A print friendly PDF version is available from this Communicable Diseases Intelligence issue's table of contents.

Results - Part A: General results, continued

Diagnosis

Data on diagnosis were available for 335,001 (98%) records from the study period. Of these 96,253 were coded as 'no clinical information available' and another 20,592 were coded as 'other diagnosis'. The 10 most common diagnoses (of 62 diagnostic categories accepted in LabVISE), which make up 201,959 or 90 per cent of the remaining 223,205 records are shown in Table 5.

Table 5. The 10 most common diagnoses for which samples were submitted for testing to LabVISE laboratories, 1991 to 2000

Code	Diagnosis description	n	%
59	Genital disease (including sexually transmitted infections)	39,860	17.9
06	Superficial skin or mucous membrane diseases	36,677	16.4
02	Lower respiratory tract infection	36,320	16.3
11	Respiratory tract infection - unspecified	23,590	10.6
07	Gastrointestinal disease	23,177	10.4
01	Upper respiratory tract infection	20,781	9.3
17	Hepatitis	7,045	3.6
29	Bone/joint disease	5,541	2.5
G8	Malaise - general and/or mild fever	4,537	2.0
08	High fever	4,431	2.0

Although samples submitted to LabVISE for investigations of genital (STI) disease make up the largest single category, the combined number of investigations of respiratory disease total 80,691 or 36 per cent of the total. It should be noted that the diagnostic descriptions are very broadly defined and the analysis that follows should be interpreted with caution.

The most frequently reported organisms in samples from patients with the 10 most common diagnoses are shown in Table 6.

Table 6. The 10 most frequently isolated organisms in the 10 most frequently reported clinical diagnoses, LabVISE, 1991 to 2000

Genital diseases (n= 39,860)			Skin/mucous membrane disease (n=36,677)
Rank	Virus/organism	Reports	Rank	Virus/organism	Reports
1	Chlamydia trachomatis	18,208	1	Herpes simplex type   1†	12,029
2	Herpes simplex type   2†	14,257	2	Herpes simplex type   2†	8,596
3	Herpes simplex type   1†	5,539	3	Varicella-zoster virus	7,702
4	Herpes simplex (not typed)†	743	4	Rubella	1,768
5	Treponema pallidum	517	5	Herpes (not typed)	1,338
6	Neisseria gonorrhoeae†	178	6	Ross River virus	1,324
7	Cytomegalovirus	89	7	Measles virus	1,253
8	Varicella-zoster virus	67	8	Parvovirus	601
9	Chlamydia trachomatis A-K	35	9	Enterovirus (untyped)	322
10	Chlamydia spp.	35	10	Epstein-Barr virus	173
Lower respiratory tract infection (n=36,320)			Respiratory tract infection - unspecified (n=23,590)
Rank	Virus/organism	Reports	Rank	Virus/organism	Reports
1	Respiratory syncytial virus	16,349	1	Respiratory syncytial virus	9,202
2	Mycoplasma pneumoniae	3,750	2	Influenza A	2,259
3	Influenza A	3,367	3	Adenovirus (untyped)	1,629
4	Parainfluenza virus type   3	2,255	4	Parainfluenza virus type   3	1,455
5	Rhinovirus	1,753	5	Mycoplasma pneumoniae	1,441
6	Cytomegalovirus	1,699	6	Rhinovirus	1,303
7	Adenovirus (untyped)	1,163	7	Enterovirus (untyped)	1,013
8	Influenza B	1,093	8	Cytomegalovirus	880
9	Bordetella pertussis	690	9	Influenza B	615
10	Parainfluenza virus type   1	478	10	Bordetella pertussis	563
Gastrointestinal disease (n=23,177)			Upper respiratory tract infection (n=20,781)
Rank	Virus/organism	Reports	Rank	Virus/organism	Reports
1	Rotavirus	15,887	1	Respiratory syncytial virus	5,358
2	Adenovirus (untyped)	3,033	2	Bordetella pertussis	2,913
3	Enterovirus (untyped)	1,865	3	Rhinovirus	1,898
4	Human calicivirus*	683	4	Epstein-Barr virus	1,720
5	Adenovirus type   40	188	5	Parainfluenza virus type   3	1,336
6	Cytomegalovirus	161	6	Influenza A	1,225
7	Adenovirus type   2	111	7	Cytomegalovirus	988
8	Poliovirus (untyped)	87	8	Adenovirus (untyped)	919
9	Adenovirus type   1	68	9	Enterovirus (untyped)	618
10	Coronavirus	59	10	Parainfluenza virus type   1	587
Hepatitis (n=7,045)			Bone/joint disease (n=5,541)
Rank	Virus/organism	Reports	Rank	Virus/organism	Reports
1	Hepatitis C†	2,805	1	Ross River virus	4,296
2	Hepatitis A	1,890	2	Barmah Forest virus	308
3	Hepatitis B antibody†	1,832	3	Parvovirus	176
4	Epstein-Barr virus	124	4	Rubella	123
5	Cytomegalovirus	124	5	Streptococcus A	119
6	Hepatitis D	103	6	Epstein-Barr virus	72
7	Coxiella burnetii	29	7	Influenza A	55
8	Hepatitis B antigen†	23	8	Cytomegalovirus	55
9	Chlamydia trachomatis	19	9	Coxiella burnetii	49
10	Hepatitis E	17	10	Dengue type   2	40
Malaise (n=4,537)			High fever (n=4,431)
Rank	Virus/organism	Reports	Rank	Virus/organism	Reports
1	Epstein-Barr virus	710	1	Ross River virus	1,270
2	Cytomegalovirus	699	2	Epstein-Barr virus	458
3	Ross River virus	602	3	Cytomegalovirus	380
4	Coxiella burnetii	236	4	Influenza A	280
5	Influenza A	192	5	Respiratory syncytial virus	210
6	Hepatitis C†	152	6	Coxiella burnetii	185
7	Mycoplasma pneumoniae	145	7	Adenovirus (untyped)	138
8	Rubella	143	8	Mycoplasma pneumoniae	138
9	Influenza B	141	9	Barmah Forest virus	127
10	Barmah Forest virus	125	10	Enterovirus (untyped)	99

