NNDSS Annual Report Writing Group

Abstract

In 2011, 65 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 238,158 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 14% on the number of notifications in 2010. This increase was largely due to the ongoing pertussis epidemic and higher than usual inter-season notifications of influenza. In 2011, the most frequently notified diseases were sexually transmissible infections (95,456 notifications, 40.1% of total notifications), vaccine preventable diseases (81,872 notifications, 34.4% of total notifications), and gastrointestinal diseases (32,784 notifications, 13.8% of total notifications). There were 17,123 notifications of bloodborne diseases; 8,306 notifications of vectorborne diseases; 1,928 notifications of other bacterial infections; 681 notifications of zoonoses and 8 notifications of quarantinable diseases. Commun Dis Intell 2013;37(4):E313–E393.

Keywords: Australia, communicable diseases, epidemiology, surveillance

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Introduction

Australia’s notifiable diseases status, 2011, is an annual surveillance report of nationally notifiable communicable diseases. Communicable disease surveillance in Australia operates at the national, jurisdictional and local levels. Primary responsibility for public health action lies with the state and territory health departments. The role of communicable disease surveillance at the national level includes:

• identifying national trends;
• providing guidance for policy development and resource allocation at the national level;
• monitoring the need for and impact of national disease control programs;
• coordinating the response to national or multi-jurisdictional outbreaks;
• describing of the epidemiology of rare diseases that occur infrequently at state and territory levels;
• meeting various international reporting requirements, such as providing disease statistics to the World Health Organization (WHO); and
• supporting quarantine activities, which are the responsibility of the Commonwealth government.

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Methods

Australia is a federation of 6 states (New South Wales, Queensland, South Australia, Tasmania, Victoria and Western Australia) and 2 territories (the Australian Capital Territory and the Northern Territory).

State and territory health departments collect notifications of communicable diseases under their respective public health legislation. In September 2007, the National Health Security Act 2007¹ received royal assent. This Act provides a legislative basis for and authorises the exchange of health information, including personal information, between jurisdictions and the Commonwealth. The Act provides for the establishment of the National Notifiable Diseases List,² which specifies the diseases about which personal information can be provided. The National Health Security Agreement,³ which was signed by Health Ministers in April 2008, establishes the operational arrangements to formalise and enhance existing surveillance and reporting systems, an important objective of the Act. Under the Agreement, in 2011 states and territories forwarded de-identified data on the nationally agreed set of 65 communicable diseases to the Australian Government Department of Health for the purposes of national communicable disease surveillance, although not all 65 diseases were notifiable in each jurisdiction. Data were updated electronically from states and territories, daily or several times a week. The system was complemented by other surveillance systems, which provided information on various diseases, including four that are not reported to National Notifiable Diseases Surveillance System (NNDSS) (HIV, AIDS and the classical and variant forms of Creutzfeldt-Jakob disease (CJD)).

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In 2011, the NNDSS core dataset included the following 5 mandatory data fields: unique record reference number; notifying state or territory; disease code; confirmation status and the date when the jurisdictional health department was notified (notification receive date). In addition, the following core but non-mandatory data fields were supplied where possible: date of birth; age at onset; sex; Indigenous status; postcode of residence; disease onset date; date when the medical practitioner signed the notification form (notification date); death status; date of specimen collection; and outbreak reference number (to identify cases linked to an outbreak). Where relevant, information on the species, serogroups/subtypes and phage types of organisms isolated, and on the vaccination status of the case were collected and reported to the NNDSS. Data quality was monitored by the Office of Health Protection and the National Surveillance Committee (NSC) and there was a continual process of improving the national consistency of communicable disease surveillance through the daily, fortnightly and quarterly review of these data.

While not included in the core national dataset, enhanced surveillance information for some diseases (invasive pneumococcal disease, hepatitis B, hepatitis C, tuberculosis and some sexually transmissible infections) were reported from states and territories to NNDSS but not included in this report. These data, along with influenza enhanced data, are reported in individual annual reports. Additional information concerning mortality and specific health risk factors for some diseases were obtained from states and territories and included in this annual report.

Newly diagnosed HIV infection and AIDS were notifiable conditions in each state or territory health jurisdiction in 2011. These were forwarded to the Kirby Institute for infection and immunity in society. Further information can be found in the Kirby Institute’s annual surveillance report.⁴

The surveillance for the classical and variant forms of CJD in Australia has been conducted through the Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR) since its establishment in October 2003. CJD is a nationally notifiable disease and by June 2006, CJD was notifiable in all states and territories. Further surveillance information on CJD can be found in surveillance reports from the ANCJDR.⁵

Information on communicable disease surveillance is communicated through several avenues. The most up-to-date information on topics of interest is provided at the fortnightly teleconferences of the Communicable Diseases Network Australia (CDNA). A summary of these reports is available on the CDNA web site (http://www.health.gov.au/internet/main/publishing.nsf/Content/cdnareport.htm). The Communicable Diseases Intelligence (CDI) quarterly journal publishes surveillance data, annual surveillance reports, short reports, and articles on the epidemiology and control of communicable diseases.

Notification rates for each notifiable disease were calculated using the estimated 2011 mid-year resident population supplied by the Australian Bureau of Statistics (Appendix 1 and Appendix 2).⁶ Where diseases were not notifiable in a state or territory, national rates were adjusted by excluding the population of that jurisdiction from the denominator. For some diseases, age adjusted rates were calculated using the direct method of standardisation, with 2006 census data as the standard population. All rates are represented as the rate per 100,000 unless stated otherwise.

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Notes on interpretation

This report is based on 2011 data from each state and territory, agreed upon in August 2012, and represents a snap shot of the year after duplicate records and incorrect or incomplete data were removed. Totals in this report may vary slightly from the totals reported in CDI quarterly publications.

Analyses in this report were based on the date of disease diagnosis in an attempt to estimate disease activity within the reporting period. The date of diagnosis is the onset date or where the date of onset was not known, the earliest of the specimen collection date, the notification date, or the notification receive date. As considerable time may have elapsed between the onset and diagnosis dates for hepatitis B (unspecified), hepatitis C (unspecified) and tuberculosis, the earliest of specimen date, health professional notification date or public health unit notification receive date was used for these conditions.

