Surveillance of notifiable infectious diseases in Victoria, 2004

Public Health Branch 2005 ii Surveillance of notifiable infectious diseases in Victoria, 2004

Published by the Communicable Disease Acknowledgements Control Unit, Rural & Regional Health We thank the following individuals, groups and Aged Care Services, Department of and organisations for the provision of data Human Services, Victoria, 2006. and assistance in the preparation of this © State of Victoria 2005 report: This publication is copyright, however, • Clinicians and laboratory staff who have whole or part thereof may be reproduced notified scheduled infectious diseases in the interests of public health provided to the department’s Communicable that acknowledgement is made. This Disease Control Unit in a timely manner, publication is available at http://www. allowing surveillance and public health health.vic.gov.au/ideas action. ISBN 0 7311 6089 4 • Medical Officers of Health and Environmental Health Officers for help in Editor the follow up of cases and contacts. James Fielding • The staff of the Victorian public health Document production laboratories; the Microbiological Diagnostic Unit (MDU), University of Rebecca Gelsi, Rowena Southgate Melbourne, and the Victorian Infectious Contributing authors Diseases Reference Laboratory Lynne Brown, Danny Csutoros, James (VIDRL), for providing advice, and Fielding, Joy Gregory, Rebecca Guy, Nasra helping investigate sporadic cases and Higgins, Genevieve Klug, Helen Pitcher, outbreaks of infection. Alina Tooley and Rodney Moran. • The Burnet Institute for contributing to the surveillance of HIV/AIDS.

Notes • Data presented in this report relate to notifications received by the department and do not necessarily reflect the true incidence of disease. • The analyses in this report were performed on data extracted in June 2005. Due to ongoing database management, differences may be observed between this report and those produced in 2004. • Up to date surveillance data and weekly commentary reports can be accessed at www.health.vic.gov.au/ideas Surveillance of notifiable infectious diseases in Victoria, 2004 iii

Contents

List of tables and figures v Alphabetical list of diseases viii Executive summary ix 1. Introduction 1 2. Methods 2 3. Blood-borne viruses 6 Hepatitis B 6 Acute hepatitis B 6 Chronic hepatitis B 7 Hepatitis C 7 Newly acquired hepatitis C 7 Hepatitis C (not further specified) 8 Hepatitis D 8 4. Enteric diseases 10 Campylobacter infection 10 Cholera 11 Cryptosporidiosis 11 Food- and water-borne illness 12 Giardiasis 13 Haemolytic uraemic syndrome and verotoxin-producing E. coli 14 Verotoxin-producing E. coli 14 Haemolytic uraemic syndrome 14 Hepatitis A 15 Hepatitis E 16 Listeriosis 16 Salmonellosis 17 Shigellosis 19 Typhoid and paratyphoid 20 5. Legionellosis 22 6. Invasive meningococcal disease 25 7. Creutzfeldt-Jakob disease 27 8 Sexually transmissible infections 29 Acquired immunodeficiency syndrome 29 Human immunodeficiency virus 33 Chlamydia 37 Gonorrhoea 39 Syphilis – infectious 40 iv Surveillance of notifiable infectious diseases in Victoria, 2004

9. Mycobacterial infections 42 Mycobacterium ulcerans infection 42 Tuberculosis 42 10. Vaccine preventable diseases 45 Haemophilus influenzae type b (Hib) infection 45 Influenza (laboratory confirmed) 45 Invasive pneumococcal disease 47 Measles 48 Mumps 49 Pertussis 49 Immunisation coverage in Victoria, 2004 51 11. Vector-borne diseases 55 Arbovirus infections 55 Barmah Forest virus disease 55 Kunjin virus disease 55 Ross River virus disease 56 Flavivirus infections 57 Malaria 57 12. Zoonoses 59 Brucellosis 59 Leptospirosis 59 Psittacosis 60 Q fever 61 13. Public health project funding 2003–04 63 14. Reports and publications 65 Peer review journals 65 Public health bulletins 65 Conference presentations 65 Communicable diseases training programs/workshops 66 15. Resources 67 Appendices 68 Appendix 1: Department of Human Services regions by Local Government area, Victoria 68 Appendix 2: Supplementary data – sexually transmissible infections, Victoria 2004 69 Surveillance of notifiable infectious diseases in Victoria, 2004 v