* Combines Norwalk like virus, small round virus and human calicivirus
† Data collected up to 1996 only.

Top of page
The ranking of organisms identified in different diagnoses over a 10-year period includes a number of pathogens no longer under surveillance through LabVISE. Among samples submitted with a primary diagnosis of genital disease, herpes simplex viral identifications combined comprise 20,539 (51% of the total), although data on herpesvirus were not included in LabVISE after 1996. Since the late 1970s the prevalence of herpes simplex type 2 (HSV-2) infections increased by 30 per cent in the United States of America (USA) and HSV-2 infects an estimated 86 million people worldwide.⁶

Among respiratory infections, respiratory syncytial virus was most frequently identified in cases of all kinds of respiratory infection, while rotavirus was the predominant organism identified in cases of gastroenteritis. Cases of hepatitis tested in LabVISE were predominantly hepatitis C, although reporting of this pathogen to the system ceased in 1996.

Specimens processed and methods used

Although data fields for type of specimen and methods used for the diagnosis were no longer required in LabVISE after 1996, many laboratories continued to send these data fields. The 10 most common specimens received by LabVISE and the 10 most common methods used in LabVISE laboratories for the detection of antigens and antibodies are shown in Tables 7, 8 and 9.

Table 7. The 10 most common specimens received by LabVISE, 1991 to 2000

Rank	Specimen	n	%
1	Blood	80,019	25.0
2	Nasopharyngeal swab or aspirate	54,657	17.1
3	Other	42,937	13.4
4	Genital swab	42,782	13.4
5	Serum	34,039	10.6
6	Skin	25,462	8.0
7	Faeces/rectal swab	23,572	7.4
8	Urine	6,367	2.0
9	Eye	3,457	1.1
10	Cerebrospinal fluid	2,196	0.7

Table 8. The 10 most common methods used to detect microbial antigens in LabVISE laboratories, 1991 to 2000

Rank	Antigen description	n	%
1	Immunofluorescence	69,646	29.5
2	Enzyme-linked immunosorbent assay	38,221	16.2
3	Light microscopy	36,955	15.7
4	Immunoenzymatic techniques	33,138	14.0
5	Nucleic acid detection	18,354	7.8
6	Radio-immunoassay	17,547	7.4
7	Electronic microscopy	8,487	3.6
8	Other	3,862	1.6
9	Growth characteristics	2,935	1.2
10	Latex agglutination	2,899	1.2

Table 9. The 10 most common methods used to detect antibodies in LabVISE, 1991 to 2000

Rank	Antibody description	n	%
1	Enzyme-linked immunosorbent assay	71,611	42.3
2	Complement fixation	31,598	18.7
3	Immunofluorescence	26,001	15.3
4	Immunoenzymatic techniques	15,591	9.2
5	Other	9,165	5.4
6	Haemagglutination	3,230	1.9
7	Haemagglutination inhibition	3,169	1.9
8	Slide/tube agglutination	2,473	1.5
9	Radioimmunoassay	2,308	1.4
10	Latex agglutination	2,156	1.3

Top of page

Pathogens under surveillance in LabVISE, 1991 to 2000

A complete list of pathogens under surveillance for this report is shown in Appendix 3 and is summarised in Table 10.

