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Other communicable disease surveillance

LabVISE

The Laboratory Virology and Serology (LabVISE) Reporting Scheme is a passive surveillance scheme based on voluntary reports of infectious agents contributed by sentinel virology and serology laboratories around Australia, to the Commonwealth Department of Health and Aged Care. In 1999, reports from the scheme were analysed and published monthly in Communicable Diseases Intelligence.

LabVISE provides information on a number of viruses and other infectious agents (bacteria, parasites and fungi), and the demographic characteristics of persons they infect. LabVISE records information on some infectious agents that are not reported by other surveillance schemes. The scheme currently holds over 500,000 records collected since 1982.

In 1999, there were 26,452 reports to LabVISE, contributed by 15 laboratories representing every State and Territory. This was a small increase on the number of reports in 1998 (26,359). Although there were no contributing laboratories contributing directly to LabVISE in either the Northern Territory or the Australian Capital Territory, samples from these jurisdictions were included in the reports from reference laboratories (Table 9). LabVISE reporting is not equally distributed across Australia; indeed the Northern Territory has the highest number of reports per 100,000 population while some southern States are relatively poorly represented in the data set.

The breakdown of reports is shown in Table 9. Of the 26,452 reports received, 19,531 (74%) were of viral infections and 6,921 (26%) were bacterial, spirochaetes, fungal, protozoan or helminthic infections. Among reports of viral infection, ortho/paramyxoviruses (including influenza A and B, parainfluenza and RSV viruses) made up 32 per cent of reports, and reports of Herpes viruses (including Herpes, CMV, Varicella-zoster and Epstein-Barr virus) constituted 26 per cent (Figure 46). Among reports of non-viral infections, Chlamydia made up nearly half of all reports (49%).

The following table displays infectious agents notified to the Laboratory Serology and Virology Reporting Scheme in 1999, by State and Territory. If you are not able to access these data please e-mail cdi.editor@health.gov.au.

Table 9. Infectious agents reported to LabVISE, 1999

Organism Type	ACT	NSW	NT	Qld	SA	Tas	Vic	WA	Total
Measles virus	0	4	2	3	9	1	117	36	172
Mumps virus	0	0	0	0	2	0	6	50	58
Rubella	1	7	0	100	9	2	11	15	145
Hepatitis A virus	0	9	30	101	43	2	10	180	375
Hepatitis D virus	0	0	0	3	4	0	0	1	8
Hepatitis E virus	0	0	0	1	0	0	0	0	1
Ross River virus	0	42	65	875	28	3	44	366	1,423
Barmah Forest virus	1	8	9	123	0	0	4	35	180
Dengue virus	1	1	13	3	1	1	0	68	88
MVE virus	0	0	0	0	0	0	0	2	2
JE virus	0	0	0	0	0	0	0	1	1
Kunjin virus	0	0	1	0	0	0	0	4	5
Flaviviruses (unspecified)	0	0	3	22	0	0	2	0	27
Adenoviruses	10	213	7	45	217	6	328	479	1,305
Herpes viruses	15	425	52	1,671	1,006	17	902	997	5,085
Other DNA viruses	3	3	1	59	26	14	201	167	474
Picornavirus family	17	590	36	25	47	2	168	745	1,630
Ortho/paramyxoviruses	108	1,570	24	596	481	38	1,494	1,921	6,232
Other RNA viruses	56	895	6	4	204	32	503	620	2,320
Chlamydia trachomatis	61	373	205	1,226	326	17	101	981	3,290
Chlamydia pneumoniae	0	0	0	0	0	0	0	2	2
Chlamydia psittaci	0	0	0	0	0	0	68	10	78
Chlamydia spp	0	8	0	12	0	0	1	0	21
Mycoplasma spp	0	94	6	364	82	3	486	95	1,130
Coxiella burnetti	6	18	1	144	2	0	27	23	221
Rickettsia spp	0	0	0	0	0	1	3	14	18
Streptococcus group A	0	15	69	280	1	0	3	0	368
Brucella species	0	2	0	7	0	0	2	0	11
Bordetella pertussis	1	30	1	443	1	2	329	38	845
Legionella pneumophila	0	6	0	0	3	0	2	6	17
Legionella longbeachae	0	1	0	0	12	0	0	38	51
Yersinia enterocolitica	1	8	0	1	0	0	0	0	10
Fungi	0	9	0	0	0	0	0	0	9
Leptospira spp	0	3	0	40	0	0	1	12	56
Treponema pallidium	1	49	431	280	0	0	1	12	774
Protozoa	1	3	0	2	1	1	2	6	16
Echinococcus granulosus	0	0	0	0	0	0	0	4	4
Total	283	4,386	962	6,430	2,505	142	4,816	6,929	26,452

Top of pageFigure 46. LabVISE reports, 1999



In 1999/2000, an evaluation highlighted a number of weaknesses of the LabVISE scheme, which prevent the optimal utilisation of the collected data. These were the lack of clear objectives, the inability to collect population-based data and the reduction in the number of participating laboratories.

