Compiled by Elizabeth Elliott, Donna Rose
Australian Paediatric Surveillance Unit
Background
The Australian Paediatric Surveillance Unit (APSU) was established in 1993
and is a unit of the Division of Paediatrics and Child Health, Royal Australasian
College of Physicians. The activities of the APSU are funded in part by the
Federal Department of Health and Ageing through the communicable diseases
program. The APSU is a founding member of the International Network of Paediatric
Surveillance Units (INoPSU). INoPSU now has 15 member units who employ
a similar methodology.
The APSU conducts national active surveillance of rare diseases of childhood,
including infectious and vaccine preventable diseases, genetic disorders,
childhood injuries and mental health conditions. Surveillance through the
APSU provides the only available method of national data collection for most
of the childhood conditions studied.
The primary aim of the APSU is to document the epidemiology of the conditions
under surveillance, their clinical features, current management and short-term
outcome. The APSU’s secondary aims are to provide a mechanism for national
collaborative research and to disseminate data acquired by the Unit to inform
best practice, appropriate prevention strategies and optimal health resource
allocation.
Contributors to the APSU are clinicians known to be working in paediatrics
and child health in Australia. In 2003, and average of 1,050 clinicians
participated in the monthly surveillance of 14 conditions, with an overall
response rate of 96 per cent.
As one-hundred per cent case ascertainment is unlikely to be achieved by
any one surveillance scheme, additional data sources are used to supplement
or verify case finding through the APSU. For further information please
contact the APSU on telephone: +61 2 9845 2200 or email: apsu@chw.edu.au
Table. Confirmed cases of communicable diseases
reported to the Australian Paediatric Surveillance Unit between 1 January
and 30 June 2004*
Condition |
Previous reporting period
Jan–Dec 2003 |
Current reporting period
Jan–June 2004* |
| Acute Flaccid Paralysis |
30 |
12 |
| Congenital cytomegalovirus |
10 |
8 |
| Congenital rubella |
3 |
1 |
| Perinatal exposure to HIV
HIV infection |
14 1† |
9 |
| Neonatal herpes simplex virus infection |
6 |
2 |
| Hepatitis C Virus infection |
12 |
5 |
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About the APSU communicable diseases studies:
Acute flaccid paralysis
Heath Kelly, Bruce Thorley, Kerri Anne Brussen, Jayne Antony, Elizabeth Elliott, Anne Morris
Acute flaccid paralysis (AFP) surveillance in children under 15 years of
age was initiated in 1995 to help meet the World Health Organisation (WHO)
certification standards for poliomyelitis eradication. To the end of 2003
there were 289 confirmed cases of non-polio AFP. The reported rate of non-polio
AFP (1995–2003) is therefore 0.83 (95% CI 0.74–0.94) per 100,000 children
under 15 years (the World Health Organization (WHO) AFP case notification
target for developed countries (1/100.000 children < 15 years) was reached
in 2000 and 2001 but not 2003. In 2003 Guillain-Barre syndrome was again
the most common cause of AFP (35% of confirmed cases), followed by transverse
myelitis (18%). Adequate faecal specimens were received from 26 per cent
of all eligible cases in 2002 and 24 per cent in 2003, well below the WHO
target of 80 per cent. However, relevant diagnostic tests and/or 60 day follow
up data available for these cases allowed them to be classified as AFP–non-polio.
Congenital cytomegalovirus infection
William Rawlinson, Daniel Trincado, Gillian Scott, Sian Munro,
Pamela Palasanthiran, Mark Ferson, David Smith, Geoff Higgins, Michael Catton,
Alistair McGregor, Dominic Dwyer, Alisson Kesson
Congenital Cytomegalovirus infection (CMV) surveillance in children up to
12 months of age commenced through the APSU in 1999. Between January 1999
and December 2003 there were 31 confirmed cases of CMV (that is infants with
CMV being isolated in blood, urine, saliva or tissue in the first three weeks
of life). However, follow-up information available on children reported with
CMV was of poor quality in 2003 prohibiting classification of all cases notified
to APSU. Thus, the reported rate of confirmed cases in 2003—1.78 (95% CI
1.21–2.52) per 100,000 live births—is likely to be an underestimate of the
true rate.
