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Annual report National Notifiable Diseases Surveillance System, 2004 There were 44 cases of SLTEC/VTEC reported to NNDSS in 2004. With a notification rate of 0.2 cases per 100,000 population, the rate of SLTEC/VTEC notifications remained stable compared to 2003. Seventy-three per cent of cases were notified in South Australia (1.8 cases per 100,000 population), where bloody stools are routinely tested by polymerase chain reaction (PCR) for genes coding for Shiga toxin. New South Wales, Queensland, and Victoria were the only other jurisdictions that notified SLTEC/VTEC. OzFoodNet reported that among typed E. coli (67% of all notifications) 15 per cent were subtype O157, 16 per cent were subtype O11 and 13 per cent were O26. 6 Haemolytic uraemic syndrome Case defi nitions – Haemolytic uraemic syndrome (HUS) Only confirmed cases are reported. In 2004, there were 73 notifi cations of typhoid, a rate of 0.4 cases per 100,000 population, representing an increase of 43 per cent compared to 2003. The largest increase, compared to 2003, occurred in New South Wales (increase of 143%). Nationally, the male to female ratio was 1:1, with the highest notifi cation rates in males aged 0–4 years (0.9 cases per 100,000 population) and in females aged 15–19 years (1.2 cases per 100,000 population) (Figure 26). The National Enteric Pathogen Surveillance Scheme identifi ed 71 Salmonella Typhi isolates, 68 of which were from Australian residents. Of the 68 Australian residents, 17 had no travel history recorded, two had not travelled, and the remaining 49 cases had travelled outside Australia in South East Asia, Africa, Europe, Pacifi c Islands, and South America. 7 Figure 26. Notification rates of typhoid, Australia, 2004, by age group and sex Confirmed case: Requires acute microangiopathic anaemia on peripheral blood smear (schistocytes, burr cells or helmet cells) AND AT LEAST ONE OF THE FOLLOWING: acute renal impairment (haematuria, proteinuria or elevated creatinine level), OR, thrombocytopaenia, particularly during the fi rst seven days of illness. Rate per 100,000 population 1.4 1.2 1.0 0.8 0.6 0.4 0.2 Male Female Note: Where STEC/VTEC is isolated in the context of HUS, it should be notifi ed as both STEC/VTEC and HUS. 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 Age group (years) 65-69 70-74 75-79 80-84 85+ In 2004, 15 cases of HUS were reported to NNDSS, a rate of 0.1 cases per 100,000 population, the same rate as in 2003. No HUS cases were notifi ed in the Australian Capital Territory, Tasmania, the Northern Territory or Western Australia. Among the 15 cases of HUS notifi ed in 2004, six were males. The median age among males was 19 years (range 2–54 years) and among females was 34 years (range 0–82 years). STEC was isolated in three cases of HUS. Typhoid Case defi nitions – Typhoid fever Only confirmed cases are reported. Quarantinable diseases Human diseases covered by the Quarantine Act 1908, and notifi able in 2004 were cholera, plague, rabies, yellow fever, smallpox, highly pathogenic avian infl uenza in humans (HPAIH), severe acute respiratory syndrome (SARS) and four viral haemorrhagic fevers (Ebola, Marburg, Lassa and Crimean-Congo). HPAIH was declared a quarantinable disease on 23 March 2004 and consequently became subject to the routine quarantine powers available under the Quarantine Act 1908. SARS was declared a quarantinable disease under the Quarantine Act 1908 on 7 April 2003. Confirmed case: Requires isolation or detection of Salmonella Typhi. 34 CDI Vol 30 No 1 2006
National Notifiable Diseases Surveillance System, 2004 Annual report Cholera Case defi nition – Cholera Only confirmed cases are reported. Confirmed case: Requires isolation of toxigenic Vibrio cholerae O1 or O139. In 2004, there were fi ve cases of cholera notifi ed in Australia, two from Victoria, and one each from New South Wales, Queensland and Western Australia. Four of these cases acquired their disease overseas: one in Indonesia, one in the Philippines, and two in India. The place of acquisition of the fi fth case was unknown. All fi ve notifi cations were Vibrio cholerae serogroup O1. There were two El Tor biotype notifi cations and two Ogawa serotypes reported. Table 11 summarises the serogroups, biotypes, serotypes and toxin producing status of these notifi cations. In 2004, there were several suspected cases of SARS reported by jurisdictions. Enhanced surveillance by general practitioners and hospitals in Australia resulted in the testing of fi ve people with fever, respiratory symptoms and history of travel to China. All tests for SARS were negative. Cholera, plague, rabies, yellow fever, SARS, HPAIH and viral haemorrhagic fevers are of international public health importance and are notified to the World Health Organization. Although no local transmission had been reported in Australia, these diseases continue to occur around the world. Travellers are advised to seek information on the risk of contracting these diseases in their destinations and take appropriate measures. More information on quarantinable diseases and travel health can be found on the Australian Government Department of Health and Ageing Website at: http://www.health.gov.au/internet/ wcms/Publishing.nsf/Content/health-pubhlth-strategquaranti-index.htm Sexually transmissible infections In 2004, sexually transmissible infections (STIs) reported to NNDSS were chlamydial infection, donovanosis, gonococcal infections and for the first time two categories of syphilis: syphilis – infectious (primary, secondary and early latent) less than 2 years duration and syphilis – of greater than 2 years or unknown duration. The NNDSS also received reports on congenital syphilis. These conditions were notifiable in all states and territories. Other national surveillance systems that monitor STI in Australia include the Australian Gonococcal Surveillance Programme, which is a network of specialist laboratories, and the National Centre in HIV Epidemiology and Clinical Research. The national trends in the number and rates of STI notifi cations reported to the NNDSS between 2000 and 2004 are shown in Table 4. In interpreting these data it is important to note that changes in notifi cations over time may not solely refl ect changes in disease prevalence. Increases in screening rates, more targeted screening, the use of more sensitive diagnostic tests, as well as periodic public awareness campaigns may contribute to changes in the number of notifi cations over time. Age adjusted notifi cation rates were calculated for Indigenous and non-Indigenous populations for jurisdictions that had Indigenous status data completed in more than 50 per cent of notifi cations. These data however, have to be interpreted cautiously as STI screening occurs predominantly in specifi c high-risk groups including Indigenous populations. Similarly, rates between males and females need to be interpreted cautiously as rates of testing for STI differ between the sexes. Table 11. Cholera notifications 2004, Australia, by notifying jurisdiction and case details Notifying jurisdiction Sex Age at onset Vibrio cholerae serogroup/biotype/ serotype Toxin production Country of acquisition NSW Male 45 Vibrio cholerae O1 El Tor Unknown Philippines Qld Female 50 Vibrio cholerae O1 Unknown Unknown Vic Female 23 Vibrio cholerae O1 Ogawa Not reported India Vic Female 34 Vibrio cholerae O1 El Tor Ogawa Not reported India WA Male 33 Vibrio cholerae O1 Unknown Indonesia CDI Vol 30 No 1 2006 35
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