Advances in technology and improvements to laboratory systems have made the prospect of data acquisition direct from laboratory achievable. The use of such technology would facilitate reporting procedures for laboratories, improve the quality and timeliness of data and enhance the capacity of the scheme to collect additional data. Improved analysis and dissemination of the information generated by LabVISE would further enhance the scheme. The evaluation recommended three options of which the Public Health Laboratory Network (PHLN) endorsed the following: 'that LabVISE be retained and developed as a broad based surveillance scheme with clear objectives and that a feasibility study be performed to assess additional uses of laboratory generated data and the possibility of real time transfer of these data direct to public health units and the Commonwealth Department of Health and Aged Care. Such a feasibility study should also examine safeguards for confidentiality and what additional resources may be required for implementation.' These developments to LabVISE will commence in 2002.

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Additional reports related to pathogens under surveillance by LabVISE

The Rotavirus Surveillance Programme 1999-2000⁷⁶

Rotavirus surveillance began in July 1999 with the formation of the National Rotavirus Reference Centre, a collaborative laboratory-based initiative. Between June 1999 and May 2000, 1,126 rotavirus specimens from children hospitalised with acute diarrhoea were typed. The common serotypes G1-G4 were represented with serotype G1 being the most common isolate from the whole country. The program reported the first isolates of serotype G9, not previously found in Australia and accounting for 10 per cent of typable strains. The emergence of this new serotype has implications for the rotavirus vaccination strategy, which targets serotypes G1-G4.

Norwalk-like virus outbreaks in 1999⁷⁷

Three outbreaks of gastroenteritis in nursing homes in Brisbane in 1999 were demonstrated to be associated with the presence of Norwalk-like virus (NLV). These findings have implications for infection control procedures, particularly in institutional settings. This, and other reports based on PCR diagnosis, of NLV incidents in Australia and overseas, demonstrate that NLV represents a significant but previously unrecognised cause of gastroenteritis.

Enterovirus 71 outbreak in Western Australia

A report on an outbreak of hand, foot and mouth disease caused by enterovirus 71 in Western Australia in 1999 associated with severe neurological disease, was recently published.⁷⁸ Fourteen children with enterovirus 71 were identified, of whom four developed long-term neurological sequelae. Several large epidemics of enterovirus 71 infection in young children have occurred in South East Asia, including a large outbreak of 129,106 cases of hand, foot and mouth disease in Taiwan in 1998.⁷⁹

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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 that report on a number of conditions each week. The aim of ASPREN is to provide an indicator of the burden of disease in the primary care setting and to detect trends in consultation rates.

There were approximately 120 general practitioners participating in the scheme from all States and Territories in 1999. Approximately 75 per cent of these were located in metropolitan areas and the remainder were in rural areas. Between 7,000 and 8,000 consultations were recorded each week.

In 1999, 7 conditions related to communicable diseases and environmental health were reported. These were influenza, rubella, measles, chickenpox, and gastroenteritis. Case definitions for these conditions were published in Commun Dis Intell 1999;24:7-8. In total there were 323,417 consultations in the sentinel practices reported to ASPREN of which 5,938 were of communicable diseases. The majority of communicable diseases reported were gastroenteritis (3,227 presentations, 47% of the total) and influenza (2,106 presentations, 31%, Figure 47). The weekly reporting of gastroenteritis and influenza as a rate per 1,000 consultations is shown in Figures 48 and 49 respectively. While presentations with symptoms of gastroenteritis were highest in the warmer months (weeks 40 to 52), influenza-like illnesses peaked in the winter months (week 34).

Figure 47. ASPREN communicable disease surveillance presentations to GPs, 1999



Figure 48. ASPREN consultations for gastroenteritis, 1999



Figure 49. ASPREN presentations of influenza-like illness, 1999



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National Influenza Surveillance

This summary is based on the 'Annual report of the National Influenza Surveillance Scheme 1999'.⁴¹

Influenza surveillance is based on 3 systems: laboratory diagnosis, including virus isolation and serology by laboratories participating in LabVISE; consultation rates for clinically diagnosed influenza illness by sentinel general practitioners; and the absenteeism data of workers from a national employer.

A total of 3,247 reports were received by LabVISE, with 2,681 for influenza A and 386 for influenza B. The ratio of influenza A to influenza B was 7.4:1. Total influenza reports showed a baseline until May, a small peak in June and a second higher and broader peak from late June to early September. The greatest number of reports were recorded in the 15-44 year age group and the male to female ratio approached 1:1. The expected predominance of influenza reports amongst the elderly was not seen in the collected surveillance data. The ASPREN and New South Wales sentinel general practitioner schemes showed a peak of GP attendances for influenza-like illnesses from mid-May to September 1999. Comparison of ASPREN and LabVISE data showed a similar pattern, with the trends in ASPREN data followed about 2 weeks later by similar patterns in LabVISE data. Absenteeism surveillance showed the highest levels in August and September for absences of more than 3   days.

