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Quarterly Surveillance Report Notifiable Sexually Transmissible Infections and Blood-borne Viruses in Western Australia Period ending 30 June 2016 Vol. 13 (3), issued August 2016 Contents Summary...................................................................................................................................... 2 Chlamydia .................................................................................................................................... 2 Gonorrhoea .................................................................................................................................. 5 Infectious syphilis ......................................................................................................................... 7 HIV/AIDS...................................................................................................................................... 9 Hepatitis B.................................................................................................................................. 11 Hepatitis C ................................................................................................................................. 14 Notes: 1. All data in this report are provisional and subject to future revision. 2. To help place the data in this report in perspective, comparisons with other reporting periods are provided. As no formal statistical testing has been conducted, some caution should be taken with interpretation. 3. Notifications for Christmas Island, Curtin, Leonora, Perth and Yongah Hill Immigration Detention Centres have been excluded from all analyses because of potential bias introduced through the inclusion of cases detected by screening of asylum seekers at these locations. 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. Produced by the Epidemiology & Surveillance Program, Communicable Disease Control Directorate, Department of Health, Western Australia. 1 Summary Table 1 Number and percentage change of STI and BBV notifications by reporting period, WA 2nd Quarter Disease Category Disease 2nd Quarter 5 Year Mean for 2nd Quarter 2016 2nd Quarter1 % Change 2 Chlamydia Infectious Syphilis STI Total 2,946.0 5% 11,608 11,323 11,531.4 1% 504.4 67% 2,832 2,096 1,967.4 44% 69 3,996 29.8 3,480.2 132% 15% 259 14,699 107 13,526 95.6 13,594.4 171% 8% 9 6.0 50% 27 28 26.2 3% 240 249 126.8 132.8 89% 88% 643 589 670 617 557.0 583.2 15% 15% 27 34.2 -21% 164 154 130.2 26% Hepatitis C (Unspecified) 317 235.6 35% 1,006 986 967.6 4% Hepatitis C (Total) BBV Total 344 593 269.8 402.6 28% 47% 1,170 1,840 1,140 1,757 1,097.8 1,681 7% 9% 20 28.4 -30% 130 129 118.4 10% 4,609 3,911.2 18% 16,669 15,412 15,393.8 8% Hepatitis B (Unspecified) Hepatitis B (Total) Hepatitis C (Newly acquired) HIV Combined Total Notes: 01 Jul - 30 Jun % Change 4 842 Hepatitis B (Newly acquired) BBVs 01 Jul 15 - 01 Jul 14 - 5 Year Mean for 30 Jun 16 30 Jun 15 01 Jul - 30 Jun3 3,085 Gonorrhoea STIs 12-month period: 01 July to 30 June 1 Historical five-year mean (i.e. from 2011 to 2015) for the current quarter. Percentage change of the number of notifications in the current quarter compared to the historical five-year mean of the same quarter. Positive values indicate an increase in comparison to the historical five-year mean of the same quarter. Negative values indicate a decrease in comparison to the historical five-year mean of the same quarter. 3 Historical five-year mean (i.e. from 2011 to 2015) for the current 12-month period. 