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COMMUNICABLE DISEASE
Communicable diseases are those diseases 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 2004 these two groups accounted for 4% of all deaths in Australia (5,305 deaths). Influenza and pneumonia accounted for 64% (3,381) of these deaths. Death rates increase with age, and were greater for males than females in most age groups. In 2004-05, there were 87,519 hospital separations in Australia with a principal diagnosis of infectious and parasitic diseases. Acute respiratory infections including influenza and pneumonia were responsible for a further 129,255 separations.
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 Australian Government Department of Health and Ageing (DoHA).
The total of notifications to NNDSS in 2005 was 125,675, an increase of 10% on the 113,852 notifications made in 2004 (table 9.36). In 2005 sexually transmitted infections (STI) were the most commonly reported communicable diseases, accounting for 43% of all notifications, followed by gastrointestinal diseases (23%) and blood-borne diseases (15%).
Chlamydia was the most common STI (41,310 notifications, 76% of total STIs); campylobacteriosis the most common gastroenteritis (16,479 notifications, 56% of total) and hepatitis C (unspecified) was the most common blood-borne disease (12,232 notifications, 63% of total).
9.36 NATIONAL NOTIFIABLE DISEASE SURVEILLANCE SYSTEM REPORTS
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| Disease(c) | Notifications | Rate(a) |
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|
2004(b) | 2005 | 2003(b) | 2004(b) | 2005 |
no. | no. | % | % | % |
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| Blood-borne diseases |  | | | | |
| Hepatitis B (incident) | 281 | 247 | 1.7 | 1.4 | 1.2 |
| Hepatitis B (unspecified) | 5,815 | 6,392 | 29.6 | 29.2 | 31.4 |
| Hepatitis C (incident) | 451 | 366 | 3.3 | 2.8 | 2.2 |
| Hepatitis C (unspecified) | 12,863 | 12,232 | 69.0 | 64.0 | 60.2 |
| Hepatitis D | 28 | 30 | 0.1 | 0.1 | 0.1 |
| Hepatitis n.e.c. | - | - | - | - | - |
| Gastrointestinal diseases | | | | | |
| Botulism | 1 | 3 | - | - | - |
| Campylobacteriosis | 15,584 | 16,479 | 116.5 | 116.5 | 121.6 |
| Cryptosporidiosis | 1,684 | 3,208 | 6.2 | 8.4 | 15.8 |
| Haemolytic uraemic syndrome | 16 | 20 | 0.1 | 0.1 | 0.1 |
| Hepatitis A | 319 | 325 | 2.2 | 1.6 | 1.6 |
| Hepatitis E | 28 | 31 | 0.1 | 0.1 | 0.2 |
| Listeriosis | 67 | 54 | 0.3 | 0.3 | 0.3 |
| Salmonellosis | 7,834 | 8,444 | 35.3 | 39.0 | 41.5 |
| Shigellosis | 522 | 731 | 2.2 | 2.6 | 3.6 |
| SLTEC, VTEC(d) | 49 | 87 | 0.3 | 0.2 | 0.4 |
| Typhoid | 76 | 52 | 0.3 | 0.4 | 0.3 |
| Quarantinable diseases | | | | | |
| Cholera | 5 | 3 | - | - | - |
| Sexually transmissible diseases | | | | | |
| Chlamydial infection | 36,222 | 41,310 | 153.2 | 180.1 | 203.2 |
| Donovanosis | 10 | 13 | 0.1 | - | 0.1 |
| Gonococcal infection | 7,193 | 8,023 | 34.2 | 35.8 | 39.5 |
| Syphilis (all categories) | 2,332 | 2,213 | 10.1 | 11.6 | 10.8 |
| Syphilis less than 2 years duration | 615 | 623 | - | 3.1 | 3.1 |
| Syphilis more than 2 years duration | 1,579 | 1,589 | - | 7.9 | 7.8 |
| Syphilis - congenital | 12 | 15 | 0.1 | 0.1 | 0.1 |
| Vaccine preventable diseases | | | | | |
| Diphtheria | - | - | - | - | - |
