aedes aegypti and Aedes albopictus mosquitoes. Chikungunya is not endemic in Australia, although there is potential for transmission in northern Queensland and the Torres Strait Islands, where these mosquitoes are established (CDCD, 2013b). Chikungunya became a notifiable disease in WA in May 2008, with initially low numbers of notified cases between 2009 and 2012. In 2013, the number of chikungunya cases rose to 31, but in 2014, dropped by 55% to 14 cases. In 2014, the median age was 46 years (range: 26 to 58 years). All cases acquired the infection overseas, the majority in Indonesia (79%, n=11). The remaining three chikungunya infections were acquired in Sri Lanka (n=1) and an unspecified location in the Caribbean (n=2). Dengue Dengue is also transmitted by Aedes aegypti and Aedes albopictus mosquitoes and is predominantly acquired from Asian holiday destinations. There is currently no known Aedes aegypti activity in WA, although prior to the 1930s it existed at least as far south as Harvey. Activity remains in far north Queensland, so ongoing surveillance for dengue in Australia is essential (Russell et al., 2009). There were 171 notifications of dengue in 2014, similar to 2013 (n=168), with all cases acquired overseas. The main countries of acquisition were Indonesia (77%; n=132), Malaysia (7.0%; n=12) and Thailand (5.3%; n=9). The SMHS and WA notification rate for dengue notifications was 18 per 100,000, 2.6 times the national rate of 6.8 per 100,000, reflecting the high proportion of WA residents who travel to Southeast Asia, particularly Bali (CDCD, 2013a). Ross River virus and Barmah Forest virus There were 584 Ross River virus (RRV) notifications in the SMHS in 2014, 13% higher than in 2013 (n=516). Notifications of RRV and Barmah Forest virus (BFV) usually follow a seasonal pattern, with more disease notified in the summer months. Although this seasonal pattern occurred in 2014, there was a higher than usual baseline throughout the winter months (Figure 12). 20 Figure 12: Number of Ross River virus notifications by month, SMHS, 2010 - 2014 180 Number of notifications 160 140 120 100 80 60 40 20 0 Jan Feb Mar 2010 Apr May 2011 Jun Jul 2012 Aug Sep 2013 Oct Nov Dec 2014 Notifications in the Perth metropolitan area tend to be concentrated around the outer suburbs, close to bushland and water bodies (Environmental Health Directorate, 2012). In the SMHS, most RRV notifications occurred in postcode 6210 among residents of the Mandurah area, (22%; n=130). There were 17 BFV notifications in 2014, a decrease of 81% from 90 cases in 2012 and a marked decrease from the 551 notifications in 2013. This was due to a high rate of false positive IgM results associated with a commercial test kit which started in October 2012 and was resolved by 2014. The notification rate in the SMHS was 1.8 per 100,000, which was lower than the state and national rates (2.2 and 3.2 per 100,000 respectively). Other vector borne diseases In 2014 in the SMHS there were 41 cases of schistosomiasis, over three times the number in 2013 (n=12). This is an overseas acquired infection. There were three notifications of typhus – one of which was acquired in Bangladesh, and 18 malaria notifications, all of which were acquired overseas. 21 Sexually transmitted infections There were 4,750 sexually transmitted infections (STI) notified in the SMHS in 2014 which was similar to 2013 (n=4,801). Chlamydia accounted for 87% of all STI notifications in 2014. Chlamydia There were 4,120 notifications of chlamydia in the SMHS in 2014, which is a decrease of 4.6% since 2013 (n=4,317). The number of notifications has been essentially stable since 2011, although the SMHS notification rate (436 per 100,000) and the WA rate (451.2 per 100,000) remain higher than the national rate of 372 per 100,000. Females accounted for 57% of chlamydia notifications in the SMHS. The highest age-specific rate for females occurred in the 20 to 24 year age group (2,287 per 100,000) followed by the 15 to 19 year age group (2,234 per 100,000) . For males the highest age-specific rate was in the 20 to 24 year age group (1,477 per 100,000; Figure 13). Figure 13: Chlamydia notification rates by age group and gender, SMHS, 2014 Of all chlamydia notifications, 6.2% occurred in Aboriginal people (n=254). The overall rate for Aboriginal people (1,567 per 100,000) was 3.8 times higher than that for non-Aboriginal people (416 per 100,000).3 Aboriginal age-specific notification rates were highest in the 15 to 19 year olds (males: 6,549 per 100,000; females: 5,902 per 100,000). 3 8.4% of notifications were of unknown ethnicity. These were included in the non-Aboriginal cases. 