4 Percentage change of the number of notifications in the current 12-month period compared to the historical five-year mean for the same 12-month period. For interpretation of positive and negative values, see note 2. 2 Chlamydia Figure 1 Number of chlamydia notifications in WA by month, for the two most recent 12-month periods 1,200 Number of notifications 1,000 800 600 400 200 2014 2015 Jun May Apr Mar Feb Jan Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan Dec Nov Oct Sep Aug Jul 0 2016 Year and Month The number of chlamydia notifications for the 12-month period from July 2015 to June 2016 was comparable to the previous 12-month period and the previous five year average, reflecting a trend for relative stability in chlamydia notifications over this period, after many years of increasing notifications (Table 1). 2 Table 2 Number and proportion of chlamydia notifications in WA by sex, for the two most recent 12-month periods Sex 01 Jul 15 - 30 Jun 16 Period Number 01 Jul 14 - 30 Jun 15 Period Percent Number Percent Male 5,001 43% 4,798 42% Female Male:Female ratio 6,606 0.8 57% N/A 6,524 0.7 58% N/A 11,608 100% 11,323 100% Total Notes: N/A = Not applicable Table 3 Number and proportion of chlamydia notifications in WA by age group, for the two most recent 12month periods Age group 01 Jul 15 - 30 Jun 16 Period (Years) Number Percent 0–9 01 Jul 14 - 30 Jun 15 Period Number Percent 0 0% 3 0% 10–14 99 1% 122 1% 15–19 2,420 21% 2,519 22% 20–24 3,761 32% 3,871 34% 25–29 2,570 22% 2,377 21% 30–34 1,315 11% 1,128 10% 35–39 567 5% 501 4% 40–44 348 3% 340 3% 45–49 218 2% 209 2% 50–54 143 1% 132 1% 55–59 60+ 92 75 1% 1% 64 57 1% 1% Total 11,608 100% 11,323 100% The age distribution of chlamydia notifications was similar to the previous 12-month period. The largest proportion of notifications was among 15 to 24 year olds (52%) and notifications among this age group remained relatively stable. The number of notifications among 25 to 34 year olds increased by 11%. Table 4 Number and crude rate of chlamydia notifications in WA by Aboriginality, for the two most recent 12-month periods Aboriginality 01 Jul 15 - 30 Jun 16 Period Number Rate 01 Jul 14 - 30 Jun 15 Period Number Rate Aboriginal 1,510 1,856.0 1,355 1,687.4 Non-Aboriginal 9,219 358.1 9,340 371.3 879 0.2 N/A 5.2 628 0.1 N/A 4.5 11,608 437.2 11,323 436.3 Unknown Aboriginal:Non-Aboriginal ratio Total Notes: Rate = Crude notification rate per 100,000 population N/A = Not applicable The chlamydia notification rate increased by 10% among Aboriginal people and decreased by 4% among non-Aboriginal people resulting in an increase in the rate ratio compared to the previous 12-month period. 3 Table 5 Number and crude rate of chlamydia notifications in WA by region, for the two most recent 12month periods Region 01 Jul 15 - 30 Jun 16 Period Number Rate 01 Jul 14 - 30 Jun 15 Period Number Rate Goldfields 367 606.4 285 475.7 Great Southern 174 288.7 199 332.5 Kimberley 610 1,427.9 648 1,550.2 Midwest 335 483.4 295 431.0 4,461 409.4 4,517 423.9 382 469.4 361 460.3 4,403 441.1 4,136 425.3 South West 589 336.0 575 335.2 Wheatbelt 179 231.8 200 260.9 Other Unknown 108 0 N/A N/A 107 0 N/A N/A 11,608 437.2 11,323 450.2 North Metropolitan Pilbara South Metropolitan Total Notes: Rate = Crude notification rate per 100,000 population Other = Interstate + Overseas residents diagnosed in WA Unknown = Unknown residential address within WA N/A = Not applicable Chlamydia notification rates declined or remained stable in most regions except the Goldfields and Midwest, where there were modest increases (27% and 12%, respectively). 