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ASPREN | Childhood immunisation coverage | Meningococcal surveillance | HIV/AIDS surveillance | National Enteric Pathogens Surveillance System

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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 2005, six conditions are being monitored, four 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 Communicable Diseases Intelligence, published in Commun Dis Intell 2005;29:91. Note that in 2005, two case definitions for influenza are being recorded in parallel.

Data from 1 January to 31 March 2005 are shown as the rate per 1,000 consultations in Figures 5 and 6.

Figure 5. Consultation rates for influenza-like illness, ASPREN, 1 January to 31 March 2005, by week of report

Figure 6. Consultation rates for gastroenteritis, ASPREN, 1 January to 31 March 2005, by week of report

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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 age 12 months for the cohort born between 1 October to 31 December 2003; at 24 months of age for the cohort born between 1 October to 31 December 2002; and at 6 years of age for the cohort born between 1 October to 31 December 1998, according to the Australian Standard Vaccination Schedule.

For information about the Australian Childhood Immunisation Register see Surveillance systems reported in Communicable Diseases Intelligence, published in Commun Dis Intell 2005;29:94 and for a full description of the methodology used by the Register see Commun Dis Intell 1998;22:36-37.

Commentary on the trends in ACIR data is provided by the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS). Telephone: +61 2 9845 1256. 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 0.4 percentage points to 90.7 per cent (Table 6). There was a substantial decrease in 'fully immunised' coverage by state or territory in Western Australia, with a decrease of 2.5 percentage points, and a substantial increase of 2.4 per cent in the Northern Territory, whilst all other jurisdictions experienced very little significant change in coverage. As expected, Western Australia also had decreases in coverage for individual vaccines.

Table 6. Percentage of children immunised at 1 year of age, preliminary results by vaccine and state or territory for the birth cohort 1 October to 31 December 2003; assessment date 31 March 2005

	State or territory
	ACT	NSW	NT	Qld	SA	Tas	Vic	WA	Aust
Number of children	1,061	21,546	857	12,581	4,338	1,487	15,793	6,086	63,749
Diphtheria, tetanus, pertussis (%)	93.4	92.1	92.9	92.2	92.0	94.6	92.6	90.3	92.2
Poliomyelitis (%)	93.4	92.0	92.3	92.0	91.8	94.2	92.5	90.2	92.0
Haemophilus influenzae type b (%)	95.9	94.2	97.2	94.2	95.1	95.6	94.4	94.1	94.4
Hepatitis B (%)	95.5	95.0	97.1	94.8	95.4	95.5	94.2	93.8	94.7
Fully immunised (%)	92.7	90.7	92.2	90.8	91.2	92.9	90.8	89.2	90.7
Change in fully immunised since last quarter (%)	-0.0	-0.0	+2.4	-0.6	+0.2	-0.1	-0.5	-2.5	-0.4

There was no change in coverage for children 'fully immunised' at 24 months of age for Australia, which remained at 91.7 per cent (Table 7). Coverage for individual vaccines remained largely unchanged in most jurisdictions with coverage greater than 95 per cent in almost all jurisdictions for all vaccines except Haemophilus influenzae type b.

Table 7. Percentage of children immunised at 2 years of age, preliminary results by vaccine and state or territory for the birth cohort 1 October to 31 December 2002, assessment date 31 March 2005

	State or territory
	ACT	NSW	NT	Qld	SA	Tas	Vic	WA	Aust
Number of children	1,013	21,810	875	12,289	4,257	1,460	15,577	6,148	63,429
Diphtheria, tetanus, pertussis (%)	96.0	94.6	96.8	94.9	95.4	96.4	95.1	93.7	94.9
Poliomyelitis (%)	96.1	94.5	96.7	94.8	95.4	96.2	95.1	93.8	94.8
Haemophilus influenzae type b (%)	94.6	92.7	95.5	93.6	93.9	94.6	93.6	92.2	93.2
Measles, mumps, rubella (%)	94.5	92.8	96.2	93.6	94.3	94.8	94.0	92.2	93.4
Hepatitis B(%)	96.7	95.3	97.8	95.6	95.8	96.6	95.7	94.9	95.5
Fully immunised (%)	93.7	90.9	95.0	91.9	92.7	94.0	92.2	90.6	91.7
Change in fully immunised since last quarter (%)	+1.7	-0.2	+1.2	+0.3	-0.5	+1.1	-0.4	+0.7	0.0

* The 12 months age data for this cohort was published in Commun Dis Intell 2004;28:119.