Notified cases can only represent a proportion (the ‘notified fraction’) of the total incidence (Figure 1) and this has to be taken into account when interpreting NNDSS data. Moreover, the notified fraction varies by disease, by jurisdiction and over time.

Figure 1: Communicable diseases notifiable fraction

Text version of Figure 1 (TXT 1 KB)

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Methods of surveillance vary between states and territories, each having different requirements for notification by medical practitioners, laboratories and hospitals. Although the National Notifiable Diseases List² was established, some diseases are not notifiable in all 8 jurisdictions (Table 1).

Table 1: Diseases notified to the National Notifiable Diseases Surveillance System, Australia, 2011

Disease	Data received from
* Infection with Shiga toxin/verotoxin-producing Escherichia coli. NEC - Not elsewhere classified.
Bloodborne diseases
Hepatitis (NEC)	All jurisdictions, except Western Australia
Hepatitis B (newly acquired)	All jurisdictions
Hepatitis B (unspecified)	All jurisdictions
Hepatitis C (newly acquired)	All jurisdictions, except Queensland
Hepatitis C (unspecified)	All jurisdictions
Hepatitis D	All jurisdictions
Gastrointestinal diseases
Botulism	All jurisdictions
Campylobacteriosis	All jurisdictions, except New South Wales
Cryptosporidiosis	All jurisdictions
Haemolytic uraemic syndrome	All jurisdictions
Hepatitis A	All jurisdictions
Hepatitis E	All jurisdictions
Listeriosis	All jurisdictions
Salmonellosis	All jurisdictions
Shigellosis	All jurisdictions
STEC, VTEC*	All jurisdictions
Typhoid	All jurisdictions
Quarantinable diseases
Cholera	All jurisdictions
Highly pathogenic avian influenza in humans	All jurisdictions
Plague	All jurisdictions
Rabies	All jurisdictions
Severe acute respiratory syndrome	All jurisdictions
Smallpox	All jurisdictions
Viral haemorrhagic fever	All jurisdictions
Yellow fever	All jurisdictions
Sexually transmissible infections
Chlamydial infections	All jurisdictions
Donovanosis	All jurisdictions
Gonococcal infection	All jurisdictions
Syphilis < 2 years duration	All jurisdictions
Syphilis > 2 years or unspecified duration	All jurisdictions, except South Australia
Syphilis – congenital	All jurisdictions
Vaccine preventable diseases
Diphtheria	All jurisdictions
Haemophilus influenzae type b	All jurisdictions
Influenza (laboratory confirmed)	All jurisdictions
Measles	All jurisdictions
Mumps	All jurisdictions
Pertussis	All jurisdictions
Pneumococcal disease (invasive)	All jurisdictions
Poliomyelitis	All jurisdictions
Rubella	All jurisdictions
Rubella – congenital	All jurisdictions
Tetanus	All jurisdictions
Varicella zoster (chickenpox)	All jurisdictions, except New South Wales
Varicella zoster (shingles)	All jurisdictions, except New South Wales
Varicella zoster (unspecified)	All jurisdictions, except New South Wales
Vectorborne diseases
Arbovirus infection (NEC)	All jurisdictions
Barmah Forest virus infection	All jurisdictions
Dengue virus infection	All jurisdictions
Japanese encephalitis virus infection	All jurisdictions
Kunjin virus infection	All jurisdictions
Malaria	All jurisdictions
Murray Valley encephalitis virus infection	All jurisdictions
Ross River virus infection	All jurisdictions
Zoonoses
Anthrax	All jurisdictions
Australian bat lyssavirus	All jurisdictions
Brucellosis	All jurisdictions
Leptospirosis	All jurisdictions
Lyssavirus (NEC)	All jurisdictions
Ornithosis	All jurisdictions
Q fever	All jurisdictions
Tularaemia	All jurisdictions
Other bacterial infections
Legionellosis	All jurisdictions
Leprosy	All jurisdictions
Meningococcal disease (invasive)	All jurisdictions
Tuberculosis	All jurisdictions

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Changes in surveillance practices may have been introduced in some jurisdictions and not in others, and must be taken into consideration when comparing data between jurisdictions.

Postcode information usually reflects the residential location of the case, but this does not necessarily represent the place where the disease was acquired.

Data completeness was assessed for cases’ sex, age at onset, and Indigenous status, and reported as the proportion of complete notifications. The completeness of data in this report is summarised in the Results.

The per cent of data completeness was defined as:

Per cent of data completeness=(total notifications – missing or unknown) / total notifications x 100

The Indigenous status was defined by the following nationally accepted values:⁷

1=Indigenous – (Aboriginal but not Torres Strait Islander origin)

2=Indigenous – (Torres Strait Islander but not Aboriginal origin)

3=Indigenous – (Aboriginal and Torres Strait Islander origin)

4=Not Indigenous – (not Aboriginal or Torres Strait Islander origin)

9=Not stated

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Notes on case definitions

Each notifiable disease is governed by a national surveillance case definition for reporting to the NNDSS. These case definitions were agreed by CDNA and implemented nationally in January 2004 and were used by all jurisdictions for the first time in 2005. These case definitions are reviewed by the Case Definitions Working Group (CDWG) as required.

The national surveillance case definitions and their review status are available from the Australian Government Department of Health’s web site (http://www.health.gov.au/casedefinitions).

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Results

There were 238,158 communicable disease notifications received by NNDSS in 2011 (Table 2)

Table 2: Notifications to the National Notifiable Diseases Surveillance System, Australia, 2011, by disease category rank order

Disease category	Number	%
Sexually transmissible infections	95,456	40.1
Vaccine preventable diseases	81,872	34.4
Gastrointestinal diseases	32,784	13.8
Bloodborne diseases	17,123	7.2
Vectorborne diseases	8,306	3.5
Other bacterial infections	1,928	0.8
Zoonoses	681	0.3
Quarantinable diseases	8	0.0
Total	238,158	100.0

In 2011, the most frequently notified diseases were sexually transmissible infections (95,456 notifications, 40.1% of total notifications), vaccine preventable diseases (81,872 notifications, 34.4% of total notifications), and gastrointestinal diseases (32,784 notifications, 13.8% of total notifications).

