INFECTIOUS DISEASES

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NFECTIOU5 DISEASE NOTIFICATIONS FOR NSW, 1995BY SELECTED MONTH OF ONSETRECE1VED BY AIJGUST 31, 1995

Condition May Jun Jul Aug Total

Adverse event afterimmunisation 4 4 3 1 12AIDS 32 28 12 3 75Arboviral infection 80 24 12 9 125Brucello5is 1 - - 1Cholera - - 1 - 1Foodborne illness (NOS) 6 9 12 4 31Gastroentritit (instit) 37 12 184 147 380Gonorrhoea infection 42 32 12 11 97H. influenzae meningitis - 2 2 - 4H. influenzae septicaemia 1 - - 1 2Hepatitis A- acute viral 51 32 16 9 108Hepatitis B - acute viral 5 5 3 - 13Hepatitis B - chronic/carrier 55 47 26 13 141Hepatitis B - unspecified 411 369 235 103 1,1 18Hepatitis C - acute viral 13 7 4 1 25Hepatitis C - unspecified 817 680 441 172 2,119Hepatitis D - unspecified 1 2 - - 3Hepatitis, acute viral (NOS) - -. 1 - 1HIV infection 47 32 32 27 138Hydatid disease - 5 1 - 6Legionnaires disease 7 6 5 2 20Leptospirosis - - 1 - 1Malaria 17 1 3 1 22Measles 62 42 28 36 168Meningococcal infection (NOS) 1 - - - 1Meningococcal meningitis 4 12 10 6 32Meningococcal septicaemia 1 3 2 3 9Mumps 1 2 2 1 6Mycobacterial atypical 25 13 - - 38Mycobacterial infection (NOS) 18 15 10 3 46Mycobacterial tuberculosis 29 21 14 11 75Fertussis 145 122 102 49 408Qfever 15 18 15 5 53Rubela 49 35 55 58 197Salrnonela (NOS) 104 4.8 61 22 235Syphilis infection 93 60 62 24 239Tuberculosis - non-active 7 11 5 5 28Typhccd end paretyphoid 1 - 1 - 2

NoTIFIcATIoN TRENDS

igure 1 shows that there were relatively high levels ofI notifications in July 1995 for gastroenteritis, pertussisand rubella.The pattern of gastroenteritis notifications was discussedin the August issue of the NSW Public Health Bulletin.Notifications have continued at a high level, with 147 inAugust, all from the Northern Sydney, Western Sydneyand Wentworth Areas. In addition, the Hunter Area PublicHealth ljrsit advised that several diagnoses of Norwalkvirus were made from an outbreak in a hospital ward.

Rubella and pertussis notifications are discussed below.

Table 1 shows that notifications of meningococcalmeningitis have increased in recent months, with four casesin May 1995, 12 in June, 10 in July and six in August. Thecases were sporadic and the notifications came from almostall Public Health Units (PHIIJs). This reflects a typicalseasonal pattern of meningococcal disease, with higherlevels in spring and late winter.

Measles notifications in July 1995 were below the historicalaverage (Figure 1). However, Table 2 shows that cumulativenotifications have been higher for 1995 than for the sameperiod in 1994. Measles notifications peak each year duringspring and therefore notifications for the year until Augustreflect only the period of low activity. Measles notificationsso far this year have been a mixture of sporadic cases andsmall local outbreaks.

INCREASE IN RUBELLA NOTIFICATIONSSeveral PHUs have reported high rubella notification ratesin recent months. The highest notification rate was from theNorth Coast (PHU), with 22.6/100,000 so far this year,followed by Hunter Area PHIJ with 11.8/100,000. Theoverall Statewide rate was 5.4/100,000. Rubella notificationsusually peak in late spring in NSW. Figure 2 shows thatnotifications for August this year were the second highestrecorded for the month of August since laboratorynotification began late in 1991. So far this year 332 caseshave been notified, compared with 232 for the whole of1994.

Rubella is a mild febrile viral disease with a diffuse rashsometimes resembling that of measles or scarlet fever. Itis highly infectious, and is transmitted by nasopharyngealsecretions, either via droplets or direct contact. Childrenusually present few or no constitutional symptoms butadults may have a low-grade fever, headache, tiredness,nasal discharge and conjunctivitis. Up to half of infectionsoccur without a rash.

Rubella is notiflable by laboratories, but not doctors orhospitals. School principals and directors of child carecentres are required to inform their local PH1J if theybecome aware of cases in their institutions. As the clinicalsymptoms are non-specific, laboratory confirmation isrequired for a notification. Since a laboratory test would berequested only in a minority of cases of rubella, only a smallproportion of cases is notified.