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Congenital rubella
Margaret Burgess, Jill Forrest, Cheryl Anne Jones, Peter McIntyre
Surveillance of newly diagnosed congenital rubella in children and adolescents
under 16 commenced in 1993. A total of 49 children with congenital rubella
were identified through the APSU between May 1993 and December 2003. The
national Measles Control Campaign in 1998 aimed to give measles-mumps-rubella
(MMR) vaccine to all unvaccinated preschoolers and a second dose to primary
schoolchildren. Following the Campaign no children with congenital rubella
defects were born to Australian residents during the five years 1998 to 2002.
However, during this period five imported cases were reported. Two cases
of congenital rubella were reported from Queensland in late 2003. These children
were born to young mothers who missed vaccination with rubella in the school
programme and highlight the need for continuing education regarding the risks
of rubella infection in pregnancy.
HIV infection, AIDS and perinatal exposure to HIV
Ann McDonald, John Kaldor, Michelle Good, John Ziegler
This study monitors new cases of HIV/AIDS infection in children under 16
years and perinatal exposure to HIV. Perinatal exposure to HIV is now the
most frequently reported source of HIV infection in Australian children.
Between January 1997 and December 2003, 136 children with perinatal exposure
to HIV were reported through the APSU and/or the National HIV/AIDS surveillance
program. Additionally, in 2003 there was one reported case of HIV infection
in a young person, which was attributed to heterosexual contact. The reported
rate of perinatal HIV exposure is 7.80 (95% CI 6.54–9.22) per 100,000 live
births. Of 39 cases of perinatal exposure to HIV reported through the APSU
in 2002–2003, 38 were born to women whose HIV infection was diagnosed antenatally.
Only one of 38 (2.6%) children born to these women acquired HIV infection.
This reflects the use of interventions (antiretroviral treatment in pregnancy,
elective caesarian delivery, and avoidance of breastfeeding) in women whose
HIV infection is diagnosed antenatally, which substantially reduce the risk
of mother to child HIV transmission.
Neonatal herpes simplex virus infection
Cheryl Anne Jones, David Isaacs, Peter McIntyre, Tony Cunningham,
Suzanne Garland
Surveillance of HSV infection in children aged up to 28 days commenced in
1997. There were 59 confirmed cases of neonatal HSV infection in infants
up to 28 days of age reported between January 1997 and December 2003. The
reported rate is 3.38 (95% CI 2.57–4.36) per 100,000 live births (similar
to the United Kingdom but considerably lower than the rate in the United
States of America). In contrast to the United States of America, Herpes simplex
type 1 is the predominant isolate causing neonatal HSV infection in Australia.
Hepatitis C virus infection
John Kaldor, Cheryl Anne Jones, Elizabeth Elliott, Winita Hardikar,
Alison Keeson, Susan Polis, Catherine Mews
Surveillance of Hepatitis C infection in children commenced in January 2003.
APSU contributors are asked to report any child less than 15 years of age
newly diagnosed with Hepatitis C infection. Twelve confirmed cases of Hepatitis
C virus infection were reported to the APSU in 2003. The reported rate of
HCV virus infection in Australian children less than 15 years of age, based
on these preliminary data, is very low at 0.30 (95% CI 0.16–0.53) per 100,000
children under 15 years of age. In these children HCV infection was due to
vertical transmission from an infected mother or childhood intravenous drug
use. Most children were asymptomatic at diagnosis. Although the study findings
are consistent with previous global studies, the small number of HCV cases
identified nationally to date raises the possibility of under reporting.
It is likely that some infected women remain undiagnosed during pregnancy
and that some children born to infected mothers are not referred for investigation
and paediatric follow-up.
This report was published in Communicable Diseases Intelligence Vol 28 No 4, December 2004.