4 Gonorrhoea Figure 2 Number of gonorrhoea notifications in WA by region and exposure category, for the two most recent 12-month periods 900 800 Number of notifications 700 600 500 400 300 200 100 0 3 4 1 2014 Metro MSM 2 3 4 1 2015 Year and quarter Non-metro MSM Metro heterosexual 2 2016 Non-metro heterosexual WA (Total) The total number of gonorrhoea notifications was 35% higher compared to the previous 12-month period and 44% higher than the previous 5-year mean (Table 1), with most of the increase seen in Perth residents. In the Perth metropolitan area, the number of gonorrhoea notifications categorised as “heterosexual” (on the basis of enhanced surveillance data provided by notifying clinicians) increased by 53% in comparison to the previous 12-month period (n=1,119 vs. 731), and by 92% in comparison to the previous five-year mean of 583 cases per year. The largest increases occurred among females, with a 78% increase compared to the previous 12-month period (n=542 vs. 304) and a 128% increase in comparison to the previous five-year mean of 238 cases per year. The number of gonorrhoea notifications in the Perth metropolitan area categorised as “men who have sex with men” (MSM) increased by 31% in comparison to the previous 12-month period (n=498 vs. 379), and by 84% in comparison to the previous five-year mean of 271 cases per year. The number of notifications peaked in the first quarter of 2016. Table 6 Number and proportion of gonorrhoea notifications in WA by sex, for the two most recent 12month periods Sex 01 Jul 15 - 30 Jun 16 Period Number Percent 01 Jul 14 - 30 Jun 15 Period Number Percent Male 1,682 59% 1,318 63% Female Male:Female ratio 1,149 1.5 41% N/A 778 1.7 37% N/A Total 2,832 100% 2,096 100% Notes: N/A = Not applicable 5 The number of gonorrhoea notifications increased by 28% among males and by 48% among females, with a resulting decline in the male to female ratio compared to the previous 12-month period. Table 7 Number and proportion of gonorrhoea notifications in WA by age group, for the two most recent 12-month periods Age group 01 Jul 15 - 30 Jun 16 Period (Years) Number Percent 0–9 7 01 Jul 14 - 30 Jun 15 Period Number 0% Percent 1 0% 10–14 61 2% 63 3% 15–19 460 16% 308 15% 20–24 659 23% 474 23% 25–29 627 22% 456 22% 30–34 414 15% 300 14% 35–39 195 7% 159 8% 40–44 139 5% 125 6% 45–49 116 4% 89 4% 50–54 65 2% 56 3% 55–59 60+ 41 48 1% 2% 32 33 2% 2% Total 2,832 100% 2,096 100% The age distribution of gonorrhoea notifications was similar to the previous 12-month period, with the number of notified cases increasing in all age-groups above 15 years. The largest proportion of notifications was among 20 to 29 year olds (45%) and notifications among this age group increased by 38%. Table 8 Number and crude rate of gonorrhoea notifications in WA by Aboriginality, for the two most recent 12-month periods Aboriginality 01 Jul 15 - 30 Jun 16 Period Number Aboriginal Non-Aboriginal Unknown Aboriginal:Non-Aboriginal ratio Total Rate 01 Jul 14 - 30 Jun 15 Period Number Rate 877 1,078.0 744 926.5 1,944 75.5 1,345 53.5 11 0.5 N/A 14.3 7 0.6 N/A 17.3 2,832 106.7 2,096 80.8 Notes: Rate = Crude notification rate per 100,000 population N/A = Not applicable The gonorrhoea notification rate increased by 16% among Aboriginal people and by 41% among non-Aboriginal people, resulting in a decrease in the rate ratio compared to the previous 12-month period. Nonetheless, the rate of gonorrhoea among Aboriginal people was 14-times higher than non-Aboriginal rates. Aboriginal status was reported for 99.7% of notifications, reflective of the efforts of public health staff in ascertaining this information. 