Table 8 shows immunisation coverage estimates for 'fully immunised' and for individual vaccines at six years of age for Australia and by state or territory. 'Fully immunised' coverage at six years of age for Australia was largely unchanged overall, apart from small decreases in South Australia (-1.5%), Queensland (-1.0%) and in the Northern Territory (-1.6%), also reflected in individual vaccines. Coverage for vaccines assessed at six years is at or near 85 per cent in the most jurisdictions, but Western Australia and Queensland remain below the average.

Table 8. Percentage of children immunised at 6 years of age, preliminary results by vaccine and state or territory for the birth cohort 1 October to 31 December 1998; assessment date 31 March 2005

	State or territory
	ACT	NSW	NT	Qld	SA	Tas	Vic	WA	Aust
Number of children	1,042	21,913	779	12,533	4,668	1,655	16,293	6,663	65,546
Diphtheria, tetanus, pertussis (%)	90.9	85.2	85.5	82.0	84.3	86.4	86.9	81.6	84.7
Poliomyelitis (%)	91.2	85.1	87.8	82.2	84.3	86.5	87.0	81.9	84.8
Measles, mumps, rubella (%)	90.1	84.9	88.3	82.1	84.1	85.6	87.1	81.4	84.6
Fully immunised (%)	89.8	83.7	85.1	80.6	82.8	84.2	85.8	79.8	83.3
Change in fully immunised since last quarter (%)	+2.6	-0.0	-1.6	-1.0	-1.5	+0.9	+0.1	-0.8	-0.3

Figure 7 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. The figure shows that there have now been six 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. However, both measures have been above 90 per cent for this 18-month period and show levels of high coverage being maintained over a significant period of time.

Figure 7. 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.

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Meningococcal surveillance

John Tapsall, The Prince of Wales Hospital, Randwick, NSW, 2031 for the Australian Meningococcal Surveillance Programme.

The reference laboratories of the Australian Meningococcal Surveillance Programme report data on the number of laboratory confirmed cases confirmed either by culture or by non-culture based techniques. Culture positive cases, where a Neisseria meningitidis is grown from a normally sterile site or skin, and non-culture based diagnoses, derived from results of nucleic acid amplification assays and serological techniques, are defined as invasive meningococcal disease (IMD) according to Public Health Laboratory Network definitions. Data contained in the quarterly reports are restricted to a description of the number of cases per jurisdiction, and serogroup, where known. A full analysis of laboratory confirmed cases of IMD is contained in the annual reports of the Programme, published in Communicable Diseases Intelligence .

Laboratory-confirmed cases of invasive meningococcal disease for the period 1 January to 31 March 2005, are included in this issue of Communicable Diseases Intelligence (Table 9).

Table 9. Number of laboratory confirmed cases of invasive meningococcal disease Australia, 1 January to 31 March 2005, by jurisdiction and serogroup

Jurisdiction	Year	Serogroup
		A	B	C	Y	W135	ND	All
		Q1	Q1	Q1	Q1	Q1	Q1	Q1	ytd
Northern Territory	05		1	0				1	1
	04		(5)	(0)				(5)	(5)
Queensland	05		12	4				16	16
	04		(12)	(7)			(2)	(1)	(21)
New South Wales	05		15	7	1		2	25	25
	04		(15)	(4)	(0)		(6)	(25)	(25)
Australian Capital Territory	05		1	1				2	2
	04		(4)	(2)				(6)	(6)
Victoria	05		7	1	0	2	1	11	11
	04		(10)	(4)	(2)	(0)	(2)	(17)	(17)
South Australia	05		0	2				2	2
	04		(4)	(0)				(4)	(4)
Western Australia	05		4	0	1			5	5
	04		(4)	(1)	(0)			(5)	(5)
Tasmania	05		0					0	0
	04		(2)				(2)	(4)	(4)
Australia	05		40	15	2	2	3	62	62
	04		(56)	(18)	(2)	(0)	(11)	(87)	(87)

* Numbers of laboratory-confirmed diagnoses of invasive meningococcal disease made in the same period in 2004 are shown in parentheses.

