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ASPREN | HIV/AIDS surveillance | Childhood immunisation coverage | Australian Paediatric Surveillance Unit | National Enteric Pathogens Surveillance System
Australian Sentinel Practice Research Network
The Research and Health Promotion Unit of the Royal Australian College of General Practitioners operates the Australian Sentinel Practice Research Network (ASPREN). ASPREN is a national network of general practitioners who report presentations of defined medical conditions each week. The aim of ASPREN is to provide an indicator of the burden of disease in the primary health care setting and to detect trends in consultation rates.
There are currently about 50 general practitioners participating in the network from all states. Seventy-five per cent of these are in metropolitan areas and the remainder are rural based. Between 4,000 and 6,000 consultations are recorded each week.
The list of conditions is reviewed annually by the ASPREN management committee and an annual report is published.
In 2004, nine conditions are being monitored, five of which are related to communicable diseases. These include influenza, gastroenteritis, varicella and shingles. Definitions of these conditions are described in Surveillance systems reported in CDI, published in Commun Dis Intell 2004;28:99. Note that in 2004, two case definitions for influenza are being recorded in parallel.
Data from 1 October to 31 December 2004 are shown as the rate per 1,000 consultations in Figures 6, 7, 8 and 9.
Figure 6. Consultation rates for influenza-like illness, ASPREN, 1 October to 31 December 2004, by week of report
Figure 7. Consultation rates for gastroenteritis, ASPREN, 1 October to 31 December 2004, by week of report
Figure 8. Consultation rates for chickenpox, ASPREN, 1 October to 31 December 2004, by week of report
Figure 9. Consultation rates for shingles, ASPREN, 1 October to 31 December 2004, by week of report
Childhood immunisation coverage
Tables 6, 7 and 8 provide the latest quarterly report on childhood immunisation coverage from the Australian Childhood Immunisation Register (ACIR).
The data show the percentage of children fully immunised at 12 months of age for the cohort born between 1 July and 30 September 2003, at 24 months of age for the cohort born between 1 July and 30 September 2002, and at 6 years of age for the cohort born between 1 July and 30 September 1998 according to the Australian Standard Vaccination Schedule.
For information about the Australian Childhood Immunisation Register see Surveillance systems reported in CDI, published in Commun Dis Intell 2004;28:102 and for a full description of the methodology used by the Register see Commun Dis Intell 1998;22:36-37.
The National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS) provides commentary on the trends in ACIR data. For further information please contact NCIRS by telephone on +61 2 9845 1256, or email: brynleyh@chw.edu.au
Immunisation coverage for children ‘fully immunised’ at 12 months of age for Australia decreased marginally from the last quarter by 0.1 percentage points to 91.2 per cent (Table 6). There was a substantial increase in ‘fully immunised’ coverage in Western Australia, with an increase of 2.9 percentage points, whilst all other jurisdictions experienced very little change in coverage. As expected, Western Australia also had increases in coverage for individual vaccines.
Coverage for children ‘fully immunised’ at 24 months of age for Australia decreased marginally from the last quarter by 0.6 percentage points to 91.7 per cent (Table 7). Coverage for individual vaccines decreased marginally in most jurisdictions with coverage greater than 95 per cent in almost all jurisdictions for all vaccines except Haemophilus influenzae type b.
Table 8 shows immunisation coverage estimates for ‘fully immunised’ and for individual vaccines at 6 years of age for Australia and by state or territory. ‘Fully immunised’ coverage at 6 years of age for Australia was unchanged overall, apart from increases in the Australian Capital Territory (+3.4%) and in the Northern Territory (+3.9%), also reflected in individual vaccines. Coverage for vaccines assessed at 6 years is at or near 85 per cent in the most jurisdictions, but Western Australia and Queensland remain below the average.
Figure 10 shows the trends in vaccination coverage from the first ACIR-derived published coverage estimates in 1997 to the current estimates. There is a clear trend of increasing vaccination coverage over time for children aged 12 months, 24 months and 6 years, although the rate of increase has slowed over the past 18 months for all age groups. Figure 10 shows that there have now been five consecutive quarters where ‘fully immunised’ coverage at 24 months of age has been greater than ‘fully immunised’ coverage at 12 months of age, following the removal of the requirement for 18 month DTPa vaccine.