List of tables and figures

List of tables Table 1: Notified cases of confirmed and probable infectious diseases, Victoria, 2000–2004 4 Table 2: Notified cases of acute hepatitis B, Victoria, 1998–2004 6 Table 3: Reported risk factors for newly acquired hepatitis C, Victoria, 2004 8 Table 4: Notified cases of food- and water-borne illness, by causative organism/agent, Victoria, 2004 13 Table 5: Notified cases of verotoxin-producing E. coli (VTEC) and haemolytic uraemic syndrome (HUS), by serogroup and phage type, Victoria, 2004 14 Table 6: Risk factors for acquiring hepatitis A infection, Victoria, 2004 15 Table 7: Ten most common types of Salmonella notified, Victoria, 2004 17 Table 8: Notified cases of S. Enteritidis, by country of infection, Victoria, 2004 18 Table 9: Salmonellosis outbreaks, by Salmonella type, setting and source, Victoria, 2004 19 Table 10: Notified cases of shigellosis, by species and type, Victoria, 2004 19 Table 11: Notified cases of shigellosis, by risk factor, Victoria, 2004 20 Table 12: Notified cases of typhoid and paratyphoid, by country of acquisition, Victoria, 2004 21 Table 13: Notified cases of legionellosis, by species/serogroup, Victoria, 2004 22 Table 14: Notified cases of legionellosis, by species/serogroup and method of diagnosis, Victoria, 2004 23 Table 15: Notified cases of legionellosis, by employment/occupation status, Victoria, 2004 24 Table 16: AIDS diagnoses, by age group and sex, Victoria, 1983–2004 29 Table 17: AIDS diagnoses, by CD4 count, Victoria, 1983−2004 29 Table 18: AIDS diagnoses, by AIDS defining illness, Victoria, 1983−2004 30 Table 19: People living with AIDS, by sex and region, Victoria, 31 December 2004 31 Table 20: AIDS diagnoses, by sex and exposure category, Victoria, 1983–2004 31 Table 21: Exposure category of individuals diagnosed with AIDS within 12 months of their HIV diagnosis 32 Table 22: Deaths following AIDS diagnosis, by sex, Victoria, 1983−2004 32 Table 23: HIV diagnoses, by age group and sex, Victoria, 1983−2004 33 Table 24: HIV diagnoses, by region and sex, Victoria, 1983–2004 34 Table 25: HIV diagnoses, by sex and exposure category, Victoria, 1983–2004 35 Table 26: HIV diagnoses reporting heterosexual exposure, by partner type, Victoria, 1983–2004 36 Table 27: Reported reason for chlamydia testing, Victoria, 2004 38 Table 28: Susceptibility of N. gonorrhoeae isolates to ciprofloxacin, by sex, sex of partner and place of acquisition, Victoria, 2004 40 Table 29: Notified cases of gonorrhoea, by sex, sex of partner, partner type and place of acquisition, Victoria, 2004 40 Table 30: Notified cases of infectious syphilis, by reason for testing, Victoria, 2004 40 Table 31: Notified cases of tuberculosis, by site of disease, Victoria, 2004 43 Table 32: Notified cases of Haemophilus influenzae type b, by manifestation, Victoria, 1999–2004 45 Table 33: Notified cases of invasive pneumococcal disease, by age group and clinical presentation, Victoria, 2004 48 Table 34: Immunisation coverage at 12–<15 months of age, by region, Victoria, 2004 51 Table 35: Immunisation coverage at 24–< 27 months of age, by region, Victoria, 2004 51 Table 36: Immunisation coverage at 72–<75 months, by region, Victoria, 2004 52 Table 37: Notified cases of arbovirus, by type, Victoria, 1999–2004 55 Table 38: Notified cases of malaria, by species, Victoria, 2004 57 Table 39: Notified cases of malaria, by country of acquisition, Victoria, 2004 57 Table 40: Notified cases of leptospirosis, by region and rate per 100,000 population, Victoria, 2004 59 vi Surveillance of notifiable infectious diseases in Victoria, 2004