22 Gonorrhoea There has been a steady increase in gonorrhoea notifications in the SMHS over the last five years. There were 207 gonorrhoea notifications in 2010, but by 2013 the number of notifications had more than doubled to 438 notifications. In 2014, the number of notifications increased again, by 35% to 589. Non-Aboriginal males, and to a lesser degree non-Aboriginal females, were responsible for this increase (Figure 14). Nearly three quarters of gonorrhoea cases in 2014 were males (74%; n=435). Figure 14: Number of gonorrhoea notifications by Aboriginality and gender, SMHS, 2009– 2014 In WA, young heterosexual adults account for much of the increase in notifications, which could indicate a decline in safe sex practices (CDCD, 2013c). In 2014, the highest age-specific rate for non-Aboriginal males was in the 20 to 24 year age group (245 per 100,000; n=97), followed by the 25 to 29 year age group (236 per 100,000; n=98). In 2013, the highest age-specific rate for non-Aboriginal males was also in the 20 to 24 year age group, but the rates were lower (166 per 100,000; n=64). For non-Aboriginal females, the highest age-specific rate in 2014 was also in the 20 to 24 year age group (84 per 100,000; n=31), but in 2013 it was in the 15 to 19 year age group (72 per 100,000; n=21) (Figure 15). In 2014, 9.7% (n=57) of gonorrhoea cases acquired the infection overseas. The most commonly reported countries of acquisition were Thailand (32%; n=18), Indonesia (18%; n=10), and the Philippines (14%; n=8). All the overseas acquired cases were non-Aboriginal and 53 (93%) were males. The overseas acquired cases accounted for 14% of non-Aboriginal male cases and 3% of non-Aboriginal female cases. 23 Figure 15: Age-specific rates of gonorrhoea notifications for non-Aboriginal people by gender, SMHS, 2013 and 2014 300 Notification rate per 100,000 250 200 150 100 50 0 10-14y 15-19y 20-24y 25-29y 30-34y 35-39y 40-44y 45-49y 50-54y 55-59y 60-65y 65-69y 2014 Male non-Aboriginal 2013 Male non-Aboriginal 2014 Female non-Aboriginal 2013 Female non-Aboriginal In 2014, the proportion of gonorrhoea notifications among Aboriginal people accounted for 12% of notifications (n=69), which was a decrease from 2013 where the proportion was 26% (n=113). However, the notification rates continued to be significantly higher in the Aboriginal population. Age-specific rates among Aboriginal males peaked in 15 to 19 year olds, at 2,079 per 100,000 (n=20), and rates for Aboriginal females peaked in 20 to 24 year olds at 809 per 100,000 (n=7). Syphilis There were 21 notifications of infectious syphilis in the SMHS in 2014. Infectious syphilis is defined as syphilis of less than two years duration, being primary, secondary or early latent (Communicable Diseases Network Australia, 2010). In 2014, all cases of infectious syphilis occurred in non-Aboriginal people, 95% were males (n=20) and 76% (n=16) were acquired in WA. Nine cases presented with primary syphilis (chancre), five presented with secondary syphilis (rash or other systemic signs), and seven presented with early latent syphilis (no signs or symptoms but with definite laboratory evidence of infection onset within the past two years). There were 20 cases of non-infectious syphilis (late latent) in 2014. All cases occurred among non-Aboriginal people and 90% were male (n=18). 24 Blood borne viruses There were 725 blood borne virus notifications in the SMHS in 2014, which was a slight increase from 2013 (n=697). Over half of these notifications (54%; n=388) were due to unspecified hepatitis C. Hepatitis C There were 51 cases of newly acquired 4 hepatitis C (5.4 per 100,000) in the SMHS in 2014. Over three quarters (77%; n=39) of cases were male and 35% (n=18) were Aboriginal. The notification rate in Aboriginal people was 111 per 100,000, which was over 30 times higher than the rate among non-Aboriginal people (3.6 per 100,000). There were 388 cases (41 per 100,000) of unspecified hepatitis C notified in the SMHS in 2014. Of these, 69% were male (n=266), and 18% (n=69) were Aboriginal. Ethnicity was unknown in 11% (n=44) of unspecified hepatitis C cases, so these cases were analysed as non-Aboriginal cases. The notification rate for Aboriginal people (426 per 100,000) was more than 12 times higher than the rate for non-Aboriginal people (34 per 100,000). Hepatitis B In 2014, nine cases of newly acquired4 hepatitis B were notified in the SMHS (1.0 per 100,000). Eight cases (89%) were male and none were Aboriginal. Two cases were acquired overseas (in Thailand and Cambodia). There were 277 cases of unspecified hepatitis B (29 per 100,000) in the SMHS in 2014. Of these, 52% (n=144) occurred in males. Two cases were Aboriginal, although ethnicity was unknown in a quarter of notifications (n=68). 