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Annual report National Notifiable Diseases Surveillance System, 2004 Ross River virus infection Case defi nition – Ross River virus infection Only confirmed cases are reported. Confirmed case: Requires isolation of Ross River virus, OR detection of Ross River virus by nucleic acid testing, OR IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to Ross River virus, OR detection of Ross River virus-specific IgM. There were 4,000 notifi cations of Ross River virus (RRV) infection reported to NNDSS in 2004, which accounts for two-thirds (67%) of the total mosquitoborne disease notifi cations received in 2004. The highest contributors to RRV notifications in 2004 were Queensland (45%, n=1,795), Western Australia (27%, n=1,099), and New South Wales (18%, n=700). The highest rates of infection were reported by the Northern Territory (117.6 cases per 100,000 population), Western Australia (55.4 cases per 100,000), and Queensland (46.2 cases per 100,000 population). The 2004 national RRV notification rate (19.9 cases per 100,000) was the third highest RRV notification rate reported to NNDSS since 1999. Map 8 shows that the highest rate of RRV infection in 2004, was in the Kimberley region area of Western Australia (202.8 cases per 100,000 population). RRV infection notifi cations in the Northern Territory peaked in January 2004 at 606.3 cases per 100,000 population (Figure 51). This was the highest rate since 1999, closely resembling the RRV peak notifi cation rate and profi le in the Northern Territory in Figure 51. Notification rates for Ross River virus infection, select jurisdictions, 1999 to 2004, by month and season of onset 700 January 2001. Queensland reported the peak notifi cation rate for RRV in March 2004 at 216.7 cases per 100,000 population, and this was a 24 per cent reduction from the peak notifi cation rate for April 2003 (286.3 cases per 100,000 population). In Western Australia, a state-wide outbreak of RRV peaked in January 2004 at 263.9 cases per 100,000 population which was the largest recorded outbreak of RRV in Western Australia 21,22 despite early warning through media and publicity channels. The predisposing environmental, entomological and virological aspects of the outbreak have been described elsewhere. 22,23 The age and sex distribution of RRV notifi cations are shown in Figure 52. The notification rates were highest in the 40–44 age group (38.9 cases per 100,000 population) and the female to male ratio was 1:0.9. Figure 52. Notification rates for Ross River virus infection, Australia, 2004, by age group and sex Rate per 100,000 population 45 40 35 30 25 20 15 10 5 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 65-69 70-74 75-79 80-84 85+ Flaviviruses Age group (years) Male Female Flaviviruses are single-stranded RNA viruses, some of which are associated with epidemic encephalitis in various regions of the world. In Australia, the flaviviruses of public health importance are Murray Valley encephalitis virus (MVEV), Kunjin virus (KUNV), Japanese encephalitis and dengue viruses. Rate per 100,000 population 600 500 400 300 200 100 0 Jan 1999 Jul Jan 2000 Jul Jan 2001 Jul Northern Territory Queensland Western Australia Jan 2002 Jul Jan 2003 Month and year of onset Jul Jan 2004 Jul The Sentinel Chicken Programme is a surveillance network involving New South Wales, the Northern Territory, Victoria and Western Australia, and is designed to provide early warning of increased fl avivirus activity. 24 Antibodies to MVEV and KUNV are detected in sentinel fl ocks located in four Australian states. Sentinel chicken surveillance reports from previous seasons have been published, 25–27 and the latest report was published in CDI in 2005 as part of the National Arbovirus and Malaria Advisory Committee annual report, 2004–05. 28 56 CDI Vol 30 No 1 2006
National Notifiable Diseases Surveillance System, 2004 Annual report Map 8. Notification rates for Ross River virus infections, Australia, 2004, by Statistical Division of residence Murray Valley encephalitis virus Case defi nition – Murray Valley encephalitis virus Only confirmed cases are reported. Confirmed case: Requires isolation of Murray Valley encephalitis virus, OR detection of Murray Valley encephalitis virus by nucleic acid testing, OR IgG seroconversion or a significant increase in antibody level or a fourfold or greater rise in titre to Murray Valley encephalitis virus, OR detection of Murray Valley encephal itis virus-specific IgM in cerebrospinal fluid in the absence of IgM to Kunjin, Japanese encephalitis or dengue viruses, OR detection of Murray Valley encephalitis virus-specific IgM in serum in the absence of IgM to Kunjin, Japanese encephalitis or dengue viruses. This is only accepted as laboratory evidence for encephalitic illnesses. AND Non-encephalitic disease: acute febrile illness with headache, myalgia and/or rash, OR encephalitic disease: acute febrile meningoencephalitis characterised by one or more of the following: 1. focal neurological disease or clearly impaired level of consciousness, 2. an abnormal computerised tomograph or magnetic resonance image or electrocardiograph, 3. presence of pleocytosis in cerebrospinal fl uid, OR asymptomatic disease: Case detected as part of a serosurvey should not be notifi ed. Confi rmation of laboratory result by a second arbovirus reference laboratory is required if the case occurs in areas of Australia not known to have established enzootic/endemic activity or regular epidemic activity. In April 2004, there was one notification of MVEV from Central Australia, when an 11-month-old infant with an onset of symptoms in March 2004 was hospitalised in Alice Springs for one week, and then transferred to South Australia. The infant developed serious neurological sequelae and after a long and debilitating illness, died from complications from MVEV. The Health Department of the Northern Territory government issued a general seasonal warning for CDI Vol 30 No 1 2006 57
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