Table 6. Percentage of children immunised at 1 year of age, preliminary results by vaccine and state or territory for the birth cohort 1 July to 30 September 2003; assessment date 31 December 2004
| Vaccine | State or territory | Australia | |||||||
|---|---|---|---|---|---|---|---|---|---|
| ACT | NSW | NT | Qld | SA | Tas | Vic | WA | ||
| Number of children | 1,051 |
22,438 |
839 |
13,035 |
4,629 |
1,438 |
16,129 |
5,954 |
65,513 |
| Diphtheria, tetanus, pertussis (%) | 93.9 |
92.3 |
91.2 |
92.5 |
92.5 |
94.1 |
92.6 |
93.2 |
92.6 |
| Poliomyelitis (%) | 93.7 |
92.2 |
90.5 |
92.5 |
92.4 |
93.9 |
92.6 |
93.1 |
92.5 |
| Haemophilus influenzae type b (%) | 95.8 |
94.3 |
95.6 |
94.8 |
94.5 |
95.1 |
94.7 |
96.3 |
94.8 |
| Hepatitis B (%) | 95.7 |
95.1 |
96.1 |
94.9 |
95.0 |
95.2 |
94.4 |
96.0 |
95.0 |
| Fully immunised (%) | 92.8 |
90.7 |
89.8 |
91.4 |
91.0 |
93.0 |
91.3 |
91.7 |
91.2 |
| Change in fully immunised since last quarter (%) | -0.7 |
-0.5 |
-0.7 |
-0.3 |
-0.7 |
+0.5 |
-0.4 |
+2.9 |
-0.1 |
Table 7. Percentage of children immunised at 2 years of age, preliminary results by vaccine and state or territory for the birth cohort 1 July to 30 September 2002, assessment date 31 December 2004
| Vaccine | State or territory | Australia | |||||||
|---|---|---|---|---|---|---|---|---|---|
| ACT | NSW | NT | Qld | SA | Tas | Vic | WA | ||
| Number of children | 1,078 |
22,056 |
882 |
13,007 |
4,538 |
1,523 |
16,122 |
6,192 |
65,398 |
| Diphtheria, tetanus, pertussis (%) | 95.2 |
94.9 |
96.4 |
94.5 |
95.9 |
96.1 |
95.6 |
93.9 |
95.0 |
| Poliomyelitis (%) | 95.1 |
94.8 |
96.4 |
94.4 |
95.9 |
95.9 |
95.6 |
93.8 |
95.0 |
| Haemophilus influenzae type b (%) | 93.5 |
93.1 |
94.7 |
93.4 |
94.7 |
94.4 |
93.9 |
91.7 |
93.4 |
| Measles, mumps, rubella (%) | 95.2 |
93.0 |
95.7 |
93.5 |
95.0 |
94.2 |
94.3 |
92.3 |
93.6 |
| Hepatitis B(%) | 96.2 |
95.3 |
97.3 |
94.7 |
96.0 |
96.6 |
96.0 |
94.4 |
95.4 |
| Fully immunised (%) | 92.0 |
91.1 |
93.8 |
91.6 |
93.3 |
92.9 |
92.6 |
89.8 |
91.7 |
| Change in fully immunised since last quarter (%) | -0.7 |
-0.7 |
-0.0 |
-0.7 |
+0.3 |
-0.9 |
-0.5 |
-0.8 |
-0.6 |
* The 12 months age data for this cohort was published in Commun Dis Intell 2004;28:119.