4 Hepatitis B and C are defined as newly acquired if there is evidence of infection occurring within the last 24 months (CDCD, 2013). 25 Enteric diseases There were 1,582 enteric notifications in the SMHS in 2014, which is a 30% increase from 2013 (n=1,215), due to an increase in campylobacterosis notifications. Two thirds of all enteric disease notifications were campylobacterosis and one quarter were salmonella. Campylobacterosis There was a significant rise (61%) in campylobacter notifications from 2013 (n=649) to 2014 (1,045 cases), in comparison to the trend over recent years which had shown a decline. The rise in 2014 was seen across WA, with the state rate increasing from 78 per 100,000 in 2013 to 118 per 100,000 in 2014. However, the campylobacter notification rates for the SMHS (111 per 100,000) and WA (118 per 100,000) were lower than the national rate of 127 per 100,000. The cause of this is under investigation and at the time of publication had not been ascertained. The highest rate of campylobacter notifications occurred among people aged 75 to 79 years (273 notifications per 100,000; n=57) (Figure 16). In 2014, 55% of notifications occurred in males (n=575). Whether the campylobacter infection was acquired in Australia or overseas was recorded in 58% of notifications (n=606) and, of these, 165 (27%) acquired their infection overseas, the majority (64%; n=105) in Indonesia. Figure 16: Campylobacter notification rates by age group, SMHS, 2014 300 Notification rate per 100,000 250 200 150 100 50 0 Salmonellosis There were 393 salmonellosis notifications in the SMHS in 2014, similar to the number in 2013 (n=406). Fifty two percent of cases (n=206) were females, and 1.8% (n=7) were Aboriginal. The highest salmonellosis notification rate was amongst 0 to 4 year olds (107 per 100,000; n=69). 26 Whether the salmonellosis infection was acquired in Australia or overseas was recorded in 75% of notifications (n=293), and of these, nearly half (n=145) acquired their infection overseas. The majority of overseas acquired infections were from Indonesia (56%; n=81) and Thailand (12%; n=18). Other enteric diseases There were 112 cryptosporidiosis cases notified in the SMHS in 2014, similar to the number in 2013 (n=108). Whether the infection was acquired in Australia or overseas was recorded in 62% of notifications (n=69) and, of these, 12 (17%) acquired their infection overseas. Half of the overseas acquired infections were from Indonesia (n=6). Six cases of typhoid fever were notified in the SMHS in 2014, the same number as in 2013. All were acquired overseas; three cases in Indonesia, two in India and one in the Philippines. There were five cases of paratyphoid fever notified in the SMHS in 2014, a decrease from seven in 2013. One case acquired the infection in WA and the other four acquired it overseas; three in India and one in Cambodia. There were 12 cases of shigellosis in 2014, a decrease of 57% from 28 cases in 2013. Two thirds of cases (n=8) acquired shigellosis overseas. Of these, three cases acquired the infection in Indonesia, and one case acquired the infection in each of Cambodia, India, the Cote d’Ivoire, the UK and an unknown country. There were six cases of Vibrio parahaemolyticus, four of which occurred in people aged 50 years and older. Three cases were acquired overseas, two in Thailand and one in Indonesia. There were two cases of listeriosis in the SMHS in 2014, which both occurred in males; one aged 59 and the other 77 years. One case of yersiniosis occurred in a 33 year old female, but it was not known where the infection was acquired. Gastroenteritis outbreaks in residential care facilities Public / Population Health Units are responsible for following up gastroenteritis outbreaks in residential care facilities (RCF). Their role is to provide education and support to RCFs and monitor the outbreak through daily line listings of cases notified. In 2014, SMPHU followed up 59 gastroenteritis outbreaks in RCFs (compared to 40 in 2013). Of these, where an organism was identified, the majority of outbreaks were due to norovirus. 