6 Table 9 Number and crude rate of gonorrhoea notifications in WA by region, for the two most recent 12month periods 01 Jul 15 - 30 Jun 16 Period Region Number Rate 01 Jul 14 - 30 Jun 15 Period Number Rate Goldfields 96 158.6 103 171.9 Great Southern 12 19.9 7 11.7 Kimberley 436 1,020.6 435 1,040.6 Midwest 103 148.6 45 65.8 North Metropolitan 981 90.0 683 64.1 Pilbara 192 235.9 157 200.2 South Metropolitan 872 87.4 569 58.5 South West 84 47.9 46 26.8 Wheatbelt 26 33.7 22 28.7 Other Unknown 30 0 N/A N/A 29 0 N/A N/A 2,832 106.7 2,096 80.8 Total Notes: Rate = Crude notification rate per 100,000 population Other = Interstate + Overseas residents diagnosed in WA Unknown = Unknown residential address within WA N/A = Not applicable Trends in the gonorrhoea notification rate varied between regions. While the rate increased across most regions, it was stable in the Kimberley and there was an 8% decrease in the Goldfields region. Infectious syphilis Figure 3 Number of infectious syphilis notifications in WA by region and exposure category, for the two most recent 12-month periods 100 90 Number of notifications 80 70 60 50 40 30 20 10 0 3 4 1 2014 Metro MSM 2 3 4 1 2015 Year and quarter Non-metro MSM Metro heterosexual Non-metro heterosexual 2 2016 WA (Total) The total number of infectious syphilis notifications was more than double the number in the previous 12-month period and the previous 5-year mean (Table 1). 7 In the Perth metropolitan area, the number of infectious syphilis cases categorised as MSM was more than double the previous 12-month period (n=157 vs. 62) and the previous five-year mean of 56 cases per year. Notifications increased sharply in the first quarter of 2016 (n=59), and declined somewhat in the second quarter, but remain significantly elevated. The number of infectious syphilis notifications attributed to heterosexual transmission in the Perth metropolitan area was also more than 5.5 times higher compared to the previous 12-month period (n=39 vs. 7). Table 10 Number and crude rate of infectious syphilis notifications by Aboriginality for the two most recent 12-month periods, WA 01 Jul 15 - 30 Jun 16 Period Aboriginality Number Aboriginal Rate 01 Jul 14 - 30 Jun 15 Period Number Rate 43 52.9 31 38.6 Non-Aboriginal 214 8.3 76 3.0 Unknown Aboriginal:Non-Aboriginal Ratio 2 0.2 N/A 6.4 0 0.4 N/A 12.8 WA (Total) 259 9.8 107 4.1 Notes: Rate = Crude notification rate per 100,000 population N/A = Not applicable The infectious syphilis notification rate increased by 37% among Aboriginal people (primarily associated with an ongoing outbreak in the Kimberley region) and more than doubled among non-Aboriginal people, resulting in a lower rate ratio compared to the previous 12-month period. Table 11 Number and crude rate of infectious syphilis notifications by region for the two most recent 12month periods, WA Region 01 Jul 15 - 30 Jun 16 Period Number Rate 01 Jul 14 - 30 Jun 15 Period Number Rate Goldfields 8 13.2 2 3.3 Great Southern 0 0.0 0 0.0 31 72.6 27 64.6 Kimberley Midwest 4 5.8 1 1.5 127 11.7 47 4.4 2 2.5 2 2.6 78 7.8 24 2.5 South West 5 2.9 0 0.0 Wheatbelt 2 2.6 1 1.3 Other Unknown 2 0 N/A N/A 3 0 N/A N/A 259 9.8 107 4.1 North Metropolitan Pilbara South Metropolitan WA (Total) Notes: Rate = Crude notification rate per 100,000 population Unknown = Unknown residential address within WA N/A = Not applicable Trends in infectious syphilis notifications varied between regions. Most notable were the increases in the combined Perth metropolitan regions (almost three-fold), and in the 8 Goldfields and Midwest regions (based on small numbers). Several cases in the Goldfields region had unconfirmed links to the Northern Territory. While the notification rate