| Haemophilus influenza type b | 15 | 17 | 0.1 | 0.1 | 0.1 |
| Influenza (laboratory confirmed) | 2,133 | 4,568 | 17.5 | 10.6 | 22.5 |
| Measles | 45 | 10 | 0.5 | 0.2 | - |
| Mumps | 102 | 241 | 0.4 | 0.5 | 1.2 |
| Pertussis | 8,752 | 11,200 | 25.7 | 43.5 | 55.1 |
| Pneumococcal disease | 2,377 | 1,705 | 11.3 | 11.8 | 8.4 |
| Rubella | 31 | 31 | 0.3 | 0.2 | 0.2 |
| Rubella - congenital | 1 | 1 | - | - | - |
| Tetanus | 5 | 2 | - | - | - |
| Vector-borne diseases | | | | | |
| Barmah Forest virus infection | 1,106 | 1,321 | 6.9 | 5.5 | 6.5 |
| Dengue | 351 | 220 | 4.3 | 1.7 | 1.1 |
| Flavivirus n.e.c. | 61 | 29 | 0.3 | 0.3 | 0.1 |
| Japanese encephalitis | 1 | - | - | - | - |
| Kunjin virus | 12 | 1 | 0.1 | 0.1 | - |
| Malaria | 558 | 821 | 3.0 | 2.8 | 4.0 |
| Murray Valley encephalitis | 1 | 2 | - | - | - |
| Ross River virus infection | 4,210 | 2,548 | 19.4 | 20.9 | 12.5 |
| Zoonoses | | | | | |
| Brucellosis | 39 | 41 | 0.1 | 0.2 | 0.2 |
| Leptospirosis | 178 | 130 | 0.6 | 0.9 | 0.6 |
| Ornithosis | 236 | 164 | 1.0 | 1.2 | 0.8 |
| Q fever | 463 | 353 | 2.8 | 2.3 | 1.7 |
| Other diseases | | | | | |
| Legionnellosis | 311 | 337 | 1.7 | 1.5 | 1.7 |
| Leprosy | 7 | 9 | - | - | - |
| Meningococcal infection | 405 | 393 | 2.8 | 2.0 | 1.9 |
| Tuberculosis | 1,060 | 1,090 | 4.8 | 5.3 | 5.4 |
| Total | 116,046 | 127,724 | 528.1 | 566.1 | 618.2 |
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(a) Rate per 100,000 population is calculated using the estimated resident population at the midpoint (30 June) of the relevant calendar year.
(b) Revised totals for 2002 to 2005 as at July 2006. Totals may vary over time as notifications are subject to revision.
(c) Diseases reported to NNDSS from all jurisdictions except hepatitis B (unspecified) not reported from NT; incident hepatitis C not reported from Qld; campylobacteriosis not reported from NSW.
(d) SLTEC/VTEC: Shiga-like toxin/verotoxin producing E. coli infections. |
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| Source: Commonwealth Department of Health and Ageing, 'National Notifiable Disease Surveillance System', last viewed August 2006, <http://www9.health.gov.au/cda/source/CDA-index.cfm>. |
HIV AND AIDS
In collaboration with the state and territory health authorities and the Australian Government, surveillance for human immunodeficiency virus (HIV) and acquired immunodeficiency 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 DoHA.
At 31 December 2005 the cumulative number of cases of newly diagnosed HIV infections (since 1985) was 25,242. The annual number of new HIV diagnoses reached a low of 716 in 1999, after which there was a continual increase (to 954 in 2005). The cumulative number of AIDS diagnoses, adjusted for reporting delay, was 9,859 (since 1981) and there was a total of 6,668 deaths following AIDS (table 9.37).
There has been a reduction in numbers of new AIDS diagnoses since the late-1990s, which has been due to the decline in HIV incidence that took place in the mid-1980s, and the use, since around 1996, of effective combination antiretroviral therapy for the treatment of HIV infection. In Australia, around 70% of all people living with HIV/AIDS are receiving antiretroviral treatment. However, the long-term effectiveness of antiretroviral treatment in preventing progression of HIV infection remains unknown.