There was an increase of 14% compared with the total number of notifications in 2010 but numbers were similar to those in 2009 (Figure 2). This increase in total notifications was largely due to the ongoing pertussis epidemic and higher than usual inter-season notifications of influenza.

Figure 2: Trends in notifications received by the National Notifiable Diseases Surveillance System, Australia, 1991 to 2011

Text version of Figure 2 (TXT 1 KB)

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Notifications and notification rates per 100,000 for each disease by state or territory, in 2011, are shown in Tables 3 and 4 respectively. Trends in notifications and rates per 100,000 for the period 2006 to 2011 are shown in Table 5.

Table 3: Notifications of communicable diseases, Australia, 2011, by state or territory

Disease	State or territory
	ACT	NSW	NT	Qld	SA	Tas.	Vic.	WA	Aust.
* Newly acquired hepatitis includes cases where the infection was determined to be acquired within 24 months prior to diagnosis. Queensland reports hepatitis C newly acquired under hepatitis C unspecified. † Unspecified hepatitis and syphilis includes cases where the duration of infection could not be determined or is greater than 24 months. South Australia does not provide data on unspecified syphilis cases. ‡ Infection with Shiga toxin/verotoxin-producing Escherichia coli. § Includes Chlamydia trachomatis identified from cervical, rectal, urine, urethral, throat and eye samples, except for South Australia, which reports only cervical, urine and urethral specimens; the Northern Territory and Western Australia exclude ocular infections. || The national case definitions for chlamydial, gonococcal and syphilis diagnoses include infections that may be acquired through a non-sexual mode (especially in children – e.g. perinatal infections, epidemic gonococcal conjunctivitis). ¶ Does not include congenital syphilis. ** In the Australian Capital Territory, Murray Valley encephalitis virus infection and Kunjin virus infection are combined under Murray Valley encephalitis virus infection. †† Only invasive meningococcal disease is nationally notifiable. However, New South Wales and the Australian Capital Territory also report conjunctival cases. NEC Not elsewhere classified. NN Not notifiable.
Bloodborne diseases
Hepatitis (NEC)	0	0	0	0	0	0	0	0	0
Hepatitis B (newly acquired)*	2	31	4	46	9	13	67	18	190
Hepatitis B (unspecified)†	93	2,501	159	859	403	40	1,915	659	6,629
Hepatitis C (newly acquired)*	9	45	3	NN	33	27	163	120	400
Hepatitis C (unspecified)†	182	3,281	206	2,435	425	202	2,174	956	9,861
Hepatitis D	0	9	0	7	8	0	17	2	43
Gastrointestinal diseases
Botulism	0	2	0	0	0	0	0	0	2
Campylobacteriosis	496	NN	160	5,134	2,121	864	6,766	2,176	17,717
Cryptosporidiosis	13	359	94	465	128	42	259	448	1,808
Haemolytic uraemic syndrome	0	4	1	1	3	0	4	0	13
Hepatitis A	3	57	3	25	6	4	34	12	144
Hepatitis E	2	20	0	6	0	0	8	4	40
Listeriosis	1	21	1	10	6	2	22	7	70
Salmonellosis	161	3,480	403	2,923	1,055	195	2,732	1,318	12,267
Shigellosis	9	131	77	63	34	2	94	84	494
STEC,VTEC‡	5	10	1	16	49	2	9	3	95
Typhoid	2	45	3	21	9	3	36	15	134
Quarantinable diseases
Cholera	0	0	0	5	0	0	0	1	6
Highly pathogenic avian influenza in humans	0	0	0	0	0	0	0	0	0
Plague	0	0	0	0	0	0	0	0	0
Rabies	0	0	0	0	0	0	0	0	0
Severe acute respiratory syndrome	0	0	0	0	0	0	0	0	0
Smallpox	0	0	0	0	0	0	0	0	0
Viral haemorrhagic fever	0	0	0	0	0	0	0	0	0
Yellow fever	0	0	0	2	0	0	0	0	2
Sexually transmitted infections
Chlamydial infection§,||	1,261	20,495	2,630	18,649	5,128	1,779	19,184	11,674	80,800
Donovanosis	0	0	0	0	0	0	0	0	0
Gonococcal infection||	128	2,880	1,956	2,960	445	19	1,879	1,820	12,087
Syphilis – congenital||	0	3	0	4	0	0	0	0	6
Syphilis – all||,¶	33	730	89	553	47	26	862	223	2,563
Syphilis < 2 years duration||	9	422	30	332	47	6	330	127	1,303
Syphilis > 2 years or unspecified duration†,||	24	308	59	221	NN	20	532	96	1,260
Vaccine preventable diseases
Diphtheria	0	0	1	3	0	0	0	0	4
Haemophilus influenzae type b	0	4	2	5	0	0	1	1	13
Influenza (laboratory confirmed)	270	5,700	597	10,409	4,738	364	3,208	1,863	27,149
Measles	21	90	5	17	4	0	39	17	193
Mumps	1	67	0	38	7	4	24	14	155
Pertussis	829	13,065	378	8,987	2,351	354	8,649	3,989	38,602
Pneumococcal disease (invasive)	27	530	129	341	143	47	427	243	1,887
Poliomyelitis	0	0	0	0	0	0	0	0	0
Rubella	2	17	0	10	3	0	11	15	58
Rubella – congenital	0	0	0	0	0	0	0	0	0
Tetanus	0	1	0	1	0	0	0	1	3
Varicella zoster (chickenpox)	11	NN	148	302	477	34	688	434	2,094
Varicella zoster (shingles)	28	NN	186	75	1,614	202	993	901	3,999
Varicella zoster (unspecified)	99	NN	3	4,002	116	79	2,409	1,007	7,715
Vectorborne diseases
Arbovirus infection (NEC)	0	0	1	9	0	0	14	0	24
Barmah Forest virus infection	2	459	63	872	130	2	187	155	1,870
Dengue virus infection	15	137	25	188	22	3	106	321	817
Japanese encephalitis virus infection	0	0	0	0	0	0	0	0	0
Kunjin virus infection**	0	1	1	0	0	0	0	0	2
Malaria	3	77	23	137	4	9	95	63	411
Murray Valley encephalitis virus infection**	0	3	2	0	2	0	0	9	16
Ross River virus infection	8	577	184	1,220	979	7	1,312	879	5,166
Zoonoses
Anthrax	0	0	0	0	0	0	0	0	0
Australia bat lyssavirus	0	0	0	0	0	0	0	0	0
Brucellosis	0	6	0	30	0	0	2	1	39
Leptospirosis	1	40	2	157	2	1	11	3	217
Lyssavirus (NEC)	0	0	0	0	0	0	0	0	0
Ornithosis	0	19	0	1	0	1	58	6	85
Q fever	1	131	1	164	7	0	24	10	338
Tularaemia	0	0	0	0	0	2	0	0	2
Other bacterial diseases
Legionellosis	4	95	5	45	40	7	74	78	348
Leprosy	0	3	0	0	1	0	3	1	8
Meningococcal infection††	2	72	4	61	21	10	50	21	241
Tuberculosis	20	470	33	223	73	17	371	124	1,331
Total	3,744	55,668	7,583	61,481	20,643	4,363	54,981	29,696	238,158