Vol.6INo.9 95

RUBELLA NOTIFICATIONSNSW 1992-1995

250/

200

150

100

50

1992 1993 Jfl 1994 Jan 1995 Aag

- v.: ;ii*SUMMARY OF NSW INFECTiOUS DISEASE NOTIFICATIONSAUGUST 1995

Condition Number of cases notifiedPeriod Cumulative

August August August August1994 1995 1994 1995

Adverse reaction 4 1 29 21AIDS 47 1 362 185Arboviral infection 5 9 355 475Brucellosis 2 - 2 1Cholera - 1Diphtheria - -

Foodborne illness (NOS) 4 4 139 293Gastroenteritis (instit.) 39 147 200 430Gonorrhoea 33 11 251 241H influenzaeepiglottitis - - 18 3H influenzae B - meningitis 2 - 12 7H influenzaeB-septicaemia 1 1 10 5H influenae infection (NOS) - - 8 2Hepatitis A 44 9 375 333Hepatitis B 415 116 2,976 2,954Hepatitis C 909 173 6,119 5,092Hepatitis D - - 14 11Hepatitis, acute viral (NOS) - - 2 1H1V infection 37 27 303 320Hydatid disease 2 - 12 10Legionnaires' disease 4 2 50 56Leprosy 1 - 3 1Leptospirosis 2 - 13 4Lj5teriosis 1 - 5 7Malaria 17 1 145 80Measles 40 36 387 424Meningococcal meningitis 18 6 54 46Meningococcalsepticaemia 7 3 25 16Meningococcal infection (NOS) 2 - 10 10Mumps 1 1 4 8Mycobacterial tuberculosis 27 11 283 211Mycobacterial-atypical 39 - 349 217Mycobacterial infection (NOS) 6 3 26 67Pertussis 128 49 981 700Plague - - - -

Poliomyelitis - - -

Qfever 15 5 182 119Rubella 12 58 128 332Salmonella infection (NOS) 62 22 762 804Syphilis 114 24 735 547Tetanus - - 2Typhoid and paratyphoid 3 - 25 29Typhus - - - -

Viral haemorrhagic fevers - - - -

Yellow fever - - - -

Infectious diseases

Continued from page 95

Rubella is important because of its ability to producecongenital abnormalities if a pregnant woman is infected atless than 20 weeks gestation. Congenital rubella syndromemay include foetal death, malformations of major organsystems, deafness or mental retardation. Twelve cases ofcongenital rubella syndrome were reported in Australiain 1994.

The emphasis is therefore on the prevention of congenitalrubella. Initially this focused on immunisation of adolescentfemales with measles-mumps-rubella (MMR) vaccine,through the schoolgirl rubella program. In 1989 a furtherrecommendation for inoinuiiisation of all children at12 months of age was implemented, and from 1995 theschoolgirl immunisation program was extended to includeadolescent males. Most cases occur in the unimmunised,notably adolescent and adult males, and children 6-10 yearsof age. Seventy-four per cent (247) of the 332 notificationsreceived so far in 1995 referred to adolescent or adult males,and 13 per cent (42) to women of child-hearing age.

The pool of unimmunised people has been reduced everyyear since the introduction of the new immunisationrecommendations in 1989 and 1995 mentioned above. Thisshould lead to a progressive reduction in the magnitude ofepidemics. The NSW Health Department and several PHUshave recently produced media releases recommending that:

• women who are intending to become pregnantshould have their level of immunity checked;

• pregnant women should avoid contact withsuspected cases of rubella and seek medical adviceif contact occurs;

• people known or suspected of having rubella shouldavoid school and work, and especially avoid contactwith pregnant women, for at least four days afterthe onset of rash; and

• parents should ensure that their children areimmunised with MMIR at 12 months of age andagain in early adolescence, as recommended by theNational Health anti Medical Research Council.

PERTUSSIS (WHOOPING COUGH) IN ADULTSThe pertussis notification rate was higher than averagefor the month of July (Figure 1). The North Coast PHIJreported the highest notification rate for the periodJanuary ito August 31, 1995 (48 cases per 100,000,compared with the Statewide rate of 1 ii100,000). Forty percent of 1995 notifications were of people aged 20 years ormore, and two of the notifications were of people aged >75years. Vaccine efficacy wanes over a few years, soimmunised adolescents and adults provide a significantreservoir for pertussis. Pertussis in adults often takes theform of a mild atypical respiratory illness and is thereforeoften diagnosed late, after other tests have been negative inthe face of persisting symptoms. Erythromycin prophylaxisis effective only if given within three weeks of exposure,therefore late diagnosis severely limits the effectiveness ofpublic health follow-up. Doctors are encouraged to considera diagnosis of perbussis in adults with a persistent coughand to report cases to their local PHIl.