Table 41: Notified cases of Q fever, by occupation, Victoria, 2004 62 Table 42: Reported partner type (from whom HIV was reported to be acquired) in males reporting homosexual contact, Victoria, 1997–2004 69 Table 43: Clinical presentation at HIV diagnosis, Victoria, 1994–2004 69 Table 44: HIV diagnoses, by sex and reason for testing, Victoria, 1994–2004 70 Table 45: HIV diagnoses, by exposure category, probable place infection acquired and sex, Victoria, 2004 71 Table 46: HIV diagnoses in IDUs (excluding MSM), by region of birth and sex, Victoria, 1994–2004 72 Table 47: Diagnoses of newly acquired HIV infection by year, HIV exposure category and sex, Victoria, 1983–2004 72 Table 48: Diagnoses of HIV by time since last negative test or seroconversion illness and exposure category, Victoria, 1994–2004 73 Table 49: Total HIV tests performed and HIV rate per 100,000 tests by year, 1995 to 2004 74 List of figures Figure 1: Department of Human Services regions, Victoria 3 Figure 2: Notified cases of acute hepatitis B, by age group, sex and rate per 100,000 population, Victoria, 2004 6 Figure 3: Notified cases of acute hepatitis B, by region and rate per 100,000, Victoria, 2004 6 Figure 4: Notified cases of chronic hepatitis B, by age group, sex and rate per 100,000, Victoria, 2004 7 Figure 5: Notified cases of newly acquired hepatitis C, by age group, sex and rate per 100,000 population, Victoria, 2004 8 Figure 6: Notified cases of not further specified hepatitis C, by age group, sex and rate per 100,000 population, Victoria, 2004 9 Figure 7: Notified cases of Campylobacter infection, by age group and rate per 100,000 population, Victoria, 2004 10 Figure 8: Notified cases of Campylobacter infection, by region and rate per 100,000 population, Victoria, 2004 10 Figure 9: Notified cases of cryptosporidiosis, by age group and rate per 100,000 population, Victoria, 2004 12 Figure 10: Notified cases of cryptosporidiosis, by region and rate per 100,000 population, Victoria, 2004 12 Figure 11: Notified cases of giardiasis, by age group and rate per 100,000 population Victoria, 2004 13 Figure 12: Notified cases of giardiasis, by region and rate per 100,000 population Victoria, 2004 14 Figure 13: Notified cases of hepatitis A, by month of notification, Victoria, 2000–2004 15 Figure 14: Notified cases of hepatitis A, by age group and rate per 100,000 population, Victoria, 2004 15 Figure 15: Notified cases of salmonellosis, by age group and rate per 100,000 population, Victoria, 2004 18 Figure 16: Notified cases of salmonellosis, by region and rate per 100,000 population, Victoria, 2004 18 Figure 17: Notified cases of shigellosis, by age group and rate per 100,000 population, Victoria, 2004 20 Figure 18: Notified cases of legionellosis, by age group, sex and rate per 100,000 population, Victoria, 2004 22 Figure 19: Notified cases of legionellosis, by region and rate per 100,000 population Victoria 2004 23 Figure 20: Notified cases of invasive meningococcal disease, by age group and rate per 100,000 population, Victoria, 2004 25 Figure 21: Notified cases of invasive meningococcal disease, by region and rate per 100,000 population, Victoria, 2004 25 Figure 22: Notified cases of HIV and AIDS diagnoses, Victoria, 1983–2004 33 Figure 23: Notified cases of chlamydia, by age group, sex and rate per 100,000 population, Victoria, 2004 37 Figure 24: Notified cases of chlamydia, by region and rate per 100,000 population, Victoria, 2004 38 Figure 25: Notified cases of gonorrhoea, by age group, sex and rate per 100,000 population, Victoria, 2004 39 Figure 26: Notified cases of gonorrhoea, by region and rate per 100,000 population, Victoria, 2004 39 Figure 27: Notified cases of tuberculosis, by age group, sex and rate per 100,000 population, Victoria, 2004 43 Figure 28: Notified cases of tuberculosis, by region and rate per 100,000 population Victoria, 2004 43 Figure 29: Notified cases of influenza, by age group and rate per 100,000 population, Victoria, 2004 46 Figure 30: Notified cases of influenza, by month, Victoria, 2001–2004 46 Surveillance of notifiable infectious diseases in Victoria, 2004 vii