9.37 NEWLY DIAGNOSED HIV CASES(a), AIDS CASES AND DEATHS FOLLOWING AIDS(b)
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| Year of diagnosis(c) | |
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| Prior to 2002 | 2002 | 2003 | 2004 | 2005 | Total |
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| HIV cases(a) | 21,669 | 850 | 868 | 901 | 954 | 25,242 |
| AIDS cases(b) | 8,915 | 237 | 246 | 204 | 257 | 9,859 |
| AIDS deaths(b) | 6,247 | 103 | 118 | 108 | 92 | 6,668 |
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(a) Not adjusted for multiple reporting.
(b) AIDS cases diagnosed and deaths following AIDS in the years from 2002 were adjusted for reporting delays; AIDS cases diagnosed and deaths following AIDS in previous years were assumed to be completely reported.
(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. |
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| Source: 'HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2006', 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 (77% in 2005). Exposure to HIV was attributed to heterosexual contact in 19.6% of new diagnoses and to injecting drug use in 3.4% of diagnoses (table 9.38). Mother-to-child transmission of HIV remains rare in Australia.
9.38 CHARACTERISTICS OF CASES OF NEWLY DIAGNOSED HIV INFECTION(a), Number of cases and proportion of total cases
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| | Year of diagnosis(b) | |
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| |
| Units | 2002 | 2003 | 2004 | 2005 | Total(c) |
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| Total cases | no. | 850 | 868 | 901 | 954 | 25,242 |
| Males | % | 88.8 | 89.7 | 86.0 | 90.3 | 91.9 |
| State and territory | | | | | | |
| New South Wales | % | 47.9 | 49.3 | 45.2 | 42.0 | 56.1 |
| Victoria | % | 25.8 | 23.5 | 23.9 | 27.0 | 21.3 |
| Queensland | % | 15.3 | 14.6 | 17.3 | 17.5 | 11.3 |
| South Australia | % | 3.5 | 5.2 | 6.0 | 5.4 | 3.9 |
| Western Australia | % | 5.4 | 6.2 | 5.4 | 6.6 | 5.3 |
| Tasmania | % | 0.6 | - | 0.6 | 0.5 | 0.4 |
| Northern Territory | % | 0.9 | 0.6 | 0.9 | 0.2 | 0.6 |
| Australian Capital Territory | % | 0.6 | 0.6 | 0.8 | 0.7 | 1.1 |
| Exposure category(d) | | | | | | |
| Male homosexual contact | % | 70.6 | 73.6 | 67.7 | 72.1 | 76.8 |
| Male homosexual contact and injecting drug use | % | 4.3 | 4.4 | 4.0 | 4.3 | 4.4 |
| Injecting drug use(e) | % | 2.7 | 3.6 | 4.3 | 3.4 | 4.2 |
| Heterosexual contact | % | 21.9 | 18.2 | 23.6 | 19.6 | 11.9 |
| Haemophilia/coagulation disorder | % | - | - | - | - | 1.3 |
| Receipt of blood/tissue | % | - | - | 0.1 | 0.1 | 1.1 |
| Mother with/at risk of HIV infection | % | 0.3 | 0.2 | 0.1 | 0.6 | 0.4 |
| Health care setting | % | 0.1 | - | 0.1 | - | - |
| Other/undetermined | % | 9.4 | 7.5 | 7.5 | 10.1 | 15.2 |
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(a) Not adjusted for multiple reporting.
(b) 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.
(c) Includes figures for years prior to 2002.
(d) The ‘Other/undetermined’ category was excluded from the calculation of the percentage of cases attributed to each HIV exposure category.
(e) Excludes males who also reported a history of homosexual/bisexual contact. |
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| Source: 'HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2006', National Centre in HIV Epidemiology and Clinical Research, University of New South Wales; Australian Institute of Health and Welfare. |
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 National Health and Medical Research Council (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 March 2006, 90% of one year olds, 92% of two year olds and 84% of six year olds were fully immunised according to the NHMRC Recommended Australian Standard Vaccination Schedule. State summaries by age group based on ACIR data are published on the Medicare Australia web site at: <http://www.medicareaustralia.gov.au>.
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