Table 8. Percentage of children immunised at 6 years of age, preliminary results by vaccine and state or territory for the birth cohort 1 July to 30 September 1998; assessment date 31 December 2004
| Vaccine | State or territory | Australia | |||||||
|---|---|---|---|---|---|---|---|---|---|
| ACT | NSW | NT | Qld | SA | Tas | Vic | WA | ||
| Number of children | 1,084 |
22,538 |
772 |
13,716 |
4,847 |
1,689 |
16,511 |
6,797 |
67,954 |
| Diphtheria, tetanus, pertussis (%) | 88.9 |
85.5 |
87.3 |
83.0 |
85.7 |
85.7 |
87.3 |
82.1 |
85.2 |
| Poliomyelitis (%) | 89.5 |
85.6 |
87.7 |
83.1 |
86.0 |
85.6 |
86.8 |
82.3 |
85.2 |
| Measles, mumps, rubella (%) | 88.2 |
84.9 |
87.8 |
82.9 |
85.2 |
84.6 |
87.0 |
82.0 |
84.8 |
| Fully immunised (%) | 87.2 |
83.7 |
86.7 |
81.6 |
84.3 |
83.4 |
85.7 |
80.6 |
83.6 |
| Change in fully immunised since last quarter (%) | +3.4 |
+0.6 |
+3.9 |
-2.1 |
+0.5 |
-0.1 |
-0.1 |
+0.5 |
-0.0 |
Figure 10. Trends in vaccination coverage, Australia, 1997 to 2004, by age cohorts
Acknowledgement: These figures were provided by the Health Insurance Commission (HIC), to specifications provided by the Australian Government Department of Health and Ageing. For further information on these figures or data on the Australian Childhood Immunisation Register please contact the Immunisation Section of the HIC: telephone: +61 2 6124 6607.
HIV and AIDS surveillance
National surveillance for HIV disease is coordinated by the National Centre in HIV Epidemiology and Clinical Research (NCHECR), in collaboration with State and Territory health authorities and the Commonwealth of Australia. Cases of HIV infection are notified to the National HIV Database on the first occasion of diagnosis in Australia, by either the diagnosing laboratory (Australian Capital Territory, New South Wales, Tasmania, Victoria) or by a combination of laboratory and doctor sources (Northern Territory, Queensland, South Australia, Western Australia). Cases of AIDS are notified through the State and Territory health authorities to the National AIDS Registry. Diagnoses of both HIV infection and AIDS are notified with the person's date of birth and name code, to minimise duplicate notifications while maintaining confidentiality.
Tabulations of diagnoses of HIV infection and AIDS are based on data available three months after the end of the reporting interval indicated, to allow for reporting delay and to incorporate newly available information. More detailed information on diagnoses of HIV infection and AIDS is published in the quarterly Australian HIV Surveillance Report, and annually in 'HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia, annual surveillance report'. The reports are available from the National Centre in HIV Epidemiology and Clinical Research, 376 Victoria Street, Darlinghurst NSW 2010. Internet: http://www.med.unsw.edu.au/nchecr. Telephone: +61 2 9332 4648. Facsimile: +61 2 9332 1837. For more information see Surveillance systems reported in CDI, published in Commun Dis Intell 2004;28:99.
HIV and AIDS diagnoses and deaths following AIDS reported for 1 July to 30 September 2004, as reported to 31 December 2004, are included in this issue of Communicable Diseases Intelligence (Tables 9 and 10).
Table 9. New diagnoses of HIV infection, new diagnoses of AIDS and deaths following AIDS occurring in the period 1 July to 30 September 2004, by sex and state or territory of diagnosis
| Sex | ACT | NSW | NT | Qld | SA | Tas | Vic | WA | Jul - Sep 04 | 1 Jul - Sep 03 | 1 Jan - 30 Sep 04 | 1 Jan - 30 Sep 03 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HIV diagnoses | Female | 1 |
9 |
0 |
2 |
0 |
0 |
5 |
0 |
17 |
21 |
86 |
64 |
| Male | 0 |
55 |
0 |
38 |
18 |
1 |
48 |
6 |
166 |
179 |
558 |
589 |
|
| Not reported | 0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
3 |
3 |
5 |
|
| Total * | 1 |
65 |
0 |
40 |
18 |
1 |
53 |
6 |
184 |
204 |
648 |
659 |
|
| AIDS diagnoses | Female | 0 |
0 |
1 |
0 |
0 |
0 |
1 |
0 |
2 |
2 |
10 |
10 |
| Male | 0 |
5 |
0 |
6 |
1 |
0 |
7 |
0 |
19 |
51 |
87 |
138 |
|
| Not reported | 0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
| Total * | 0 |
5 |
1 |
6 |
1 |
0 |
8 |
0 |
21 |
53 |
98 |
149 |
|
| AIDS deaths | Female | 0 |
0 |
1 |
1 |
0 |
0 |
0 |
0 |
2 |
3 |
4 |
8 |
| Male | 0 |
5 |
0 |
1 |
3 |
0 |
5 |
0 |
14 |
23 |
46 |
56 |
|
| Not reported | 0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
| Total * | 0 |
5 |
1 |
2 |
3 |
0 |
5 |
0 |
16 |
26 |
50 |
64 |
* Persons whose sex was reported as transgender are included in the totals.