Figure 31: Notified cases of invasive pneumococcal disease, by age group and rate per 100,000 population, Victoria, 2004 47 Figure 32: Notified cases of pertussis, by age group and rate per 100,000 population, Victoria, 2004 49 Figure 33: Notified cases of pertussis, by year and age group as a proportion of total cases, Victoria, 2004 50 Figure 34: Notified cases of pertussis, by region and rate per 100,000 population Victoria, 2004 50 Figure 35: Notified cases of invasive meningococcal serogroup C disease, by year and age group, Victoria, 2000–2004 53 Figure 36: Notified cases of Ross River virus disease, by month of notification, Victoria, 1999–2004 56 Figure 37: Notified cases of Ross River virus disease, by reported exposure region and rate per 100,000 population, Victoria, 2004 56 Figure 38: Notified cases of malaria, by age group and rate per 100,000 population, Victoria, 2004 57 Figure 39: Notified cases of psittacosis, by age group, sex and rate per 100,000 population, Victoria, 2004 60 Figure 40: Notified cases of psittacosis, by region and rate per 100,000 population, Victoria, 2004 60 Figure 41: Notified cases of Q fever, by region and rate per 100,000 population, Victoria, 2004 61 viii Surveillance of notifiable infectious diseases in Victoria, 2004

Alphabetical list of diseases

Acquired immunodeficiency syndrome (AIDS) 29 Arbovirus infections 55 Barmah Forest virus disease 55 Brucellosis 59 Campylobacter infection 10 Chlamydia 37 Cholera 11 Cryptosporidiosis 11 Flavivirus infections 57 Food and water borne illness 12 Gonorrhoea 39 Giardiasis 13 Haemolytic uraemic syndrome 14 Haemophilus influenzae type b (Hib) infection 45 Hepatitis A 15 Hepatitis B 6 Hepatitis C 7 Hepatitis D 8 Hepatitis E 16 Human immunodeficiency virus (HIV) 33 Influenza (laboratory confirmed) 45 Invasive meningococcal disease 25 Invasive pneumococcal disease 47 Kunjin virus disease 55 Legionellosis 22 Leptospirosis 59 Listeriosis 16 Malaria 57 Measles 48 Mumps 49 Mycobacterium ulcerans infection 42 Pertussis 49 Psittacosis 60 Q fever 61 Ross River virus disease 56 Salmonellosis 17 Shigellosis 19 Syphilis 40 Tuberculosis 42 Typhoid and paratyphoid 20 Verotoxin-producing E. coli 14 Surveillance of notifiable infectious diseases in Victoria, 2004 ix

Executive summary Dr Rosemary Lester, Assistant Director, Communicable Disease Control Unit