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Table 4: Notification rates of nationally notifiable communicable diseases, Australia, 2011, by state or territory, per 100,000

Disease	State or territory								Aust.
	ACT	NSW	NT	Qld	SA	Tas.	Vic.	WA
* Newly acquired hepatitis includes cases where the infection was determined to be acquired within 24 months prior to diagnosis. Queensland reports hepatitis C newly acquired under hepatitis C unspecified. † Unspecified hepatitis and syphilis includes cases where the duration of infection could not be determined or is greater than 24 months. South Australia does not provide data on unspecified syphilis cases. ‡ Infection with Shiga toxin/verotoxin-producing Escherichia coli. § Includes Chlamydia trachomatis identified from cervical, rectal, urine, urethral, throat and eye samples, except for South Australia, which reports only cervical, urine and urethral specimens; the Northern Territory and Western Australia exclude ocular infections. || The national case definitions for chlamydial, gonococcal and syphilis diagnoses include infections that may be acquired through a non-sexual mode (especially in children – e.g. perinatal infections, epidemic gonococcal conjunctivitis). ¶ Does not include congenital syphilis. ** In the Australian Capital Territory, Murray Valley encephalitis virus infection and Kunjin virus infection are combined under Murray Valley encephalitis virus infection. †† Only invasive meningococcal disease is nationally notifiable. However, New South Wales and the Australian Capital Territory also report conjunctival cases. NEC Not elsewhere classified. NN Not notifiable. – A rate could not be calculated as there were no notifications.
Bloodborne diseases
Hepatitis (NEC)	–	–	–	–	–	–	–	–	–
Hepatitis B (newly acquired)*	0.5	0.4	1.7	1.0	0.5	2.5	1.2	0.8	0.8
Hepatitis B (unspecified)†	25.4	34.3	69.0	18.8	24.3	7.8	34.1	28.1	29.3
Hepatitis C (newly acquired)*	2.5	0.6	1.3	NN	2.0	5.3	2.9	5.1	2.2
Hepatitis C (unspecified)†	49.8	44.9	89.4	53.2	25.7	39.6	38.7	40.7	43.6
Hepatitis D	–	0.1	–	0.2	0.5	–	0.3	0.1	0.2
Gastrointestinal diseases
Botulism	–	<0.1	–	–	–	–	–	–	<0.1
Campylobacteriosis	135.7	NN	69.5	112.1	128.1	169.2	120.4	92.6	115.7
Cryptosporidiosis	3.6	4.9	40.8	10.2	7.7	8.2	4.6	19.1	8.0
Haemolytic uraemic syndrome	–	0.1	0.4	<0.1	0.2	–	0.1	–	0.1
Hepatitis A	0.8	0.8	1.3	0.5	0.4	0.8	0.6	0.5	0.6
Hepatitis E	0.5	0.3	–	0.1	–	–	0.1	0.2	0.2
Listeriosis	0.3	0.3	0.4	0.2	0.4	0.4	0.4	0.3	0.3
Salmonellosis	44.0	47.7	174.9	63.8	63.7	38.2	48.6	56.1	54.2
Shigellosis	2.5	1.8	33.4	1.4	2.1	0.4	1.7	3.6	2.2
STEC,VTEC‡	1.4	0.1	0.4	0.3	3.0	0.4	0.2	0.1	0.4
Typhoid	0.5	0.6	1.3	0.5	0.5	0.6	0.6	0.6	0.6
Quarantinable diseases
Cholera	–	–	–	0.1	–	–	–	<0.1	<0.1
Highly pathogenic avian influenza in humans	–	–	–	–	–	–	–	–	–
Plague	–	–	–	–	–	–	–	–	–
Rabies	–	–	–	–	–	–	–	–	–
Severe acute respiratory syndrome	–	–	–	–	–	–	–	–	–
Smallpox	–	–	–	–	–	–	–	–	–
Viral haemorrhagic fever	–	–	–	–	–	–	–	–	–
Yellow fever	–	–	–	<0.1	–	–	–	–	<0.1
Sexually transmitted infections
Chlamydial infection§,||	344.9	280.7	1141.6	407.2	309.6	348.5	341.3	496.9	357.2
Donovanosis	–	–	–	–	–	–	–	–	–
Gonococcal infection||	35.0	39.4	849.1	64.6	26.9	3.7	33.4	77.5	53.4
Syphilis – congenital||	–	<0.1	–	0.1	–	–	–	–	<0.1
Syphilis – all||,¶	9.0	10.0	38.6	12.1	2.8	5.1	15.3	9.5	11.3
Syphilis < 2 years duration||	2.5	5.8	13.0	7.2	2.8	1.2	5.9	5.4	5.8
Syphilis > 2 years or unspecified duration†,||	6.6	4.2	25.6	4.8	NN	3.9	9.5	4.1	6.0
Vaccine preventable diseases
Diphtheria	–	–	0.4	0.1	–	–	–	–	<0.1
Haemophilus influenzae type b	–	0.1	0.9	0.1	–	–	<0.1	<0.1	0.1
Influenza (laboratory confirmed)	73.8	78.1	259.1	227.3	286.1	71.3	57.1	79.3	120.0
Measles	5.7	1.2	2.2	0.4	0.2	–	0.7	0.7	0.9
Mumps	0.3	0.9	–	0.8	0.4	0.8	0.4	0.6	0.7
Pertussis	226.7	178.9	164.1	196.2	141.9	69.3	153.9	169.8	170.7
Pneumococcal disease (invasive)	7.4	7.3	56.0	7.4	8.6	9.2	7.6	10.3	8.3
Poliomyelitis	–	–	–	–	–	–	–	–	–
Rubella	0.5	0.2	–	0.2	0.2	–	0.2	0.6	0.3
Rubella – congenital	–	–	–	–	–	–	–	–	–
Tetanus	–	<0.1	–	<0.1	–	–	–	<0.1	<0.1
Varicella zoster (chickenpox)	3.0	NN	64.2	6.6	28.8	6.7	12.2	18.5	13.7
Varicella zoster (shingles)	7.7	NN	80.7	1.6	97.4	39.6	17.7	38.4	26.1
Varicella zoster (unspecified)	27.1	NN	1.3	87.4	7.0	15.5	42.9	42.9	50.4
Vectorborne diseases
Arbovirus infection (NEC)	–	–	0.4	0.2	–	–	0.2	–	0.1
Barmah Forest virus infection	0.5	6.3	27.3	19.0	7.8	0.4	3.3	6.6	8.3
Dengue virus infection	4.1	1.9	10.9	4.1	1.3	0.6	1.9	13.7	3.6
Japanese encephalitis virus infection	–	–	–	–	–	–	–	–	–
Kunjin virus infection**	–	<0.1	0.4	–	–	–	–	–	<0.1
Malaria	0.8	1.1	10.0	3.0	0.2	1.8	1.7	2.7	1.8
Murray Valley encephalitis virus infection**	–	<0.1	0.9	–	0.1	–	–	0.4	0.1
Ross River virus infection	2.2	7.9	79.9	26.6	59.1	1.4	23.3	37.4	22.8
Zoonoses
Anthrax	–	–	–	–	–	–	–	–	–
Australia bat lyssavirus	–	–	–	–	–	–	–	–	–
Brucellosis	–	0.1	–	0.7	–	–	<0.1	<0.1	0.2
Leptospirosis	0.3	0.5	0.9	3.4	0.1	0.2	0.2	0.1	1.0
Lyssavirus (NEC)	–	–	–	–	–	–	–	–	–
Ornithosis	–	0.3	–	<0.1	–	0.2	1.0	0.3	0.4
Q fever	0.3	1.8	0.4	3.6	0.4	–	0.4	0.4	1.5
Tularaemia	–	–	–	–	–	0.4	–	–	<0.1
Other bacterial diseases
Legionellosis	1.1	1.3	2.2	1.0	2.4	1.4	1.3	3.3	1.5
Leprosy	–	<0.1	–	–	0.1	–	0.1	<0.1	<0.1
Meningococcal infection††	0.5	1.0	1.7	1.3	1.3	2.0	0.9	0.9	1.1
Tuberculosis	5.5	6.4	14.3	4.9	4.4	3.3	6.6	5.3	5.9