Q1 = 1st quarter.

Ytd = Year to 31 March 2005.

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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 October to 31 Decemebr 2004, as reported to 31 March 2005, are included in this issue of Communicable Diseases Intelligence (Tables 10 and 11).

Table 10. New diagnoses of HIV infection, new diagnoses of AIDS and deaths following AIDS occurring in the period 1 October to 31 December 2004, by sex and state or territory of diagnosis

		State or territory
	Sex	ACT	NSW	NT	Qld	SA	Tas	Vic	WA	This period 2004	This period 2003	YTD 2004	YTD 2003
HIV diagnoses	Female	0	12	0	7	2	0	6	2	29	19	116	83
	Male	0	72	0	30	5	0	51	9	167	180	737	770
	Not reported	0	0	0	0	0	0	0	0	0	2	2	7
	Total*	0	84	0	37	7	0	57	11	196	201	856	861
AIDS diagnoses	Female	0	2	0	2	1	0	1	0	6	2	17	12
	Male	0	14	1	2	1	0	8	3	29	60	138	206
	Total*	0	16	1	4	2	0	9	3	35	62	156	219
AIDS deaths	Female	0	0	0	0	0	0	1	0	1	1	5	9
	Male	0	10	0	2	1	0	2	3	18	24	71	80
	Total*	0	10	0	2	1	0	3	3	19	25	76	89

* Persons whose sex was reported as transgender are included in the totals.

Table 11. Cumulative diagnoses of HIV infection, AIDS and deaths following AIDS since the introduction of HIV antibody testing to 31 December 2004, by sex and state or territory

	State or territory
Sex	ACT	NSW	NT	Qld	SA	Tas	Vic	WA	Total
Female	31	781	18	230	84	8	312	164	1,628
Male	246	12,663	123	2,436	833	89	4,768	1,097	22,255
Not reported	0	238	0	0	0	0	22	0	260
Total*	277	13,710	141	2,675	918	97	5,121	1,268	24,207
Female	9	225	2	63	31	4	97	35	466
Male	92	5,165	42	976	387	48	1,873	410	8,993
Total*	101	5,405	44	1,041	419	52	1,980	447	9,489
Female	6	128	1	41	20	2	59	23	280
Male	71	3,506	26	638	269	32	1,369	287	6,198
Total*	77	3,643	27	681	289	34	1,436	311	6,498

* Persons whose sex was reported as transgender are included in the totals.

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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 andS. Typhimurium U290) and incompletely typed Salmonella.

NEPSS is operated by the Microbiological Diag-nostic Unit, Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne; and is overseen by a Steering Committee of state, territory and commonwealth stakeholders. NEPSS can be contacted at the above address or by telephone: +61 3 8344 5701, facsimile: +61 3 8344 7833 or email joanp@unimelb.edu.au

Scientists, diagnostic and reference laboratories contribute data to NEPSS, which is supported by state and territory health departments and the Australian Government Department of Health and Ageing.

Reports to the National Enteric Pathogens Surveillance System of Salmonella infection for the period 1 January to 31 March 2005 are included in Tables 12 and 13. Data include cases reported and entered by 21 April 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

First quarter 2005

The total number of reports to NEPSS of human Salmonella infection increased to 2,551 in the first quarter of 2005, 45 per cent more than in the fourth quarter of 2004. This count is six per cent less than the comparable first quarter of 2004 but similar to the historical mean for this time of year.

During the first quarter of 2005, the 25 most common Salmonella types in Australia accounted for 1,789 cases, 70 per cent of all reported human Salmonella infections. Twenty-one of the 25 most common Salmonella infections in the first quarter of 2005 were among the 25 most commonly reported in the last quarter of 2004.