Following the emergence of severe acute increased to 29,471, a rise of 16 per cent better reporting of suspected cases or respiratory syndrome (SARS) in early from 25,389 in 2003. After accounting for outbreaks. Regardless of the reason, 2003, 2004 brought with it the question cases that were subsequently rejected, the Communicable Disease Control Unit of whether there would be a seasonal re- referred to other jurisdictions and those and our partners in local government emergence of the SARS coronavirus. This that were notified from multiple sources aggressively follow up notifications to did not eventuate and instead a potentially (as notification is a legal requirement for identify and control potential outbreaks, as more serious global health threat both doctors and laboratories), in excess well as rectify practices that facilitate the presented itself. In 1997, 18 cases (six of of 55,000 notifications were processed by transmission of disease. which were fatal) of human infection with the Communicable Disease Control Unit Despite the increase in notifications for a highly pathogenic avian influenza caused in 2004. These data give an impression a number of diseases, there were also by the H5N1 subtype of influenza type A of the volume of work generated for several diseases – in particular those virus were reported in Hong Kong. There and conducted by Unit staff, which is that are vaccine-preventable – in which were no further cases until early 2003 undertaken in addition to routine reporting dramatic decreases were observed in when two more sporadic cases in Hong and quality improvement activities. 2004, demonstrating the success of Kong were reported; however in the first Comprising a substantial part of the our immunisation programs. This was three months of 2004 a total of 35 cases, increase in notifications was chlamydia particularly evident by the absence of with an alarmingly high case fatality rate and infectious syphilis, which continued to any rubella notifications and the dramatic of 69 per cent, were reported in Thailand rise alarmingly. Notifications of chlamydia reduction in the number of notifications and Vietnam. The cases were associated have risen 18 per cent in the last year to of serogroup C invasive meningococcal with large scale outbreaks among poultry more than 7,600; the continuation of an disease among the one to nineteen years across the Asian region from Japan to upward trend in which the notification rate age group. This is the cohort for which the Indonesia that resulted in the deaths and has increased 500 per cent since 1995 vaccine was introduced in 2003 and rolled culling of millions of birds. to 154 per 100,000 in 2004. Although out over several years. Similarly, cases Although Australia was not directly there were considerably fewer cases of of pneumococcal disease, particularly affected and there was no convincing infectious syphilis cases notified, the rise among people aged 65 years and older for evidence of human-to-human transmission of just over 50 per cent on the year before which vaccine has been funded in Victoria of the virus, its re-emergence in humans – especially among men who have sex since 1998, have been decreasing since in August indicated its presence in the with men – is of particular concern. There surveillance commenced in 2001. Measles region and the threat of its mutation were marginal decreases in the number continues to decline; however, the into a pandemic strain was likely to be of gonorrhoea and HIV notifications persistence of cases among people born sustained. The ensuing concern and received although in the context of between 1966 and 1982 is a challenge to heightened vigilance among both health the sharp increases in chlamydia and be overcome in meeting the regional goal professionals and the general public syphilis the significance of this is unclear. of measles elimination by 2012. Although required the Communicable Disease The department continues to seek it is satisfying to reflect on the successes Control Unit to rapidly develop appropriate and develop strategies to address this of immunisation in Victoria, it is important advice and protocols to respond to avian worsening problem with communities and that we remain vigilant in maintaining influenza queries and suspected cases. stakeholders. high immunisation rates, stay abreast of In the meantime, work on the Victoria The biggest contributor to the increase research and maintain program efficiency Influenza Pandemic Plan continued. This in notifications in 2004 was that for while incorporating changes and additions can now be accessed on our website. food- or water-borne illness. It is unclear to the National Immunisation Program. The number of confirmed or probable whether the increase was associated with Mycobacterium ulcerans infections cases of notifiable infectious diseases a genuine increase of gastrointestinal continued to present a public health reported to the department in 2004 illness in Victoria or whether it reflects problem in 2004, particularly in the x Surveillance of notifiable infectious diseases in Victoria, 2004

Point Lonsdale area where cases have occurred since 2002 following a slow but steady westerly shift along the coast from Bairnsdale. Little is known about this bacterium and the department is sponsoring research that will hopefully lead to a more targeted approach to its control. Arboviral notifications increased in 2004 compared to the previous year, but in historical terms were relatively moderate. Although the rise in notified cases was most marked for Ross River virus, one quarter were acquired interstate and no outbreaks in Victoria were identified. Among the zoonoses it was a noteworthy year for psittacosis in which there was a substantial increase on previous years. This was partly attributable to an outbreak among 26 poultry farm workers in the state’s west. Controlling the outbreak required the implementation of numerous veterinary, environmental and health measures through the cooperation of a variety of government authorities and reinforces the importance of our stakeholder relationships. The department wishes to thank all doctors and medical practitioners who promptly notified scheduled infectious diseases to the Communicable Disease Control Unit during 2004; these efforts allow us to respond quickly to public health threats. We would especially like to thank our partners in local government for their assistance in follow up activities and the staff of the Victorian Infectious Diseases Reference Laboratory, the Microbiological Diagnostic Unit and the Burnet Institute, which also provide technical assistance and conduct additional surveillance that informs our activities. Surveillance of notifiable infectious diseases in Victoria, 2004 1

