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Vaccine Preventable Disease Update
Clinical Vaccinology Update
November 2019
Janet Strachan
Senior Epidemiologist (Vaccine Preventable Diseases)
Communicable Disease Epidemiology and Surveillance
Health Protection Branch
Regulation Health Protection and Emergency Management Division
Measles
Measles Incidence Rate per Million
(12 month period)
https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/
UK 2019
Lost WHO “measles-free status"
USA 2019
Most measles cases
in 25 years
New Zealand 2019
> 2000 measles cases
Samoa 2019
≈1,800 measles cases
22 deaths
21/22 < 5 yrs old
10/22 < 12 mths old
Measles
Victoria vs Rest of Australia
January 2009 – October 2019
0
50
100
150
200
250
300
350
400
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
VIC Rest of Australia
http://www9.health.gov.au/cda/source/cda-index.cfm
Measles immunisation
Pre-1970 most children infected by 5 years of age
1970-72 single measles vaccine dose added to schedule
1992-93 2nd dose added to schedule
…
2019 Australian-born ≈ 25 – 50 years
- received maybe one dose = “under immunised”
2019 Overseas-born – unknown vaccination status
Measles prodrome
Cough
Coryza
Conjunctivitis
Fever
Rash around Day 4
Maybe not all symptoms present
Measles Rash
Rash begins behind ears
Spreads to face and neck
Spreads to rest of body
Rash can be very faint
- Might be itchy
- May appear anywhere on the body
Public Health Management
“Immune”
A person can be considered to be immune if:
• Born pre-1966 (presumed natural immunity)
• Documented evidence of 2 doses of measles vaccine
• Documented evidence of immunity (IgG positive)
• Documented lab-confirmed prior measles
Measles
Source of Infection
Victoria January 2019 – October 2019
SOURCE Cases
IMPORTED
Thailand 5
New Zealand 4
Vietnam 3
Philippines 3
India 1
Myanmar 1
Lebanon 1
[ Indonesia (Bali) 0 ]
IMPORT-RELATED
Australia (contact with known imported case) 17
Australia (unknown source) 3
November 2019
4 imported cases from Samoa
+
2 secondary cases
Samoa
Recent cases include seasonal workers in regional areas
Background Issue in Samoa
July 2018
Incorrect diluent used to prepare MMR 2 child deaths
“chaos … mistrust”
MeaslesVIC: January – October 2019By age group and sex
+
Age (years)
Measles
VIC: January – October 2019
Cases aged ≤ 12 months old
All aged ≥ 6 months
Influenza
Influenza – notified cases
VIC: 1 January 2017 – 31 October 2019
Notified cases of laboratory-confirmed influenza
Age group, influenza type, and rate (per 100,000 pop)
Victoria 2019
0
500
1000
1500
2000
2500
3000
0
1,000
2,000
3,000
4,000
5,000
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+
Age group (years)
Type A Rate
0
500
1000
1500
2000
2500
3000
0
1,000
2,000
3,000
4,000
5,000
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+
Age group (years)
Type B Rate
Nu
mb
er
of
No
tifi
ed
Cases
An
nu
al ra
te p
er 1
00,0
00 p
op
ula
tion
Influenza – notified cases
VIC: 1 January 2017 – 31 October 2019
Disease notifications based on laboratory results
eg Influenza and “Influenza-like illness”
GPs Hospital
Factors affecting number of
influenza notifications
Health-seeking behaviour
- Severity of illness
Immunity (vaccinated or previous exposure)
- Need work certificate
- Availability of doctor
- Age
Doctor testing behaviour
Flu surveillance
Flutracking - self reported online
Nurse-on-call
GPs - people presenting with influenza-like illness
Ambulance
Hospitals - emergency department, admissions, ICU
Mortality - death notifications (BDM – Dept Justice)
- Proportion of patients presenting with influenza-like illness (ILI)
- Percentage of patients with ILI who have influenza
- Identification of other circulating viruses causing ILI
VicSPIN
Sentinel GP surveillance of influenza-like illness
https://www.vidrl.org.au/surveillance/influenza-surveillance/
VicSPIN – sentinel GP surveillance
Influenza-like illness consultation proportions
2009 – October 2019
ALERT
ABOVE
AVERAGE
AVERAGE
BASELINE
Source: Victorian Infectious Diseases Reference Laboratory
0
5
10
15
20
25
30
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
ILI p
ati
en
ts p
er
1,0
00
co
nsu
ltati
on
s
Year
How severe is the flu this year?
FluCAN
Sentinel Hospital Admissions
Victoria
Laboratory-confirmed influenza admissions from 1 April
2019 2018 2017
year-to-date ICU % year-to-date ICU % year-to-date ICU %
Adult # 969 6.9 185 9.7 1029 10.9
Paediatric # 700 10.1 127 7.1 -- --
https://monashhealth.org/services/services-f-n/monash-infectious-diseases/research4/influenza-research/flucan-influenza-surveillance-2/
Meningococcal
Infection
Meningococcal Infections
VIC: 1 January 2009 – 31 October 2019
B C W Y Not typed Probable case
MenACWY
15-19 yrs
Meningococcal age groups
Victoria: 1 January 2015 – 31 October 2019
B C W Y Not typed Probable case
Whooping
Cough
Pertussis (whooping cough) – notified cases
VIC: 1 January 2009 – 31 October 2019
Pertussis – notified cases
VIC: Age groups
January – October 2019
All
ages
Infants
< 12 months
Vaccination in Pregnancy
https://www.health.gov.au/news/influenza-and-pertussis-whooping-cough-vaccination-in-pregnancy
Invasive
Pneumococcal
Disease https://www.theage.com.au/sport/afl/football-and-family-the-rising-star-and-his-heroic-grandfather
-20190802-p52d9q.html
Invasive Pneumococcal Disease
VIC: January 2009 – September 2019
Invasive Pneumococcal Disease
Age groups and mortality rate
Victoria 2014 - 2018
4.2% 16.3%
Pneumococcal serotypes
VIC: January – September 2019
PCV13 type
PPV23 type
non vaccine type
typing pending
Cases < 5 years old
Cases ≥ 65 years old
Rotavirus
Rotavirus
Victoria
October 2018 – September 2019
Age < 6 months
All ages: N=209
Vaccine Preventable Diseases
Victoria
Measles
- atypical clinical presentation
- New Zealand and Samoa
Meningococcal Infection
Pertussis
Pneumococcal Disease
- increase in non-vaccine strains
Other Victorian Vaccine Preventable Diseases Data
on DHHS website
https://www2.health.vic.gov.au/public-health/infectious-diseases/infectious-diseases-surveillance/interactive-infectious-disease-reports/local-government-
areas-surveillance-report
Thank-you
Melbourne Vaccine Education Centre
Notifying laboratories and doctors
Reference Laboratories – MDU and VIDRL
Communicable Diseases Section DHHS
- Epidemiology and Surveillance
- Prevention and Control
- Immunisation