COMMUNICABLE DISEASES

Communicable diseases are capable of being transmitted from one person to another, or from one species to another. Two major groups of communicable diseases, classified in the ICD-10, are certain infectious and parasitic diseases (ICD-10 codes A00-B99) and acute respiratory infections (ICD-10 codes J00-J22) which includes influenza and pneumonia as well as other acute upper and lower respiratory infections. In 2007, these two groups accounted for 3.4% of all deaths in Australia (4,641 deaths). Influenza and pneumonia accounted for 57% (2,623) of these deaths. Death rates increased with age, and were greater for males than females in most age groups. In 2007-08, there were 91,273 hospital separations in Australia with a principal diagnosis of infectious and parasitic diseases.

Through the National Notifiable Diseases Surveillance System (NNDSS), state and territory health authorities submit reports of more than 60 communicable disease notifications for compilation by the Department of Health and Ageing.

The total of notifications to NNDSS in 2008 was 160,498, an increase of 9.1% on the 147,555 notifications made in 2007 (table 11.20). In 2008, sexually transmitted infections (STI) were the most commonly reported communicable diseases, accounting for 43% of all notifications, followed by vaccine preventable diseases (21%) and gastrointestinal diseases (17%).

Chlamydia was the most common STI (58,515 notifications, 84% of total STIs); campylobacteriosis the most common gastroenteritis (15,533 notifications, 57% of total) and hepatitis C (unspecified) was the most common blood-borne disease (10,932 notifications, 60% of total).

11.20 NATIONAL NOTIFIABLE DISEASE SURVEILLANCE SYSTEM (NNDSS) REPORTS
	NOTIFICATIONS			RATE(a)
Disease(b)	2007	2008		2007	2008
Bloodborne diseases
Hepatitis B (incident)	294	245		1	1
Hepatitis B (unspecified)	6 883	6 591		33	31
Hepatitis C (incident)	384	385		2	2
Hepatitis C (unspecified)	11 906	10 932		57	51
Hepatitis D	34	43		-	-
Hepatitis (NEC)	-	1		-	-
Gastrointestinal diseases
Botulism	1	-		-	-
Campylobacteriosis	16 997	15 533		120	108
Cryptosporidiosis	2 812	2 005		13	9
Haemolytic uraemic syndrome (HUS)	19	31		-	-
Hepatitis A	165	277		1	1
Hepatitis E	18	44		-	-
Listeriosis	50	68		-	-
STEC, VTEC(c)	106	107		1	1
Salmonellosis	9 534	8 313		45	39
Shigellosis	602	829		3	4
Typhoid	90	105		-	1
Other bacterial infections
Legionellosis	306	273		2	1
Leprosy	13	11		-	-
Meningococcal disease (invasive)	306	285		2	1
Tuberculosis	1 174	1 225		6	6
Quarantinable diseases
Cholera	4	4		-	-
Plague	-	-		-	-
Rabies	-	-		-	-
Smallpox	-	-		-	-
Viral haemorrhagic fever (NEC)	-	-		-	-
Yellow fever	-	-		-	-
Sexually transmissible infections
Chlamydial infection	52 043	58 515		248	274
Donovanosis	3	2		-	-
Gonococcal infection	7 677	7 675		37	36
Syphilis	-	-		-	-
Syphilis - congenital	7	7		-	-
Syphilis < 2 years duration	1 422	1 298		7	6
Syphilis > 2 years or unspecified duration	1 740	1 940		8	9
Vaccine preventable diseases
Diphtheria	-	-		-	-
Haemophilus influenzae type b	17	25		-	-
Influenza (laboratory confirmed)	10 448	9 136		50	43
Measles	12	65		-	-
Mumps	586	286		3	1
Pertussis	5 347	14 524		25	68
Pneumococcal disease (invasive)	1 483	1 629		7	8
Poliomyelitis	1	-		-	-
Rubella	34	37		-	-
Rubella Congenital	2	-		-	-
Tetanus	3	4		-	-
Varicella zoster (Chickenpox)	1 668	1 790		8	8
Varicella zoster (Shingles)	1 561	2 313		7	11
Varicella zoster (Unspecified)	4 287	4 426		20	21
Vectorborne diseases
Arbovirus infection (NEC)	22	28		-	-
Barmah Forest virus infection	1 716	2 101		8	10
Chikungunya virus infection	-	9		-	-
Dengue virus infection	314	559		2	3
Japanese encephalitis virus infection	-	1		-	-
Kunjin virus infection	1	1		-	-
Malaria	568	532		3	3
Murray Valley encephalitis virus infection	-	2		-	-
Ross River virus infection	4 207	5 651		20	26
Zoonoses
Anthrax	1	-		-	-
Australian bat lyssavirus	-	-		-	-
Brucellosis	38	47		-	-
Leptospirosis	108	112		1	1
Lyssavirus (NEC)	-	-		-	-
Ornithosis	93	103		-	1
Q fever	448	373		2	2
Tularaemia	-	-		-	-
Total	147 555	160 498		702	751
- nil or rounded to zero (including null cells)
(a) Rate per 100,000 population is calculated using the ERP at the midpoint of 2007-08.
(b) Diseases reported to NNDSS from all jurisdictions except incident Hepatitis C not reported from QLD; campylobacteriosis not reported from NSW.
(c) SLTEC/VTEC: Shiga-like toxin producing E.coli infections.
Source: Commonwealth Department of Health and Ageing, National Notifiable Disease Surveillance System.