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Table 5: Notifications and notification rate for communicable diseases, Australia, 2006 to 2011, per 100,000

Disease	Number of notifications						5-year mean	Ratio	Notification rate per 100,000 population
	2006	2007	2008	2009	2010	2011			2006	2007	2008	2009	2010	2011
* Newly acquired hepatitis includes cases where the infection was determined to be acquired within 24 months prior to diagnosis. Queensland reports hepatitis C newly acquired under hepatitis C unspecified. † Unspecified hepatitis and syphilis includes cases where the duration of infection could not be determined or is greater than 24 months. South Australia does not provide data on unspecified syphilis cases. ‡ Infection with Shiga toxin/verotoxin-producing Escherichia coli. § Includes Chlamydia trachomatis identified from cervical, rectal, urine, urethral, throat and eye samples, except for South Australia, which reports only cervical, urine and urethral specimens; the Northern Territory and Western Australia exclude ocular infections. || The national case definitions for chlamydial, gonococcal and syphilis diagnoses include infections that may be acquired through a non-sexual mode (especially in children – e.g. perinatal infections, epidemic gonococcal conjunctivitis). ¶ Does not include congenital syphilis. ** In the Australian Capital Territory, Murray Valley encephalitis virus infection and Kunjin virus infection are combined under Murray Valley encephalitis virus infection. †† Only invasive meningococcal disease is nationally notifiable. However, New South Wales and the Australian Capital Territory also report conjunctival cases. NEC- Not elsewhere classified. NN - Not notifiable. – A rate could not be calculated as there were no notifications.
Bloodborne diseases
Hepatitis (NEC)	1	0	1	0	0	0	0.4	<0.1	<0.1	–	<0.1	–	–	–
Hepatitis B (newly acquired)*	291	296	259	241	228	190	263.0	0.7	1.4	1.4	1.2	1.1	1.0	0.8
Hepatitis B (unspecified)†	6,168	6,783	6,444	7,015	6,960	6,629	6674.0	1.0	29.8	32.2	30.0	32.0	31.2	29.3
Hepatitis C (newly acquired)*	437	379	363	398	401	400	395.6	1.0	2.6	2.2	2.1	2.3	2.3	2.2
Hepatitis C (unspecified)†	11,689	11,675	10,956	10,871	10,916	9,861	11221.4	0.9	56.5	55.4	51.0	49.5	49.0	43.6
Hepatitis D	29	33	41	35	34	43	34.4	1.3	0.1	0.2	0.2	0.2	0.2	0.2
Gastrointestinal diseases
Botulism	1	1	0	1	0	2	0.6	3.3	<0.1	<0.1	–	<0.1	–	<0.1
Campylobacteriosis	15,416	16,980	15,539	16,075	16,968	17,717	16,195.6	1.1	111.1	119.9	107.3	108.4	112.5	115.7
Cryptosporidiosis	3,201	2,808	2,003	4,624	1,478	1,808	2,822.8	0.6	15.5	13.3	9.3	21.1	6.6	8.0
Haemolytic uraemic syndrome	14	19	32	13	9	13	17.4	0.7	0.1	0.1	0.1	0.1	<0.1	0.1
Hepatitis A	281	166	277	564	267	144	311.0	0.5	1.4	0.8	1.3	2.6	1.2	0.6
Hepatitis E	24	18	44	33	37	40	31.2	1.3	0.1	0.1	0.2	0.2	0.2	0.2
Listeriosis	61	50	68	92	71	70	68.4	1.0	0.3	0.2	0.3	0.4	0.3	0.3
Salmonellosis	8,215	9,461	8,289	9,509	11,924	12,267	9,479.6	1.3	39.7	44.9	38.6	43.3	53.5	54.2
Shigellosis	544	596	828	616	551	494	627.0	0.8	2.6	2.8	3.9	2.8	2.5	2.2
STEC,VTEC‡	67	105	98	128	80	95	95.6	1.0	0.3	0.5	0.5	0.6	0.4	0.4
Typhoid	77	90	105	115	96	134	96.6	1.4	0.4	0.4	0.5	0.5	0.4	0.6
Quarantinable diseases
Cholera	3	4	4	5	3	6	3.8	1.6	<0.1	<0.1	<0.1	<0.1	<0.1	<0.1
Highly pathogenic avian influenza in humans	0	0	0	0	0	0	0.0	–	–	–	–	–	–	–
Plague	0	0	0	0	0	0	0.0	–	–	–	–	–	–	–
Rabies	0	0	0	0	0	0	0.0	–	–	–	–	–	–	–
Severe acute respiratory syndrome	0	0	0	0	0	0	0.0	–	–	–	–	–	–	–