Vol.6/No.9 96

INFLUENZA-LIKE ILLNESS IN NSW1994AN0 1995

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INFLUENZA SURVEILLANCEInfluenza-like illness (ILl) activity in August 1995 waslower than during the peaks in June and July (Figure 3).Laboratory reports of influenza A and B persisted at a lowlevel.

The ILl consultation rate reported by NSW GeneralPractitioner Sentinel Network for the fourth week of Augustwas 1.5 per cent. This included data from about 75 doctorsand 10,000 consultations a week. The weekly ratesdecreased from mid- July. ILl rates peaked earlier in 1995than in 1994. In 1995 the peak rate was 3.9 per cent in thesecond week of June, while in 1994 it was 3.7 per cent in thesecond week of August.

Figure 4 shows the school absenteeism rate for the lastweek of August was relatively low (5.8 per cent). The rateremained stable during August. Reports were received byfive PHIJs, covering 14 schools with 11,500 pupils.

For August 1995, 30 influenza A arid 24 influenza Bnotifications were made by the serology departmentsof The Prince of Wales and Westmead hospitals. Virologyreports received from the Institute of Clinical Pathologyat Westmead, Prince of Wales Hospital, Royal AlexandraHospital for Children and Liverpool Hospital totalled4 isolates of influenza A, 14 of influenza B, 111 of respiratory

SCHOOL ABSENTEE SURVEILLANCE1995 IN NSW

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leT

l2-

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MONTH-

syncytial virus, 7 of parainiluenza 3, 17 of rhinovirus and3 of adenovirus. The number of both serology and virologyreports was much lower than those for July 1995.

Two PHIUs have recently released reports on influenzaimmunisation.

• A retrospective study of influenza vaccine uptakeconducted in 37 nursing homes hi Hunter areashowed that in 1994, 78 per cent of nursing homeresidents and 7 per cent of nursing staff had beenimmunised for influenza. Residents' and nursingstaffs opposition to immu.nisation was the mostlikely barriers to influenza uptake CM. Rae, personalcommunication).

• Based on sentinel general practice data, the

Illawarra PHTJ reported that 80 per cent of

influenza immunisations in 1994 were given to

people aged >65 years and others at high risk. Less

than 4 per cent of ILl consultations occurred in this

group.

I. Lovegrove D. Sentinel reporting on influenza-like illness iii theIllawarra, New South Wales. Communicable Diseases Intelltence 1995;19(l7):420-2.

HEALTH EDITORIAL STAFFeditor of the Public Health Bulletin is Dr Michael Frommer, Director, Research and Development, NSW Health Department.

Lynne Madden is production manager.Bulletin aims to provide its readers with population health data and information to motivate effective public health action. Articles,

vs and coniments should be 1,000 words or less hi length and include a summary of the key points to be made in the first paragraph.erences should be set out using the Vancouver style, the full text of which can be found in British Medical Journal 1988; 296:401-5.ace submit items in hard copy and on diskette, preferably using WordPerfect, to the editor, NSW Public Health Bulletin, Locked Mail

961, North Sydney 2050. Facsimile (02)391 9029.ace contact your local Public Health Unit to obtain copies of the NSW Public Health Bulletin.

VoI.6/No.9 97

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Abbreviations used in this Bulletin:CSA Central Sydney Health Area, SSA Southern Sydney Health Area, E5A Eastern Sydney Health Area, SW5 South Western Sydney HealthArea, WSA Western Sydney Health Area, WEN Wentworth Health Area, NSA Northern Sydney Health Area, CCA Central Coast HealthArea, ILL Illawarra Health Area, HUN Hunter Health Area, NC North Coast Public Health Unit, ND Northern District Public Health Unit,WN Western New South Wales Public Health Unit, CW Central West Public Health Unit, SW South West Public Health Unit, SE South EastPublic Health Unit, 0TH Interstate/Overseas, U/K Unknown, NOS Not Otherwise Stated.Please note that the data contained in this Bulletin are provisional and subject to change because of late reports or changes in caseclassification. Data are tabulated where possible by area of residence and by the disease onset date and not simply the date ofnotification or receipt of such notification.