HIV and AIDS

In collaboration with the state and territory health authorities and the Australian Government, surveillance for human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) is conducted by the National Centre in HIV Epidemiology and Clinical Research. This centre is part of the Faculty of Medicine, University of New South Wales and is funded primarily by the Department of Health and Ageing (DoHA).

At 31 December 2008, the cumulative number of cases of newly diagnosed HIV infections since 1985 was 28,330 (table 11.21). The average number of new HIV cases diagnoses from 2004-2008 was 984 per year.

11.21 NEWLY DIAGNOSED HIV CASES(a), AIDS cases and deaths following AIDS(b)(c)
	2004	2005	2006	2007	2008	Total(d)
HIV cases(a)	911	962	1 007	1 046	995	28 330
AIDS cases(b)	202	232	221	161	99	10 348
AIDS deaths	91	69	83	53	24	6 765
(a) Not adjusted for multiple reporting. Cumulative to 31 December 2008.
(b) Number of AIDS cases diagnosed in NSW in 2008 are not available and not included in Totals.
(c) The number of HIV/AIDS diagnoses for each year may be revised over time due to late reports, updated information on exposure and testing history for reported cases, and removal of previously unrecognised duplicate diagnoses.
(d) Includes all cases reported prior to 2004
Source: HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2009', National Centre in HIV Epidemiology and Clinical Research, University of New South Wales; Australian Institute of Health and Welfare.

Transmission of HIV in Australia continues to be mainly through sexual contact between men, 66% in 2008, however, the rate of exposure through heterosexual contact has risen from 19.3% in 2005 to 27.1% in 2008 (table 11.22).

11.22 CHARACTERISTICS OF CASES OF NEWLY DIAGNOSED HIV INFECTION(a), Number of cases and proportion of total cases
			YEAR OF DIAGNOSES(a)
			2004	2005	2006	2007	2008	Total(b)
Total cases		no.	911.0	962.0	1 007.0	1 046.0	995.0	28 330
	Males	%	86.0	90.2	85.3	87.0	86.3	91.3
State and territory
	New South Wales	%	45.1	42.2	39.1	39.7	36.6	54.3
	Victoria	%	23.6	26.7	28.4	27.3	28.6	22.0
	Queensland	%	17.2	17.6	16.4	18.7	20.2	12.0
	South Australia	%	5.9	5.3	6.1	5.4	4.7	4.0
	Western Australia	%	5.5	6.6	7.6	7.2	7.6	5.6
	Tasmania	%	1.0	0.6	0.7	0.5	0.4	0.4
	Northern Territory	%	0.9	0.3	1.1	0.5	1.1	0.6
	Australian Capital Territory	%	0.8	0.7	0.6	0.9	0.7	1.1
Exposure category(c)
	Male homosexual contact	%	67.5	72.3	67.6	68.4	66.0	75.7
	Male homosexual contact and injecting drug use	%	4.0	4.3	3.9	2.8	3.2	4.3
	Injecting drug use(d)	%	4.4	3.4	2.8	2.9	3.1	4.0
	Heterosexual contact	%	23.8	19.3	25.0	24.9	27.1	13.5
	Haemophilia/coagulation disorder	%	-	-	-	-	-	1.2
	Receipt of blood/tissue	%	0.1	0.1	-	-	0.1	1.0
	Mother with/at risk of HIV infection	%	0.1	0.6	0.6	0.9	0.6	0.4
	Health care setting	%	0.1	-	-	-	-	-
	Other/undetermined	%	6.9	8.5	6.8	6.4	4.8	13.9
- nil or rounded to zero (including null cells)
(a) The number of HIV/AIDS diagnoses for each year may be revised over time due to late reports, updated information on exposure and testing history for reported cases, and removal of previously unrecognised duplicate diagnoses.
(b) Includes all reported cases prior to 2004. Not adjusted for multiple reporting.
(c) The ‘Other/undetermined’ category was excluded from the calculation of the percentage of cases attributed to each HIV exposure category.
(d) Excludes males who also reported a history of homosexual/bisexual contact.
Source: 'HIV and AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2009', National Centre in HIV Epidemiology and Clinical Research, University of New South Wales; Australian Institute of Health and Welfare.

According to the National Centre in HIV Epidemiology and Clinical Research, the per capita rate of HIV and AIDS diagnosis in Australia from 2003-2007 was at least five times higher among people born in countries in sub-Saharan Africa than among Australian born people. In the past five years, 60% of cases of HIV infection attributed to heterosexual contact were in people from high HIV prevalence countries or their sexual partners.

Children's immunisation

Immunisation programs for children are recognised as an effective public health intervention, and have been responsible for eradicating or minimising infectious diseases such as diphtheria, whooping cough and polio as major causes of death and disability in Australia.

The Australian Childhood Immunisation Register (ACIR), which commenced operation on 1 January 1996, aims to provide accurate and comprehensive information about immunisation coverage for all children under the age of seven. The register is administered by Medicare Australia and is a key component of initiatives to improve the immunisation status of Australian children.

Immunisation coverage goals for Australia for the year 2000, recommended by the NHMRC, called for 90% or more coverage of children at two years of age, and near universal coverage of children at school-entry age, against diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, measles, mumps, rubella and Hib (Haemophilus influenza type b).

ACIR data indicated, at 31 December 2008, 92% of one year olds, 93% of two year olds (see graph 11.23) and 89% of six year olds were fully immunised according to the NHMRC Recommended Australian Standard Vaccination Schedule.

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