remains highest in the Kimberley region, the increase in the notification rate in the past 12 months (12%) was relatively modest compared to the increase in the Perth metropolitan area. The increase in notifications of infectious syphilis in the Kimberley region reflects the outbreak that commenced in northern Queensland in 2011 which spread to nearby areas in the Northern Territory in 2013, and then to the Kimberley region. A total of 61 infectious syphilis cases (40 female, 21 male) have been notified in the Kimberley region since the first case was identified in June 2014, with 14 cases notified in the six month period Jan-Jun 2016. Prior to 2014, there had been no infectious syphilis notifications in the Kimberley region for two years. HIV/AIDS Figure 4 Number of HIV notifications in WA by quarter, for the two most recent 12-month periods There were 130 new HIV notifications in the July 2015 to June 2016 period, similar to the previous 12-month period (n=129) (Table 1). After a notable increase in the July - September 2015 quarter (n=46) the number of HIV notifications has declined in subsequent quarters, with 20 cases notified in the April to June quarter (Figure 4). Of the new HIV notifications in the July 2015 to June 2016 period, 106 (82%) were male and 24 (18%) were female. The male: female ratio for HIV notifications was 4.4:1, which was higher than the ratio reported in the previous 12-month period (3.4:1). 9 Table 12 Number and proportion of HIV notifications in WA by age group, for the two most recent 12-month periods Age group 01 Jul 15 - 30 June 16 Period 01 Jul 14 - 30 June 15 Period (Years) Number Percent Number Percent 0–9 1 1% 0 0% 10–14 0 0% 1 1% 15–19 0 0% 1 1% 20–24 13 10% 14 11% 25–29 21 16% 16 12% 30–34 20 15% 21 16% 35–39 17 13% 23 18% 40–44 19 15% 14 11% 45–49 10 8% 12 9% 50–54 12 9% 9 7% 55–59 60+ 2 15 2% 12% 8 10 6% 8% Total 130 100% 129 100% The median age of newly notified HIV cases in the July 2015 to June 2016 period was 38 years (range: 4 to 81 years), similar to the median age reported for the previous 12month period (37 years; range: 12 to 72 years). The two notifications in the 0 to 14 age group (Table 12) acquired HIV through vertical transmission overseas. Table 13 Number and crude rate of HIV notifications in WA by Aboriginality, for the two most recent 12month periods Aboriginality 01 Jul 15 - 30 June 16 Period 01 Jul 14 - 30 June 15 Period Number Aboriginal Note: Rate Number Rate 6 7.4 4 5.0 Non-Aboriginal Aboriginal:Non-Aboriginal ratio 123 N/A 4.8 1.5 126 N/A 5.0 1.0 Total 129 4.9 130 5.0 Rate = Crude notification rate per 100,000 population In the most recent 12-month period there were six HIV notifications among Aboriginal people. The crude HIV notification rate for Aboriginal people is sensitive to small changes in the number of cases notified and increased to 1.5 times the rate reported for nonAboriginal people in the current period (Table 13). 10 Table 14 Number and proportion of HIV notifications in WA by exposure, for the two most recent 12-month periods 01 Jul 15 - 30 June 16 Period 01 Jul 14 - 30 June 15 Period Exposure category Number Percent Number Percent Men who have sex with men 65 50% 74 57% Male Heterosexual 30 23% 22 17% Female Heterosexual 19 15% 27 21% Male and Female IDU Other/unknown Total 5 11 130 4% 8% 100% 1 5 129 1% 4% 100% In the current 12-month period there was a 12% decrease in the number of HIV notifications for which the exposure category was attributed to MSM (Table 14). Most MSM notified with HIV in the current period reported acquiring their infection in Australia (68%). The number of male cases attributed