27 Other diseases There were 125 notifications of other diseases in the SMHS in 2014, an increase of 24% from 101 cases in 2013, which was due to an increase in tuberculosis notifications. There was one notification of leprosy, one of Creuzfeldt-Jakob disease and one of acute rheumatic fever. Invasive meningococcal infection There were seven notifications of invasive meningococcal infection in the SMHS in 2014, the same as in 2013. Two cases were children aged less than one year, one was a child of 7 years and the other four were adults aged between 20 and 74 years. Invasive meningococcal infection can present as meningitis or septicaemia or both. There are several serogroups of Neisseria meningitidis, with serogroups B and C responsible for the majority of disease in Australia. Most disease in the SMHS and WA has historically been due to serogroup B (NHMRC, 2013). Universal meningococcal C vaccination for children 12 months of age was introduced in January 2003, along with a catch-up program for all children aged from one to 19 years. Interestingly, despite no vaccine for serogroup B currently on the National Immunisation Program, there has been a steady decline in the number of cases of serogroup B over the past decade (Figure 17). Since mid-2014 there has been a licenced meningococcal B vaccine available in Australia on the private market. This is not funded under the National Immunisation Program. Of the meningococcal notifications in 2014, six cases were due to serogroup B and one was due to serogroup C. Figure 17: Number of meningococcal notifications by year and serotype, SMHS, 19992014 28 Legionellosis There were 46 cases of legionellosis notified in the SMHS in 2014, a 15% increase from 2013 (n=40). The notification rates for legionellosis in the SMHS (4.9 per 100,000) and WA (4.8 per 100,000) were more than double the national notification rate of 1.9 per 100,000. L. longbeachae is the most common species of legionella notified in WA and is associated with exposure to soils, potting mixes and mulches. L. longbeachae was the cause of 41 of the cases of legionellosis (89%). The youngest case was 32 years and the oldest 96 years, with a median age of 65 years. All the cases occurred in non-Aboriginal people. L. pneumophila is associated with exposure to warm water aerosols containing the bacteria from environmental sources, such as air conditioning cooling towers, showers, spas, misting or droplet sprays and fountains. It is a more severe disease then L. longbeachae and can cause severe pneumonia which often requires intensive care treatment. Five cases of L. pneumophila occurred in 2014. One was aged 16 years, one was 46 years and the other three were in their 70s. Three of these cases were male and three of the infections were acquired overseas. No epidemiological link or common environmental exposure source was established for the two locally acquired cases. Tuberculosis There were 69 cases of tuberculosis (TB) notified in the SMHS in 2014, a 47% increase from 2013 (n=47). The SMHS notification rate of 7.3 cases per 100,000 was higher than the WA (5.6 per 100,000) and national (5.8 per 100,000) rates. The majority of TB cases acquired the infection overseas (84%; n=58). Rabies post-exposure prophylaxis In Australia, rabies post-exposure prophylaxis (PEP) is indicated in travellers who have had mammalian animal bites or scratches in a geographic location where rabies is known to be endemic in animal populations, and for people who have been bitten or scratched by bats in Australia or overseas. Rabies PEP requires a course of rabies vaccine and in some cases rabies immunoglobulin (NHMRC 2013). Over the last 20 years Australia has had no notifications of rabies in returning overseas travellers, although there have been three cases of rabies-like illness caused by Australian bat lyssavirus (ABLV) in Queensland, the last occurring in early 2013. In December 2008, Indonesian authorities declared that Bali was no longer rabies free after fatal human cases of rabies were reported (CDCD 2010b). An additional, and very significant, impact of the increased number of WA residents travelling to Bali has been the provision of rabies PEP to people who have reported being bitten or scratched by mammalian animals (mostly monkeys but including dogs) while in Bali (CDCD, 2013a). In 2014, there was an increase in ABLV detection in sick and injured bats in the Kimberley region of WA. Eleven bats tested positive for ABLV, compared with only one case in WA in the previous decade (Wildlife Health Australia, 2015). In 2014 SMPHU authorised the administration of rabies PEP by SMHS providers to 102 people (compared with 91 in 2013). Of these, 100 were returned overseas travellers, the majority from Bali. The predominant animal exposure was monkeys, followed by dogs, then less common mammals such as squirrels, cats, a rat and a luwak (civet cat). The other two people who received rabies PEP were exposed to bats within WA (one in the Kimberley and one in Perth). 