Table 10. Cumulative diagnoses of HIV infection, AIDS and deaths following AIDS since the introduction of HIV antibody testing to 30 September 2004, by sex and state or territory
| Sex | ACT | NSW | NT | Qld | SA | Tas | Vic | WA | Total | |
|---|---|---|---|---|---|---|---|---|---|---|
| HIV | Female | 31 |
769 |
17 |
224 |
82 |
8 |
307 |
161 |
1,599 |
| diagnoses | Male | 246 |
12,574 |
122 |
2,407 |
826 |
89 |
4,717 |
1,086 |
22,067 |
| Not reported | 0 |
239 |
0 |
0 |
0 |
0 |
22 |
0 |
261 |
|
| Total * | 277 |
13,610 |
139 |
2,640 |
909 |
97 |
5,065 |
1,254 |
23,991 |
|
| AIDS | Female | 9 |
221 |
2 |
61 |
30 |
4 |
94 |
34 |
455 |
| diagnoses | Male | 92 |
5,110 |
41 |
970 |
386 |
48 |
1,853 |
407 |
8,907 |
| Not reported | 0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
| Total * | 101 |
5,346 |
43 |
1,033 |
417 |
52 |
1,957 |
443 |
9,392 |
|
| AIDS | Female | 6 |
128 |
1 |
41 |
20 |
2 |
58 |
22 |
278 |
| deaths | Male | 71 |
3,486 |
26 |
632 |
268 |
32 |
1,364 |
282 |
6,161 |
| Not reported | 0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
| Total * | 77 |
3,623 |
27 |
675 |
288 |
34 |
1,430 |
305 |
6,459 |
* Persons whose sex was reported as transgender are included in the totals.
Australian Paediatric Surveillance Unit
The Australian Paediatric Surveillance Unit (APSU) conducts nationally based active surveillance of rare diseases of childhood, including specified communicable diseases and complications of rare communicable diseases in children. The primary objectives of the APSU are to document the number of Australian children under 15 years newly diagnosed with specified conditions, their geographic distribution, clinical features, current management and outcome. Contributors to the APSU are clinicians known to be working in paediatrics and child health in Australia. In 2003, over 1,050 clinicians participated in the surveillance of 14 conditions through the APSU, with an overall response rate of 96 per cent. The APSU can be contacted by telephone: +61 2 9845 2200, email: apsu@chw.edu.au. For more information about APSU see Surveillance systems reported in CDI, published in Commun Dis Intell 2004;28:101.
The results for the period 1 July to 31 December are shown in Table 9.
Table 11. Confirmed cases of communicable diseases reported to the Australian Paediatric Surveillance Unit, 1 July to 31 December 2004
| Condition | Previous reporting period Jan-June 2004 |
Current reporting period July-December 2004* |
|---|---|---|
| Acute flaccid paralysis | 12 |
21 |
| Congenital cytomegalovirus | 8 |
17 |
| Congenital rubella | 1 |
1 |
| Perinatal exposure to HIV infection | 9 |
13 |
| Neonatal herpes simplex virus infection | 2 |
17 |
| Hepatitis C virus infection | 5 |
20 |
* Surveillance data are provisional and subject to revision.