1. Introduction

This report details the results of the laboratories can notify infectious diseases communicable disease surveillance by telephone on 1300 651 160 or and investigations conducted by the facsimile on 1300 651 170. Doctors can department in 2004. This work was also notify diseases online at www.health. carried out by staff of the Communicable vic.gov.au/ideas Disease Control Unit of the department in General information on infectious diseases collaboration with regional public health appears on the department’s web site officers, local government environmental http://www.health.vic.gov.au/ideas health officers, the Burnet Institute, the which also includes specific details about MDU and VIDRL. Additionally, this work the notification process and control of would not have been possible without infectious diseases, and daily, quarterly the assistance of the myriad of health and annual reports. professionals in laboratories, clinics, hospitals and regions throughout the state. In 2004 there were notifications received for 29,471 confirmed or probable cases of notifiable infectious disease, representing a 16 per cent increase compared to 2003. These data do not include the multitude of notifications received that did not meet the surveillance case definitions, were duplicates, or were for not notifiable diseases. Smallpox, tularaemia, severe acute respiratory syndrome (SARS), Mycobacterium ulcerans, Creutzfeldt-Jakob disease (CJD) and variant Creutzfeldt- Jakob disease (vCJD) became notifiable diseases for the first time in 2004. There were no confirmed or probable notified cases in 2004 of anthrax, botulism, diphtheria, Japanese encephalitis, leprosy, lyssavirus infections, Murray Valley encephalitis, plague, poliomyelitis, rabies, rubella, smallpox, tetanus, tularaemia, variant Creutzfeldt- Jakob disease, viral haemorrhagic fevers or yellow fever. Prompt notification of infectious diseases is an integral component of responsive public health action. Doctors and 2 Surveillance of notifiable infectious diseases in Victoria, 2004

2. Methods

Surveillance for communicable diseases Analyses in this report are based on the reflect a more sensitive or specific case occurs under the authority of the Health notification date, that is, the date on definition. (Infectious Diseases) Regulations which the notification was first received 2001. The Regulations require medical by the Communicable Disease Control practitioners and pathology laboratories Unit. Population notification rates were to notify the department of the probable calculated using the estimated resident or confirmed presence of prescribed population at 30 June 2004 obtained from infectious diseases. the Australian Bureau of Statistics. Notifiable diseases are classified in the Notifications were counted in the Victorian Regulations under four categories; Groups dataset if the postcode of the diagnosing A, B, C and D. Group A diseases are doctor was in Victoria. Postcodes of those which require an immediate public residence of the case and doctor do not, health response and all notifications are however, necessarily reflect the place followed up to confirm the diagnosis, of acquisition of infection and therefore identify risk factors and sources of regional rates should be interpreted with infection, and to prevent the further caution. This is particularly important transmission of disease. Responses to in small areas where the numbers Group B diseases are defined by disease reported may be too small for rates to be specific protocols; some diseases have meaningful. enhanced surveillance procedures, responses to others may occur only if a In 2004 the department had eight health cluster, outbreak or other unusual event is regions in Victoria, three metropolitan and detected. Information may be collected five regional areas (figure 1). Notifications from either the patient, the notifying were geocoded to local government areas doctor or both. Enhanced surveillance (LGA) by postcode and then allocated to systems implemented in Victoria are a departmental region. The denominators reported in the relevant sections. for regional incidence rates were the 2004 mid-year estimated resident population Group C diseases are the sexually for the combined LGAs. Appendix 1 transmissible infections (excluding outlines the LGAs contained within each HIV/AIDS). As complete identifiers are departmental region. not required for these diseases, further information regarding the notification is Changes have occurred in the number of only obtained from the notifying doctor. notified cases reported in previous annual Group D diseases are HIV infection and reports for some diseases. This is due to AIDS, for which departmental contact the ongoing maintenance and update of tracers follow-up all notifications. notification datasets as new information Victoria uses the interim surveillance became available, or as errors were case definitions that were developed by detected through data cleaning processes. the Communicable Diseases Network In addition, the CDNA, in collaboration of Australia (CDNA). Surveillance case with states and territories, revised the definitions can be found on the Australian surveillance case definitions for nationally Government Department of Health and notifiable diseases in Australia. Therefore Ageing website http://www.cda.gov.au some changes in total notifications may Surveillance of notifiable infectious diseases in Victoria, 2004 3

Figure 1: Department of Human Services regions, Victoria. Grampians Region

Loddon-Mallee Region

Hume Region

Gippsland Region

Barwon South-Western Region

North and Western Eastern Metropolitan Metropolitan Region Region

Southern Metropolitan Region 4 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 1: Notified cases of confirmed and probable infectious diseases, Victoria, 2000–2004