29 References Bertilone C, Wallace T, Selvey L (2014). Finding the ‘who’ in whooping cough: vaccinated siblings are important pertussis sources in infants 6 months of age and under. Communicable Diseases Intelligence, 38 (9), Sept 2014: 195-200. Bisgard KM, Pascual FB, Ehresmann KR, Miller CA, Cianfrini C, Jennings CE et al. (2004). Infant pertussis: who was the source? Pediatric Infectious Disease Journal; 23(11): 985-9. Chuk LM, Lambert SB, May ML, Beard FH, Sloots TP, Selvey CE et al. (2008). Pertussis in infants: how to protect the vulnerable? Communicable Diseases Intelligence Quarterly Report; 32(4): 449-56. Commonwealth Department of Health and Ageing (2014). National Notifiable Diseases Surveillance System. Accessed 28 April 2014 from: http://www9.health.gov.au/cda/source/rpt_2_sel_a.cfm. Communicable Disease Control Directorate (2014). Measles cases linked to Philippines outbreak. Disease WAtch; May 2014: 18(1). Perth: Department of Health WA. Communicable Disease Control Directorate (2013). Surveillance Case Definitions for Notifiable Infectious Diseases and Related Conditions in Western Australia. Perth: Department of Health WA. Communicable Disease Control Directorate (2013a). Increasing impact of Bali travel on infectious disease notifications in Western Australia. Disease WAtch; June 2013: 17(2). Perth: Department of Health WA. Communicable Disease Control Directorate (2013b). Returned travellers from Bali behind spike in chikungunya virus infections. Disease WAtch; December 2013: 17(4). Perth: Department of Health WA. Communicable Disease Control Directorate (2013c). Increasing gonorrhoea notifications among non-Aboriginal Western Australians. Disease WAtch; June 2013: 17(2). Perth: Department of Health WA. Communicable Disease Control Directorate (2012). Ongoing pertussis epidemic in Western Australia. Disease WAtch; March 2012: 16(1). Perth: Department of Health WA. Communicable Disease Control Directorate (2011). Pertussis vaccination program for parents, grandparents and carers of new born babies. Disease WAtch; April 2011: 15(1). Perth: Department of Health WA. Communicable Disease Control Directorate (2010a). Decline of hepatitis A incidence in WA. Disease WAtch; November 2010: 14(4). Perth: Department of Health WA. Communicable Disease Control Directorate (2010b). Update: Rabies in Bali. Disease WAtch; February 2010: 14(1). Perth: WA Department of Health. Communicable Disease Network Australia (2010). Syphilis - infectious (primary, secondary and early latent), less than 2 years duration case definition. Canberra: Department of Health & Ageing. 30 Environmental Health Directorate (2012). Environmental Health Yearbook 2011-2012. Perth, Department of Health WA. Kaczmarek MC, Valenti L, Kelly HA, Ware RS, Britt HC, Lambert SB (2013). Sevenfold rise in likelihood of pertussis test requests in a stable set of Australian general practice encounters, 2000–2011. Medical Journal of Australia;198(11):624–628. National Health and Medical Research Council (2013). The Australian Immunisation Handbook. 10th Edition. Canberra: Commonwealth of Australia. Octavia S, Sintchenko V, Gilbert GL, Lawrence A, Keil AD, Hogg G et al. (2012). Newly emerging clones of Bordetella pertussis carrying prn2 and ptxP3 alleles implicated in Australian pertussis epidemic in 2008-2010. Journal of Infectious Diseases; 205(8): 1220-4. Pillsbury A, Quinn HE, McIntyre PB (2014). Australian vaccine preventable disease epidemiological review series: pertussis, 2006–2012. Communicable Diseases Intelligence; September 2014: 38(3) from: http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3803b.htm Roche P, Blumer C, Spencer J (2002). Surveillance of viral pathogens in Australia -varicellazoster virus. Communicable Diseases Intelligence Quarterly Report; 26(4): 576-80. Russell RC, Currie BJ, Lindsay MD, Mackenzie JS, Ritchie SA, Whelan PI (2009). Dengue and climate change in Australia: predictions for the future should incorporate knowledge from the past. Medical Journal of Australia; 190(5): 265-8. Sheridan SL, Ware RS, Grimwood K, Lambert SB (2012). Number and order of whole cell pertussis vaccines in infancy and disease protection. JAMA – Journal of the American Medical Association; 308(5): 454-6. Wildlife Health Australia (2015). Australian Bat Lyssavirus Report December 2014. Accessed on 19 May 2015 from: http://www.wildlifehealthaustralia.com.au/Portals/0/Documents/ProgramProjects/ABLV%20BAT STATS%20Dec%202014.pd 31 This document can be made available in alternative formats on request for a person with a disability. © Department of Health 2015 Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.