S. Typhimurium phage type 197 was the most common cause of human salmonellosis this quarter, reflecting a large point-source outbreak in Victoria in early 2005 and steady increases in sporadic cases of this phage type in Queensland and New South Wales since 2002. An outbreak in New South Wales ensured the continued prominence of S. Typhimurium phage type 170/108, although counts of this strain have declined in Victoria and South Australia.

Reports of other common salmonellae with recent increases and counts that remain above historical averages include S. Saintpaul (in northern Australia ), S. Aberdeen (particularly in Queensland ), S. subsp I ser 16:l,v:- (in New South Wales ) and S. Corvallis and S. Enteritidis 6a (both typically acquired overseas). S. Typhimurium phage types 9 and 135 remain common, although less so than in the mid to late 1990s.

Table 12. Reports to the National Enteric Pathogens Surveillance System of Salmonella isolated from humans during the period 1 January to 31 March 2005, as reported to 21 April 2005

	State or territory
	ACT	NSW	NT	Qld	SA	Tas	Vic	WA	Australia
Total all Salmonella for quarter	30	668	106	809	142	39	559	198	2,551
Total contributing Salmonella types	20	129	42	101	46	9	95	70	234

Table 13. Top 25 Salmonella types identified in Australia, by state or territories, 1 January to 31 March 2005

National rank	Salmonella type	State or territory								Total 1st quarter 2005	Last 10 years mean 1st quarter	Year to date 2005	Year to date 2004
		ACT	NSW	NT	Qld	SA	Tas	Vic	WA
1	S. Typhimurium 197	1	51	0	61	3	2	262	1	381	18	381	86
2	S. Typhimurium 170	5	128	0	10	1	0	16	3	163	69	163	197
3	S. Typhimurium 9	1	51	3	8	33	3	51	7	157	176	157	147
4	S. Saintpaul	2	9	17	102	3	0	6	12	151	125	151	132
5	S. Typhimurium 135	5	43	1	25	2	6	26	16	124	236	124	198
6	S. Virchow 8	0	7	1	85	2	0	3	1	99	85	99	143
7	S. Chester	0	13	1	38	3	0	2	14	71	66	71	78
8	S. Birkenhead	0	34	0	35	0	0	1	0	70	96	70	107
9	S. Aberdeen	0	6	2	56	0	0	1	0	65	39	65	34
10	S. Muenchen	1	15	6	23	3	0	4	12	64	58	64	45
11	S. Hvittingfoss	0	2	1	51	0	0	1	0	55	30	55	64
12	S. Typhimurium 12	0	17	3	15	2	0	9	8	54	27	54	140
13	S. Infantis	0	13	1	6	10	0	19	2	51	49	51	52
14	S. Waycross	0	13	0	28	0	0	3	0	44	44	44	59
15	S. Mississippi	0	2	0	0	1	23	4	2	32	36	32	41
16	S. Typhimurium RDNC	0	6	4	4	5	0	4	2	25	30	25	25
17	S. Typhimurium 4	0	20	0	2	1	0	2	0	25	23	25	29
18	S. subsp I ser 16:l,v:-	0	16	2	6	0	0	0	1	25	11	25	15
19	S. Corvallis	1	3	1	4	0	0	8	7	24	2	24	14
20	S. Singapore	0	6	0	5	0	0	3	5	19	21	19	40
21	S. Typhimurium 108	0	12	0	0	7	0	0	0	19	9	19	41
22	S. Enteritidis 6a	0	7	0	2	2	0	3	5	19	3	19	9
23	S. Anatum	0	3	0	11	0	0	1	3	18	32	18	46
24	S. Litchfield	0	2	9	4	0	0	0	3	18	13	18	14
25	S. Enteritidis 26	1	0	0	13	0	0	1	1	16	14	16	23

Acknowledgement: We thank scientists, contributing laboratories, state and territory health departments, and the Australian Government Department of Health and Ageing for their contributions to NEPSS.

 

This article was published in Communicable Diseases Intelligence Vol 29 No 2, June 2005.