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INFECTIOUS DISEASE CUMULA11VE NOTIFICATIONS FOR NSW, 1995RECEIVED BY AUGUST 31. 1995

Condition CCA CSA CW ESA HUN ILL NC ND NSA SE SSA SW SWS WEN WNS WSA U/K Total

AIDS 2 42 62 7 1 16 24 10 - 6 6 - 9 - 185Arboviral infection 6 4 7 10 24 188 42 5 151 3 12 1 2 iS 2 - 475Brucellosis 1 - - - -. - - - 1Cholera - 1 - - - - - - - 1Gonorrhoea infection 2 41 6 95 3 9 14 6 12 5 13 - 14 3 9 9 - 241Hepatitis B -acute viral - 3 1 9 3 2 1 1 - 3 - S 4 - 35Hepatitis B - chronic/carrier 15 11 171 6 10 3 10 - - 6 7 75 - 314Hepatitis B -unspecified 18 269 8 43 57 60 45 8 369 18 361 14 963 13 5 354 - 2,605Hepatitis C-acute viral 1 1 5 1 - - - 2 33 1 - 44HepatitisC-unspedfied 138 495 219 784 293 303 554 130 377 152 308 150 558 93 15 448 - 5,044Hepatitis D - unspecified - 1 4 1 1 1 - 3 - - - - 11Hepatitis, acute viral (NOS) - 1 - - - - - - - 1HiVinfection 7 54 1 116 10 8 6 15 15 2 17 6 - 15 6 320Hydatid disease - 1 1 1 1 - 2 3 - - 1 - 10Legionnaires' disease 1 2 5 9 5 1 2 8 - - 3 2 1 17 - 56Leprosy - 1 - - - - - - - ILeptospirosis - - - - 1 - 1 2 - -. - - - - - - - 4Malaria 3 5 - 7 8 4 8 1 20 1 3 3 4 3 - 10 - 80Mersingococcal infection (NOS) 1 - - 1 1 - 2 - - - 2 1 1 - I - - 10Meningococcal meningitis 5 1 4 3 8 3 3 2 6 2 2 - 4 1 - 2 - 46Meningocaccal cepticeemia - 3 - - 5 - 1 1 2 - S - 2 1 - - - 16Mycobacterial atypical 7 28 - 51 12 6 10 6 28 1 18 3 27 5 6 8 - 217Mycobaciterial infection (NOS) 3 5 - - 7 - 4 - 9 - 4 - 28 2 - 7 - 67Mycobacterialtuberculosis 3 21 2 13 5 4 3 2 26 1 24 3 51 2 3 48 - 211Qfever - 1 7 - 9 2 36 27 - .- - 1 1 - 34 1 - 119Syphilis infection 5 54 9 105 12 10 52 29 24 5 36 3 86 9 74 34 - 547

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VACCiNE PREVENTABLE AND RELATED CONDI11ON5. CUMULATIVE NOTIFICA11ONS FOR NSW, 1995BY PUBUC HEALTH UNIT. RECEIVED BY AUGUST 31, 1995

Condition CCA CSA CW ESA HUN ILL NC ND NSA SE SSA SW SWS WEN WNS WSA Total

Adverse event afterimrnunisation - - - 1 - 3 2 - 2 2 5 - 4 - 2 21H. mt uenzae epiglottitis - - - 1 - - 1 - - - 1 - - - - - 3H. influenzae infection (NOS) 1 - - - - - 1 - - - - - - .- - - 2H. influenzae meningitis - 1 - - - - 3 - - - - - 1 - - 2 7H. influenzae septicaemia - - - - 1 -. - - 1 - 1 - 1 - - 1 5Measle5 13 23 10 53 40 53 32 38 12 5 32 9 29 37 -. 38 424Mumps - - - 1 - 2 2 - 1 - - - - - - 2 8Pertussis 22 18 9 21 33 54 204 8 63 17 30 35 43 63 11 69 700Rubela 2 7 1 23 62 2 95 25 51 - 15 3 16 6 1 23 332

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FOODBORNE INFEC11OU5 DISEASE CUMULA11VE NOTIFICATIONS FOR 1995BY PUBUC HEALTH UNIT, RECEIVED BY AUGUST 31, 1995

Condition CCA CSA CW ESA HUN ILL NC ND NSA SE SSA SW SWS WEN WN WSA Total

Fcrodborne illness (NOS}Gasliroentaritis (irrstit)Hepatitis A-acute viraListeriosisSalmonella (NOS)Typhoid and paratyphoidVibrio infection (non cholera)

16 9 - -- 33 - -8 51 32 89- 1 1 1

18 41 15 56- 1 - 8- - - 1

1621815-

59-

-

-

-

7-

39-

-

34518-

923-

1-

-

153-

-

4109

311

893-

-

1-

132-

-

1

22-

715-

8-

10-

21-

-

49-

25-

674-

-

1743-

371-

2023-

29-

-

204819

185

4-

293430333

7804

291

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