to heterosexual exposure in the current 12-month period increased by 36% compared to the number reported in the previous period. (Table 14). The majority of these cases were men who acquired HIV overseas (73%). There was a 30% decrease in the number of female notifications attributed to heterosexual exposures in the current period (Table 14). Most of these women were born overseas and had acquired HIV overseas (74%). Hepatitis B Figure 5 Number of hepatitis B notifications in WA by disease status, for the two most recent 12-month periods 120 80 60 40 20 2014 2015 Jun Apr May Mar Feb Jan Dec Oct Nov Sep Jul Aug Jun May Apr Mar Feb Jan Dec Oct Nov Sep Jul 0 Aug Number of notifications 100 2016 Year and Month Newly acquired Unspecified Total 11 Table 15 Number of newly acquired and unspecified hepatitis B notifications in WA, for the two most recent 12-month periods Disease status 01 Jul 15 - 30 Jun 16 Period Number 01 Jul 14 - 30 Jun 15 Period Percent Number Percent Newly acquired Unspecified 27 643 4% 96% 28 589 5% 95% Total 670 100% 617 100% The number of newly acquired hepatitis B notifications remained stable and the number of unspecified hepatitis B notifications increased by 9%, compared to the previous 12month period. The sharp increase in unspecified hepatitis B notifications in May and June 2016 is a reporting artefact resulting from the addition of a backlog of notifications from one pathology laboratory. Table 16 Number and proportion of hepatitis B notifications (newly acquired + unspecified) in WA by sex, for the two most recent 12-month periods Sex Note: 01 Jul 15 - 30 Jun 16 Period Number Percent 01 Jul 14 - 30 Jun 15 Period Number Percent Male 348 52% 321 52% Female Male:Female ratio 322 1.1 48% N/A 296 1.1 48% N/A Total 670 100% 617 100% N/A = Not applicable Table 17 Number and proportion of hepatitis B notifications (newly acquired + unspecified) in WA by age group, for the two most recent 12-month periods Age group 01 Jul 15 - 30 Jun 16 Period (Years) Number Percent 0–9 0 0% 10–14 7 15–19 16 20–24 01 Jul 14 - 30 Jun 15 Period Number Percent 5 1% 1% 9 1% 2% 18 3% 47 7% 43 7% 25–29 92 14% 86 14% 30–34 126 19% 126 20% 35–39 95 14% 86 14% 40–44 86 13% 74 12% 45–49 49 7% 53 9% 50–54 61 9% 34 6% 55–59 60+ 33 58 5% 9% 42 41 7% 7% Total 670 100% 617 100% There was little change in the age distribution of hepatitis B cases in the past two 12month periods. 12 Table 18 Number and crude rate of hepatitis B notifications (newly acquired + unspecified) in WA by Aboriginality, for the two most recent 12-month periods 01 Jul 15 - 30 Jun 16 Period Aboriginality Number Aboriginal Rate 01 Jul 14 - 30 Jun 15 Period Number Rate 31 38.1 30 37.4 Non-Aboriginal 537 20.9 514 20.4 Unknown Aboriginal:Non-Aboriginal ratio 102 0.1 N/A 1.8 73 0.1 N/A 1.8 Total 670 25.2 617 23.8 Notes: Rate = Crude notification rate per 100,000 population N/A = Not applicable Table 19 Number and crude rate of hepatitis B notifications (newly acquired + unspecified) in WA by region, for the two most recent 12-month periods Region Goldfields 01 Jul 15 - 30 Jun 16 Period Number Rate Pilbara South Metropolitan South West 15 25.0 2 3.3 6 10.0 13 30.4 7 16.7 6 8.7 12 17.5 267 24.5 248 23.3 15 18.4 19 24.2 317 31.8 270 27.8 18 10.3 23 13.4 Wheatbelt 5 6.5 13 17.0 Other Unknown 9 0 N/A N/A 4 0 N/A N/A 670 25.2 617 24.5 Total Notes: Rate 29.7 Midwest North Metropolitan Number 18 Great Southern Kimberley 01 Jul 14 - 30 Jun 15 Period Rate = Crude notification rate per 100,000 population Unknown = Unknown residential address within WA N/A = Not applicable Trends in the notification rate varied between regions. Although based on small numbers, rates decreased in the Great Southern and Wheatbelt regions and increased in the Kimberley region. 