National Enteric Pathogens Surveillance System
The National Enteric Pathogens Surveillance System (NEPSS) collects, analyses and disseminates data on human enteric bacterial infections diagnosed in Australia. These pathogens include Salmonella, Escherichia coli, Vibrio, Yersinia, Plesiomonas, Aeromonas and Campylobacter. Communicable Diseases Intelligence quarterly reports include only Salmonella.
Data are based on reports to NEPSS from Australian laboratories of laboratory-confirmed human infection with Salmonella. Salmonella are identified to the level of serovar and, if applicable, phage-type. Infections apparently acquired overseas are included. Multiple isolations of a single Salmonella serovar/phage-type from one or more body sites during the same episode of illness are counted once only. The date of the case is the date the primary diagnostic laboratory isolated a Salmonella from the clinical sample.
Note that the historical quarterly mean counts should be interpreted with caution, and are affected by surveillance artefacts such as newly recognised (such as S. Typhimurium 197 and S. Typhimurium U290) and incompletely typed Salmonella.
Reported by Joan Powling (NEPSS Co-ordinator) and Mark Veitch (Public Health Physician), Microbiological Diagnostic Unit — Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne. NEPSS can be contacted at the above address or by telephone: +61 3 8344 5701, or facsimile: +61 3 9625 2689.
Reports to the National Enteric Pathogens Surveillance System of Salmonella infection for the period 1 October to 31 December 2004 are included in Tables 12 and 13. Data include cases reported and entered by 28 January 2005. Counts are preliminary, and subject to adjustment after completion of typing and reporting of further cases to NEPSS. For more information about NEPSS see Surveillance systems reported in CDI, published in Commun Dis Intell 2004;28:101.
Fourth quarter 2004
The total number of reports to NEPSS of human Salmonella infection increased to 1,765 in the fourth quarter of 2004, 53 per cent more than in third quarter of 2004, and approximately 15 per cent more than the final count for the fourth quarter of 2003. Case counts to 28 January 2005 are expected to comprise more than 95 per cent of the final counts for the quarter.
During the fourth quarter of 2004, the 25 most common Salmonella types in Australia accounted for 1,069 cases, 61 per cent of all reported human Salmonella infections.
Eighteen of the 25 most common Salmonella infections in the fourth quarter of 2004 were among the 25 most commonly reported in the previous quarter.
S. Typhimurium phage type 170/108 reports increased in number, particularly in New South Wales, making it the most common cause of human salmonellosis during this quarter. Reports of other common salmonellae with counts well above historical averages include S. Saintpaul (in northern Australia), S. Typhimurium phage type 197 (in the eastern mainland states, particularly Queensland), S. Virchow phage type 8 and S. Aberdeen (both particularly in Queensland), and S. Birkenhead (in New South Wales and Queensland). Counts of S. Hvittingfoss and S. Typhimurium phage type 12 and S. Waycross also remain elevated.