Smallpox	0	0	0	0	0	0	0.0	–	–	–	–	–	–	–
Viral haemorrhagic fever	0	0	0	0	0	0	0.0	–	–	–	–	–	–	–
Yellow fever	0	0	0	0	0	2	0.0	–	–	–	–	–	–	<0.1
Sexually transmitted infections
Chlamydial infection§,||	47,414	51,947	58,431	62,954	74,266	80,800	59,002.4	1.4	229.1	246.5	271.8	286.8	333.1	357.2
Donovanosis	6	3	2	1	1	0	2.6	<0.1	0.03	<0.1	<0.1	<0.1	<0.1	–
Gonococcal infection||	8,598	7,646	7,679	8,044	10,020	12,087	8,397.4	1.4	41.5	36.3	35.7	36.6	44.9	53.4
Syphilis – congenital||	11	7	6	3	3	6	6.0	1.0	0.1	<0.1	<0.1	<0.1	<0.1	<0.1
Syphilis – all||,¶	2,209	2,778	2,697	2,731	2,398	2,563	2,562.6	1.0	10.7	13.2	12.5	12.4	10.8	11.3
Syphilis < 2 years duration||	892	1,425	1,328	1,331	1,135	1,303	1,222.2	1.1	4.3	6.8	6.2	6.1	5.1	5.8
Syphilis > 2 years or unspecified duration†,||	1,317	1,353	1,369	1,400	1,263	1,260	1,340.4	0.9	6.9	6.9	6.9	6.9	6.1	6.0
Vaccine preventable diseases
Diphtheria	0	0	0	0	0	4	0.0	–	–	–	–	–	–	<0.1
Haemophilus influenzae type b	22	17	25	19	24	13	21.4	0.6	0.1	0.1	0.1	0.1	0.1	0.1
Influenza (laboratory confirmed)	3,322	10,585	9,178	59,018	13,467	27,149	19,114.0	1.4	16.0	50.2	42.7	268.9	60.4	120.0
Measles	125	12	65	105	69	193	75.2	2.6	0.6	0.1	0.3	0.5	0.3	0.9
Mumps	275	582	285	165	97	155	280.8	0.6	1.3	2.8	1.3	0.8	0.4	0.7
Pertussis	9,759	4,861	14,287	29,769	34,785	38,602	18,692.2	2.1	47.1	23.1	66.5	135.6	156.0	170.7
Pneumococcal disease (invasive)	1,448	1,468	1,628	1,554	1,639	1,887	1,547.4	1.2	7.0	7.0	7.6	7.1	7.4	8.3
Poliomyelitis	0	1	0	0	0	0	0.2	<0.1	–	<0.1	–	–	–	–
Rubella	59	34	36	27	44	58	40.0	1.5	0.3	0.2	0.2	0.1	0.2	0.3
Rubella – congenital	0	2	0	0	0	0	0.4	0.0	–	<0.1	–	–	–	–
Tetanus	3	3	4	3	2	3	3.0	1.0	<0.1	<0.1	<0.1	<0.1	<0.1	<0.1
Varicella zoster (chickenpox)	NN	1,667	1,799	1,754	1,747	2,094			NN	18.6	19.6	11.8	11.6	13.7
Varicella zoster (shingles)	NN	1,562	2,326	2,718	2,985	3,999			NN	17.5	25.4	18.3	19.8	26.1
Varicella zoster (unspecified)	NN	4,284	4,413	6,784	7,145	7,715			NN	47.9	48.2	45.8	47.4	50.4
Vectorborne diseases
Arbovirus infection (NEC)	30	17	12	8	24	24	18.2	1.3	0.1	0.1	0.1	0.0	0.1	0.1
Barmah Forest virus infection	2,129	1,709	2,085	1,477	1,470	1,870	1,774.0	1.1	10.3	8.1	9.7	6.7	6.6	8.3
Dengue virus infection	189	314	560	1,406	1,220	817	737.8	1.1	0.9	1.5	2.6	6.4	5.5	3.6
Japanese encephalitis virus infection	0	0	1	0	0	0	0.2	<0.1	–	–	<0.1	–	–	–
Kunjin virus infection**	3	1	1	2	2	2	1.8	1.1	<0.1	<0.1	<0.1	<0.1	<0.1	<0.1
Malaria	768	564	523	503	394	411	550.4	0.7	3.7	2.7	2.4	2.3	1.8	1.8
Murray Valley encephalitis virus infection**	1	0	2	4	0	16	1.4	11.4	<0.1	–	<0.1	<0.1	–	0.1
Ross River virus infection	5,529	4,175	5,659	4,787	5,152	5,166	5,060.4	1.0	26.7	19.8	26.3	21.8	23.1	22.8
Zoonoses
Anthrax	1	1	0	0	1	0	0.6	<0.1	<0.1	<0.1	–	–	<0.1	–
Australia bat lyssavirus	0	0	0	0	0	0	0.0	–	–	–	–	–	–	–
Brucellosis	50	37	45	32	21	39	37.0	1.1	0.2	0.2	0.2	0.1	0.1	0.2
Leptospirosis	145	108	111	142	131	217	127.4	1.7	0.7	0.5	0.5	0.6	0.6	1.0
Lyssavirus (NEC)	0	0	0	0	0	0	0.0	–	–	–	–	–	–	–
Ornithosis	165	93	102	65	59	85	96.8	0.9	0.8	0.4	0.5	0.3	0.3	0.4
Q fever	411	448	378	310	329	338	375.2	0.9	2.0	2.1	1.8	1.4	1.5	1.5
Tularaemia	0	0	0	0	0	2	0.0	–	–	–	–	–	–	<0.1
Other bacterial diseases
Legionellosis	349	306	272	301	299	348	305.4	1.1	1.7	1.5	1.3	1.4	1.3	1.5
Leprosy	7	14	11	4	12	8	9.6	0.8	<0.1	0.1	<0.1	<0.1	0.1	<0.1
Meningococcal infection††	317	305	286	259	229	241	279.2	0.9	1.5	1.4	1.3	1.2	1.0	1.1
Tuberculosis	1,209	1,133	1,214	1,313	1,312	1,331	1,236.2	1.1	5.8	5.4	5.6	6.0	5.9	5.9
Total	131,073	146,148	159,474	236,597	209,370	238,158