13 Hepatitis C Figure 6 Number of hepatitis C notifications in WA by disease status, for the two most recent 12-month periods 140 Number of notifications 120 100 80 60 40 20 2014 Jun Apr May Mar Jan 2015 Feb Dec Nov Oct Sep Aug Jul Jun Apr May Mar Jan Feb Dec Oct Nov Sep Jul Aug 0 2016 Year and Month Newly acquired Unspecified Total Table 20 Number of hepatitis C notifications in WA by disease status, for the two most recent 12-month periods Disease status 01 Jul 15 - 30 Jun 16 Period Number Percent 01 Jul 14 - 30 Jun 15 Period Number Percent Newly acquired Unspecified 164 1,006 14% 86% 154 986 14% 86% Total 1,170 100% 1,140 100% The number of newly and unspecified acquired hepatitis C notifications remained relatively stable, compared to the previous 12-month period. Table 21 Number, proportion and ratio of hepatitis C notifications (newly acquired + unspecified) in WA by sex, for the two most recent 12-month periods Sex 01 Jul 15 - 30 Jun 16 Period Number Percent 01 Jul 14 - 30 Jun 15 Period Number Percent Male 778 66% 771 68% Female Male:Female ratio 392 2.0 34% N/A 369 2.1 32% N/A 1,170 100% 1,140 100% Total N/A = Not applicable 14 Table 22 Number and proportion of hepatitis C notifications (newly acquired + unspecified) in WA by age group, for the two most recent 12-month periods Age group 01 Jul 15 - 30 Jun 16 Period (Years) Number Percent 0–9 01 Jul 14 - 30 Jun 15 Period Number 2 0% 10–14 0 15–19 29 20–24 Percent 5 0% 0% 0 0% 2% 35 3% 139 12% 132 12% 25–29 154 13% 155 14% 30–34 140 12% 163 14% 35–39 158 14% 152 13% 40–44 132 11% 135 12% 45–49 133 11% 107 9% 50–54 117 10% 101 9% 55–59 60+ 78 88 7% 8% 90 65 8% 6% Total 1,170 100% 1,140 100% There was little change in the age distribution of hepatitis C notifications between the two 12-month periods. Table 23 Number and crude rate of hepatitis C notifications (newly acquired + unspecified) in WA by Aboriginality, for the two most recent 12-month periods Aboriginality 01 Jul 15 - 30 Jun 16 Period Number Rate 01 Jul 14 - 30 Jun 15 Period Number Rate Aboriginal 253 311.0 232 288.9 Non-Aboriginal 791 30.7 817 32.5 Unknown Aboriginal:Non-Aboriginal ratio 126 0.3 N/A 10.1 91 0.3 N/A 8.9 1,170 44.1 1,140 43.9 Total Rate = Crude notification rate per 100,000 population N/A = Not applicable The hepatitis C notification rate increased by 8% among Aboriginal people and decreased by 5% among non-Aboriginal people, resulting in an increase in the rate ratio compared to the previous 12-month period. 15 Table 24 Number and crude rate of hepatitis C notifications (newly acquired + unspecified) in WA by region, for the two most recent 12-month periods Region 01 Jul 15 - 30 Jun 16 Period Number Rate 01 Jul 14 - 30 Jun 15 Period Number Rate Goldfields 31 51.2 29 48.4 Great Southern 38 63.1 55 91.9 Kimberley 18 42.1 21 50.2 Midwest 47 67.8 45 65.8 430 39.5 403 37.8 North Metropolitan Pilbara 31 38.1 20 25.5 449 45.0 438 45.0 South West 82 46.8 71 41.4 Wheatbelt 32 41.4 40 52.2 Other Unknown 12 0 N/A N/A 18 0 N/A N/A 1,170 44.1 1,140 45.3 South Metropolitan Total Rate = Crude notification rate per 100,000 population Other = Interstate + Overseas Unknown = Unknown residential address within WA N/A = Not applicable Trends in the notification rate varied between regions. Most notable were the decreases in the Great Southern (31%) and Wheatbelt (22%) regions and the increase in the Pilbara (49%) region. 16 This document can be made available in alternative formats on request for a person with a disability. © Department of Health 2016