Table 12. Reports to the National Enteric Pathogens Surveillance System of Salmonella isolated from humans during the period 1 October to 31 December 2004, as reported to 28 January 2005
| ACT | NSW | NT | Qld | SA | Tas | Vic | WA | Australia | |
|---|---|---|---|---|---|---|---|---|---|
| Total all Salmonella for quarter | 16 |
486 |
79 |
631 |
127 |
38 |
255 |
133 |
1,765 |
| Total contributing Salmonella types | 13 |
116 |
40 |
119 |
47 |
19 |
95 |
68 |
241 |
Table 13. Top 25 Salmonella types identified in Australia, by state or territories, 1 October to 31 December 2004
| State or territory | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| National rank | Salmonella type | ACT | NSW | NT | Qld | SA | Tas | Vic | WA | Total 4th quarter 2004 | Last 10 years mean 4th quarter | Year to date 2004 | Year to date 2003 |
| 1 | S. Typhimurium 170 | 3 |
119 |
0 |
12 |
0 |
2 |
25 |
0 |
161 |
41 |
575 |
441 |
| 2 | S. Typhimurium 135 | 1 |
34 |
0 |
56 |
2 |
0 |
12 |
8 |
113 |
135 |
563 |
695 |
| 3 | S. Saintpaul | 0 |
6 |
15 |
58 |
3 |
0 |
5 |
12 |
99 |
68 |
389 |
298 |
| 4 | S. Typhimurium 9 | 1 |
27 |
0 |
7 |
14 |
2 |
15 |
5 |
71 |
124 |
357 |
420 |
| 5 | S. Typhimurium 197 | 1 |
10 |
0 |
40 |
0 |
0 |
12 |
1 |
64 |
12 |
267 |
172 |
| 6 | S. Virchow 8 | 0 |
6 |
0 |
48 |
4 |
0 |
5 |
0 |
63 |
37 |
333 |
207 |
| 7 | S. Birkenhead | 0 |
28 |
0 |
26 |
1 |
0 |
6 |
0 |
61 |
57 |
263 |
172 |
| 8 | S. Aberdeen | 0 |
2 |
0 |
40 |
0 |
0 |
1 |
0 |
43 |
17 |
134 |
86 |
| 9 | S. Infantis | 1 |
17 |
1 |
3 |
4 |
0 |
13 |
3 |
42 |
29 |
154 |
200 |
| 10 | S. Chester | 0 |
5 |
0 |
17 |
6 |
1 |
3 |
4 |
36 |
36 |
193 |
218 |
| 11 | S. Hvittingfoss | 0 |
4 |
0 |
26 |
1 |
0 |
0 |
1 |
32 |
15 |
148 |
89 |
| 12 | S. Typhimurium 12 | 0 |
16 |
0 |
5 |
1 |
0 |
8 |
0 |
30 |
11 |
234 |
114 |
| 13 | S. Muenchen | 0 |
5 |
1 |
15 |
0 |
0 |
1 |
4 |
26 |
27 |
115 |
134 |
| 14 | Sal subsp I ser 16:l,v:- | 2 |
10 |
2 |
6 |
0 |
0 |
1 |
2 |
23 |
11 |
59 |
81 |
| 15 | S. Typhimurium RDNC | 0 |
6 |
1 |
5 |
4 |
1 |
4 |
1 |
22 |
17 |
103 |
66 |
| 16 | S. Waycross | 0 |
1 |
0 |
20 |
0 |
0 |
0 |
0 |
21 |
16 |
120 |
72 |
| 17 | S. Typhimurium 4 | 0 |
17 |
0 |
1 |
0 |
0 |
1 |
1 |
20 |
15 |
77 |
81 |
| 18 | S. Anatum | 0 |
4 |
3 |
7 |
1 |
0 |
1 |
3 |
19 |
19 |
90 |
123 |
| 19 | S. Mississippi | 0 |
0 |
0 |
1 |
0 |
16 |
2 |
0 |
19 |
14 |
75 |
81 |
| 20 | S. Enteritidis 6a | 1 |
4 |
0 |
3 |
3 |
1 |
4 |
3 |
19 |
4.4 |
70 |
24 |
| 21 | S. Typhimurium 135a | 0 |
0 |
0 |
0 |
19 |
0 |
0 |
0 |
19 |
3.5 |
31 |
21 |
| 22 | S. Agona | 1 |
5 |
0 |
4 |
1 |
1 |
5 |
0 |
17 |
15 |
80 |
66 |
| 23 | S. Stanley | 0 |
4 |
0 |
7 |
4 |
0 |
0 |
2 |
17 |
12 |
77 |
54 |
| 24 | S. Zanzibar | 0 |
2 |
1 |
10 |
1 |
1 |
1 |
0 |
16 |
7 |
53 |
42 |
| 25 | S. Enteritidis 1b | 0 |
2 |
0 |
1 |
0 |
1 |
6 |
6 |
16 |
2.2 |
42 |
16 |
Acknowledgement: Thanks to contributing laboratories and scientists.
This article was published in Communicable Diseases Intelligence Vol 29 No 1 March 2005.
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