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The year in which diseases became notifiable to NNDSS in each jurisdiction is shown in Table 6.

Table 6: Earliest notification year for which NNDSS contains disease data, Australia, by state or territory*

Disease	Year in which data first sent to Commonwealth								Period of national reporting	Exceptions to national reporting
	ACT	NSW	NT	Qld	SA	Tas.	Vic.	WA
* Data from the National Notifiable Diseases Surveillance System annual reports from 1991. First full year of reporting to Commonwealth is shown. Some diseases may have been notifiable to state or territory health departments before the dates shown here. † ‡ Infection with Shiga toxin/verotoxin-producing Escherichia coli. ‡ Includes paratyphoid in New South Wales, Queensland and Victoria. § Includes neonatal ophthalmia in the Northern Territory, Queensland, South Australia, and Victoria. || Includes syphilis – congenital from 1991 to 2002. ¶ Includes rubella – congenital from 1991 to 2002. ** Before 1997, includes Ross River virus infection, dengue virus infection and Barmah Forest virus infection. †† Flavivirus (NEC) replaced arbovirus (NEC) 1 January 2004. Arbovirus (NEC) replaced Flavivirus (NEC) in 2008. NN - Not notifiable
Bloodborne diseases
Hepatitis (NEC)	1991	1991	1991	1991	1991	1991	1991	NN	1991 to present	WA do not report
Hepatitis B (newly acquired)	1995	1993	1993	1994	1993	1993	1993	1994	1995 to present	ACT did not report 1994
Hepatitis B (unspecified)	1991	1991	2004	1994	1991	1991	1991	1991	1991 to present
Hepatitis C (newly acquired)	1995	1993	2005	NN	1993	1995	1997	1995	1993 to present	Qld do not report
Hepatitis C (unspecified)	1991	1991	1991	1991	1994	1991	1991	1993	1995 to present	Includes reports of incident hepatitis C, 1991 to 1994
Hepatitis D	1999	1999	1999	1997	1999	1999	1999	2001	1999 to present	WA did not report 1999–2000
Gastrointestinal diseases
Botulism	1992	1998	1998	1997	1993	1992	1992	2001	1992 to present
Campylobacteriosis	1991	NN	1991	1991	1991	1991	1991	1991	1991 to present	NSW do not report
Cryptosporidiosis	2001	2001	2001	1996	2001	2001	2001	2001	2001 to present
Haemolytic uraemic syndrome	1999	1999	1999	1997	1999	1999	1999	1999	1999 to present
Hepatitis A	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Hepatitis E	1999	1999	1999	1999	1999	1999	1999	2001	1999 to present	WA did not report 1999–2000
Listeriosis	1991	1991	1994	1991	1992	1991	1991	1991	1991 to present	SA did not report 1991 NT did not report 1991–1993
Salmonellosis	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Shigellosis	1991	2001	1991	1997	1991	1991	1991	1991	1991 to present	NSW did not report 1991–2000 Qld did not report 1991–2006
STEC, VTEC†	1999	1999	1999	2002	1999	1999	1999	2001	1999 to present	Qld did not report 1991–2002 WA did not report 1999–2001
Typhoid‡	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Quarantinable diseases
Cholera	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Highly pathogenic avian influenza in humans	2004	2004	2004	2004	2004	2004	2004	2004	2004 to present
Plague	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Rabies	1993	1997	1991	1991	1991	1991	1991	1991	1991 to present
Severe acute respiratory syndrome	2003	2003	2003	2003	2003	2003	2003	2003	2003 to present
Smallpox	2004	2004	2004	2004	2004	2004	2004	2004	2004 to present
Viral haemorrhagic fever	1993	1991	1991	1991	1991	1991	1991	1991	1991 to present
Yellow fever	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Sexually transmissible infections
Chlamydial infection (NEC)	1993	1991	1991	1991	1993	1991	1991	1993	1994 to present	NSW did not report 1994–1998
Donovanosis	1991	2002	1991	1991	2002	1993	1991	1991	1991 to present	NSW and SA did not report 1991–2001 Tasmania did not report 1991–1992
Gonococcal infection§	1991	1993	1991	1991	1991	1991	1991	1991	1991 to present
Syphilis – all||	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Syphilis < 2 years	2004	2004	2004	2004	2004	2004	2004	2004	2004 to present
Syphilis > 2 years or unspecified duration	2004	2004	2004	2004	–	2004	2004	2004	2004 to present	South Australia do not report
Syphilis – congenital	2003	2003	2003	2003	2003	2003	2003	2003	2003 to present
Vaccine preventable diseases
Diphtheria	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Haemophilus influenzae type b	1991	1991	1991	1991	1991	1991	1991	1994	1991 to present	WA did not report 1991–1993
Influenza (laboratory confirmed)	2001	2001	2001	2001	2001	2001	2001	2001	2001 to present	Influenza became legally notifiable in SA in May 2008
Measles	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Mumps	1992	1992	1995	1997–1998; 2002	1994	1995	1992	1994	1995 to present	Queensland did not report (1995–1996 & 1999–2000)
Pertussis	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Pneumococcal disease (invasive)	2001	2001	2001	1997	2001	2001	2001	2001	2001 to present
Poliomyelitis	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Rubella¶	1991	1991	1993	1991	1993	1995	1992	1994	1993 to present	Tasmania did not report 1993–1994
Rubella – congenital	2003	2003	2003	1997	2003	2003	2003	2003	2003 to present
Tetanus	1991	1991	1991	1985	1991	1991	1991	1991	1991 to present	Qld did not report 1991–1993
Varicella zoster (chickenpox)	2006	NN	2006	2006	2006	2006	2008	2006	2006 to present	All jurisdictions except NSW Reported by Victoria in September 2008
Varicella zoster (shingles)	2006	NN	2006	2006	2006	2006	2008	2006	2006 to present	All jurisdictions except NSW Reported by Victoria in September 2008
Varicella zoster (unspecified)	2006	NN	2006	2006	2006	2006	2008	2006	2006 to present	All jurisdictions except NSW Reported by Victoria in September 2008
Vectorborne diseases
Barmah Forest virus infection	1995	1995	1997	1995	1995	1995	1995	1995	1995 to present
Dengue virus infection	1993	1991	1991	1991	1991	1991	1991	1995	1991 to present	ACT did not report 1991–1992
Arbovirus infection (NEC)**,||	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present	Includes JEV, MVEV and Kunjin 1991–2000
Japanese encephalitis virus infection	2001	2001	2001	2001	2001	2001	2001	2001	2001 to present
Kunjin virus	2001	2001	2001	2001	2001	2001	2001	2001	2001 to present	Reported under MVEV in the ACT
Malaria	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Murray Valley encephalitis virus infection	2001	2001	2001	2001	2001	2001	2001	2001	2001 to present	Combined with Kunjin in the ACT
Ross River virus infection	1993	1993	1991	1991	1993	1993	1991	1991	1993 to present
Zoonoses
Anthrax	2001	2001	2001	1991	2002	2001	2001	2001	2001 to present
Australian bat lyssavirus	2001	2001	2001	1998	2001	2001	2001	2001	2001 to present
Brucellosis	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Leptospirosis	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Lyssavirus (NEC)	2001	2001	2001	1998	2001	2001	2001	2001	2001 to present
Ornithosis	1991	2001	1991	1992	1991	1991	1991	1991	1991 to present	NSW did not report 1991–2000 Queensland did not report 1997–2001
Q fever	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Tularaemia	2004	2004	2004	2004	2004	2004	2004	2004	2004 to present
Other bacterial infections
Legionellosis	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Leprosy	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Meningococcal infection	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present
Tuberculosis	1991	1991	1991	1991	1991	1991	1991	1991	1991 to present