Table 10. Summary of pathogens under surveillance in LabVISE, 1991 to 2000

Pathogen group	Specific pathogens
Measles, mumps, rubella	Measles, mumps and rubella viruses
Hepatitis viruses	Hepatitis A, D and E
Arboviruses	Ross River virus, Barmah Forest virus, dengue (type 1 to 4), Murray Valley encephalitis virus, Kunjin virus, Japanese encephalitis virus, Kokobera virus, Stratford virus and flavivirus (unspecified)
Adenovirus	Types 1-17, 19, 21-22, 24, 26-32, 34, 35, 37, 40-47
Herpesviruses	Herpesvirus type   6, cytomegalovirus, varicella-zoster virus, Epstein-Barr virus
Other DNA viruses	Parvovirus, papovavirus, molluscum contagiosum, orf virus, poxvirus
Picornavirus	Coxsackievirus, echovirus, poliovirus, rhinovirus, enterovirus
Ortho/paramyxovirus	Influenza, parainfluenza, respiratory syncytial virus
Other RNA virus	Rotavirus, astrovirus, reovirus (unspecified), calicivirus/Norwalk agent, coronavirus, small virus-like particles
Other non-viral pathogens	Chlamydia, Mycoplasma, Rickettsia, Streptococcus, Yersinia, Brucella, Bordetella, Legionella, Leptospira, Cryptococcus, Treponema, Entamoeba, Toxoplasma, Echinococcus

The totals for each year for each pathogen group are shown in Table 11. Figure 3 shows the relative proportions of each pathogen group in the total dataset.

Table 11. Total number of reports to LabVISE, 1991 to 2000, by pathogen group and year and percentage of each year's total

Pathogen group		1991	1992	1993	1994	1995	1996	1997	1998	1999	2000	Total
Measles, mumps, rubella	n %	534 2.7	1,005 4.0	1,856 6.6	2,464 8.8	957 4.1	810 2.9	469 1.6	196 0.8	375 1.4	144 0.6	8,810 3
Hepatitis viruses	n %	482 2.5	417 1.6	510 1.8	393 1.4	455 1.9	426 1.5	643 2.3	392 1.7	384 1.5	159 0.6	4,261 2
Arboviruses	n %	955 5.0	2,013 8.0	2,744 9.7	2,577 9.2	1,271 5.4	3,570 12.8	2,311 8.1	872 3.7	1,726 6.5	1,682 7.1	19,721 8
Adenovirus	n %	1,518 7.9	1,722 6.9	1,885 6.7	1,542 5.5	1,182 5.0	1,382 4.9	1,017 3.6	1,162 5.0	1,309 5.0	1,205 5.1	13,924 5
Herpesviruses	n %	3,706 19.2	4,039 16.1	4,059 14.4	4,311 15.4	4,367 18.5	4,589 16.4	4,426 15.5	3,923 16.9	5,090 19.2	4,738 20.0	43,248 17
Other DNA viruses	n %	67 0.3	206 0.8	109 0.4	121 0.4	121 0.5	282 1.0	310 1.1	272 1.2	474 1.8	414 1.7	2,376 1
Picornavirus	n %	1,902 9.9	2,341 9.3	2,630 9.3	2,678 9.5	1,885 8.0	1,559 5.6	1,119 3.9	1,190 5.1	1,631 6.2	1,527 6.4	18,462 7
Ortho/paramyxovirus	n %	3,833 19.9	5,981 23.8	5,432 19.2	6,244 22.2	6,129 26.0	6,992 25.0	8,782 30.8	8,261 35.5	6,238 23.6	5,604 23.6	63,496 25
Other RNA virus	n %	2,832 14.7	2,277 9.1	2,090 7.4	2,332 8.3	1,693 7.2	1,582 5.7	1,522 5.3	1,444 6.2	2,322 8.8	1,864 7.9	19,958 8
Other non-viral pathogens	n %	3,458 17.9	5,135 20.4	6,904 19.3	5,406 24.5	5,528 23.4	6,798 24.2	7,919 27.8	5,547 23.1	6,928 26.2	6,374 27.0	59,997 24

Figure 3. Laboratory reports to LabVISE, 1991 to 2000, by pathogen group



In the study period, reports of non-viral pathogens increased from 17.9 per cent to 27 per cent of the annual reports to LabVISE. Among viral pathogens, ortho/paramyxoviruses made up on average 25 per cent of the annual reports, herpesviruses 17 per cent and other RNA viruses 8 per cent.


This article was published in Communicable Diseases Intelligence Volume 26, No 3, September 2002