Independent influenza surveillance programs showed an earlier peak on the east coast of Australia than in the west, with an overall ratio of influenza A to B of 5:1. Most isolates were A Sydney 5/97 H3N2-like viruses. The WHO Collaborating Centre for Reference and Research on Influenza performed analysis on 813 isolates in 1999. This represented 25 per cent of the total influenza reports received through LabVISE. Of these, 683 were influenza A and 130 influenza B. The majority of the influenza A strains were H3N2 subtype, closely related to the A/Sydney/5/97 vaccine strain. Approximately 20 per cent reacted more strongly with a recent isolate A/Moscow/10/99. However, there was no evidence of substantial antigenic drift among the influenza A (H3N2) isolates. The three H1N1 isolates found showed significant antigenic changes from the vaccine A/Beijing/262/95 and were closely related to a new variant A/New Caledonia/20/99. Influenza B isolates remained closely related to the vaccine reference strain B/Beijing/184/93. The pattern of influenza in Australia was similar to that seen in most parts of the world in 1999. The level of influenza was lower than many regions in which more severe outbreaks occurred, such as New Caledonia and New Zealand.

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Antibiotic resistance in Australia

In 1999, the major event in this field was the publication of the report of the Joint Expert Technical Advisory Committee on Antibiotic Resistance.⁸⁰ This committee was appointed in April 1998 to examine the issue of the use of antibiotics in food-producing animals and the implications for antibiotic resistant bacteria in humans. The committee was charged with developing evidence-based recommendations for the appropriate future management of antibiotic use in food producing animals.

The following are key extracts from the JETACAR report.

Scientific background

JETACAR reviewed internationally available information on the nature of antibiotics, and the molecular basis of bacterial resistance. The bacteria known to be involved in the transfer from food-producing animals, and those recognised as the cause of medical conditions of most concern in relation to treatment failure due to antibiotic resistance, were also identified. The report identified priority medical problems potentially arising from, or exacerbated by, the use of antibiotics in livestock production. The benefits of antibiotic use in animals were also reviewed and alternatives canvassed. Focusing on Australian information, the committee reviewed current regulatory controls and use patterns of antibiotics in humans and animals and antibiotic resistance patterns in humans. Few data on antibiotic resistance were available for animal isolates in Australia. There were many gaps in the data available and in the current scientific knowledge of the mechanisms involved.

Assessment of evidence

JETACAR attempted to provide an evidenced-based hazard characterisation for antibiotic use in food-producing animals, a framework for the future development of risk assessment methodology for individual drugs, and the basis for the development of an integrated antibiotic-resistance management strategy.

Overall conclusion

JETACAR considered all aspects of the occurrence of antibiotic resistance and its importance in human and veterinary medicine. The committee agreed there was evidence for the emergence of resistant bacteria in humans and animals following antibiotic use, the spread of resistant animal bacteria to humans, the transfer of antibiotic resistance genes from animal bacteria to human pathogens, and resistant strains of animal bacteria causing human disease.

Resistance management program and recommendations

Based on the scientific findings outlined above, and the 4 factors that influence emergence and spread of antibiotic-resistant bacteria (antibiotic load, antibiotic regimen, bacterial load and prevalence of resistant bacteria), JETACAR developed an antibiotic resistance management program that focuses simultaneously on human and animal use of antibiotics in Australia. The proposed program is a coordinated multidisciplinary approach with 5 key elements, as follows: regulatory controls; monitoring and surveillance; infection prevention strategies and hygienic measures; education; and further research. The basics of this 'five point plan' are equally applicable to human and veterinary medicine, as well as other areas of antibiotic use. All 5 elements of the program must be implemented together if there is to be any chance of reversing the trend towards increasing antibiotic resistance. In addition, further recommendations are included on communication of the issues surrounding antibiotic resistance management to stakeholders and the general public. The overall coordination of the strategy is covered in recommendations 20 and 21. Finally a recommendation was made that a working group convened by the DHAC develop a fully coordinated resistance management plan for human antibiotics. The plan so developed should be incorporated into the recommended functions of the Working Party on Antibiotics or its successor.

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CJD in Australia 1999

This summary is based on report from The Australian National CJD Registry, The University of Melbourne - update to January 2000.

The Australian National Creutzfeldt-Jakob Disease Registry was established in 1993 in response to 4 CJD deaths attributed to cadaveric-derived human pituitary hormone treatment for infertility or short stature. The work of the Registry was expanded to include monitoring both healthcare acquired CJD and transmissible spongiform encephalopathies (TSE), both sporadic and familial, in Australia.

Australia is free of animal forms of prion disease, such as bovine spongiform encephalopathy (BSE) and scrapie. At the end of 1999 there were 482 cases on the Registry. These were 208 definite cases, 144 probable cases and 114 incomplete cases (cases positive in an immunoassay but not finally classified). While there has been a doubling of the average incidence to one case per million (1988-1999) compared with 1970-1987, this reflects better case ascertainment due to improved recognition, confirmation and reporting. The composition of cases on the Registry is 91.9 per cent sporadic, 5.7 per cent familial and 2.4 per cent iatrogenic.


This article was published in Communicable Diseases Intelligence Volume 25, No 4, November 2001.