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The major changes in communicable disease notifications in 2011 are shown in Figure 3 as the ratio of notifications in 2011 to the mean number of notifications for the previous 5 years. Pneumococcal disease (invasive), Murray Valley encephalitis virus (MVEV) infection, measles, leptospirosis, gonococcal infection, chlamydial infection and campylobacteriosis all surpassed the expected range (5-year mean plus 2 standard deviations). MVEV infection is very rare, and therefore any increase in case numbers leads to a large change in the ratio compared with the 5-year mean. Pertussis did not exceed the 5-year mean plus 2 standard deviations but experienced epidemic level activity in 2011.

Figure 3: Comparison of total notifications of selected diseases reported to the National Notifiable Diseases Surveillance System in 2011, with the previous 5-year mean

Text version of Figure 3 (TXT 1 KB)

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Data completeness

The case’s sex and age at onset was complete in 99.9% of notifications (Table 7). In 2011, Indigenous status was complete in 80% of notifications, and varied by jurisdiction. Indigenous status was complete for 97% of data reported in the Northern Territory and Western Australia, and 93% in South Australia. In the remaining jurisdictions, less than 76% of data were complete for Indigenous status.

Table 7: Completeness of National Notifiable Diseases Surveillance System data received, Australia, 2011, by state or territory*

	State or territory
	ACT	NSW	NT	Qld	SA	Tas.	Vic.	WA	Aust.
* Indigenous status is usually obtained from medical notification and completeness varies by disease and by state and territory. This reflects differences in notification requirements (i.e. depending on the jurisdiction, some diseases are primarily or completely notified by pathology laboratories rather than clinicians) and the fact that it is not possible to follow-up all cases for diseases with a large volume of notifications and/or not requiring specific case-based public health action.
Total notifications	3,743	55,668	7,583	61,481	20,643	4,363	54,981	29,696	238,158
Sex
Unknown/ missing	0	182	0	7	14	0	218	0	421
Per cent complete	100	99.9	100	100	99.4	100	99.8	100	99.9
Age at onset
Unknown/ missing	0	26	0	0	12	0	152	0	190
Per cent complete	100	100	100	100	99.4	100	99.9	100	99.9
Indigenous status
Unknown/ missing	2,551	45,163	331	33,542	2,663	2,047	26,410	2,040	114,747
Per cent complete	75.3	69.7	96.7	60.9	93.1	76	76.7	97.3	80.4

Data completeness on Indigenous status also varied by disease as summarised in Appendix 3. In 2011, CDNA set target thresholds of 95% completeness for key diseases and 80% completeness for the remainder of the notifiable diseases. There were 8 diseases for which notifications were 100% complete for Indigenous status. A further 22 diseases equalled or exceeded 80% completeness for Indigenous status. Of the 18 priority diseases agreed to by CDNA and the NSC in 2011 for improving Indigenous identification, seven had an Indigenous completeness that exceeded 95% (Haemophilus influenzae type b, hepatitis A, meningococcal infection, congenital syphilis, syphilis < 2 years duration, leprosy, and tuberculosis). The diseases for which there was less than 95% Indigenous completeness included hepatitis C (newly acquired), hepatitis B (newly acquired), dengue virus (DENV) infection, measles, gonococcal infection, pneumococcal disease (invasive), and shigellosis.

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