2000 2001 2002 2003 2004 Blood borne diseases Hepatitis B - acute 112 197 196 158 115 Hepatitis B - chronic/unknown 1,813 1,888 1,830 1,611 1,503 Hepatitis C - newly acquired 81 93 109 112 115 Hepatitis C - not further specified 5,513 4,900 4,059 3,641 2,918 Hepatitis D 12 7 9 13 4 Enteric diseases Botulism 1 1 0 0 0 Campylobacter infection 4,995 5,467 4,941 5,644 6,386 Cholera 0 1 1 0 2 Cryptosporidiosis1 119 445 284 214 305 Food/water/environmental - other 223 395 1,094 920 4,184 Giardiasis 860 858 710 772 783 Haemolytic uraemic syndrome 2 1 4 4 1 Hepatitis A 198 102 67 93 73 Hepatitis E 0 3 2 4 11 Listeriosis 11 9 15 21 13 Paratyphoid 4 9 14 10 24 Salmonellosis 1,005 1,090 1,207 1,263 1,130 Shigellosis 115 98 66 50 64 Typhoid 12 14 21 19 17 Verotoxin producing E.coli 0 4 5 3 4 Other notifiable diseases Invasive meningococcal disease 162 163 208 129 80 Legionellosis 246 121 108 90 102 Leprosy 0 0 2 2 0 Tuberculosis 289 298 280 329 326 Mycobacterium ulcerans infection2 2 21 24 12 26 Creutzfeldt-Jakob disease3 NN NN NN NN 5 Sexually transmissible infections Acquired immunodeficiency 69 57 46 51 38 syndrome Human immunodeficiency virus 197 218 233 225 217 Chlamydia 3,257 4,110 4,846 6,473 7,634 Gonococcal infection 742 721 802 1,165 1,112 Surveillance of notifiable infectious diseases in Victoria, 2004 5

Syphilis - infectious 8 16 28 55 83 Syphilis - other 230 306 345 302 338 Vaccine preventable diseases Haemophilus influenzae type b 3 2 2 1 1 Influenza – laboratory confirmed4 NN 176 596 658 206 Invasive pneumococcal disease5 14 321 454 468 388 Measles 21 82 13 38 15 Mumps 43 40 9 4 3 Pertussis 735 844 888 610 870 Rubella 66 60 15 3 0 Tetanus 1 1 0 1 0 Vector borne diseases Arbovirus - alphavirus 331 376 92 23 106 Arbovirus - flavivirus 13 17 13 18 13 Arbovirus - not further specified 16 5 0 0 0 Malaria 119 87 64 59 63 Zoonoses Brucellosis 0 1 2 4 3 Leptospirosis 36 38 17 10 8 Psittacosis 83 74 34 89 155 Q fever 23 62 83 18 27 Total 21,782 23,799 23,838 25,389 29,471

NN – not notifiable 1. Notification of cryptosporidiosis was voluntary until 16 May 2001 2. Creutzfeldt-Jakob disease became notifiable on 30 January 2004 3. Notification of Mycobacterium ulcerans infection was voluntary until 30 January 2004 4. Laboratory confirmed influenza became notifiable on 16 May 2001 5. Notification of invasive pneumococcal disease was voluntary from December 2000 to 16 May 2001 6 Surveillance of notifiable infectious diseases in Victoria, 2004

3. Blood-borne viruses Hepatitis B Figure 2: Notified cases of acute hepatitis B, by age group, sex and rate per 100,000 population, Victoria, 2004 Acute hepatitis B �� �� Summary of notifications ������ �� � There were 115 notified cases of ���� �

�� ���������������� acute hepatitis B infection in 2004, a � �� ���� reduction of 27 per cent on the number � �� of notifications in 2003. Although the � � 2004 total was lower than the number of � � notifications in 2002 and 2003, it was still � approximately 25 per cent higher than the �

������������������������ � annual average for the period 1998–2000 � � (table 2). Of these, 67 (58 per cent) were � �

in males. Notification rates were highest ��� ������ ������ for those aged 25–29 years (figure 2). ������������������������������������������������������������������������������������������������������������������������ ����������������� Seventy per cent of persons notified were Australian born; place of birth was Table 2: Notified cases of acute Hepatitis B, Victoria, 1998–2004 not stated for 14 notifications (12 per cent). One person was reported as being Year 1998 1999 2000 2001 2002 2003 2004 Aboriginal and/or Torres Strait Islander 79 85 112 197 196 158 115 origin; indigenous status was missing or Total not stated for five notifications (four per Figure 3: Notified cases of acute hepatitis B, by region and rate per cent). 100,000 population, Victoria, 2004 The largest number of notifications �� ��� was received for the North and West ����� Metropolitan region; however, notification �� ��� ���� ��� rates were highest for the Gippsland �� ���������������� region (figure 3). Two acute cases notified ��� �� were identified as interstate residents. ��� �� ��� Twenty-six cases (23 per cent) were ��� hospitalised; no deaths were recorded. ��

������������������������ ��� Thirty-three cases (22 per cent) were �� ��� identified as having hepatitis C co- � ��� infections. This proportion is similar to that � ��� observed in 2003 after having decreased ���� ������� �������� from 38 per cent in 2001. ��������� ��������� ��������� ������������� ������������ ��������������������������� ������������ ������������� ������ Surveillance of notifiable infectious diseases in Victoria, 2004 7

Risk factors Comment Hepatitis C Risk factor data were collected for 90 Vaccination of high-risk populations is the cases (78 per cent). Injecting drug priority for disease control because once Newly acquired hepatitis C use (IDU) in 60 cases (67 per cent) and the pool of infection is established it is Summary of notifications unsafe sex in 42 cases (47 per cent) very difficult to control. The department received notifications were identified as the main risk factors for 115 cases of newly acquired hepatitis for infection. Information acquired during Chronic hepatitis B C infection in 2004, an increase of three case follow-up suggested that the risk Summary of notifications cases compared to 2003. Newly acquired behaviours of sharing of needles, syringes infections comprised four per cent of all and other equipment among injecting drug There were 1,503 notified cases of chronic hepatitis C notifications for the year. Sixty- users continues. hepatitis B infection received in 2004 for 857 males (57 per cent) and 624 two cases (54 per cent) were female and Outbreaks and other females (41 per cent). Sex was not the median age was 23 years (range: 1–51 investigations specified for 22 notifications. Notification years). Notification rates were highest among those aged 15–19 years (figure 5). No outbreaks were identified. rates were highest for those aged 25–29 years (figure 4). Seventy-six cases (66 per cent) were diagnosed on the basis of a demonstrated seroconversion to hepatitis C virus within Figure 4: Notified cases of chronic hepatitis B, by age group, sex and the preceding 24 months. The remaining rate per 100,000, Victoria, 2004 34 per cent of the notifications were classified based on clinical evidence. ��� �� ������ Notifications were received sporadically �� ��� throughout the year from all departmental ���� �� ���������������� ��� regions. Where known, a majority of ���������� �� cases (61 per cent) were in people living �� �� in metropolitan regions. However, more in ���� �� depth locality analysis is difficult, because �� �� accurate residential addresses are not �� always supplied. ������������������������ �� �� Risk factors � � ��� Risk factor information is obtained from ������ ������ ������������������������������������������������ �������� ������������������������������������������������ �������� �������� ������� the diagnosing doctor. IDU continued ����������������� to be the highest reported risk factor for newly acquired hepatitis C infections (table 3). Two children aged one and three years were notified as acquiring hepatitis C through perinatal transmission and three minors aged between 15 and 16 years reported IDU within the previous two years as a risk factor. 8 Surveillance of notifiable infectious diseases in Victoria, 2004

Figure 5: Notified cases of newly acquired hepatitis C, by age group, Hepatitis C sex and rate per 100,000 population, Victoria, 2004 (not further specified)

�� �� ������ Summary of notifications

�� �� The department received notifications ���� ���������������� for 2,918 cases of hepatitis C (not further �� ���� � specified) in 2004, representing a 20 per cent decrease from 2003. Of these, 1,734 �� � were male and 1,156 were female; sex was �� � not specified for 30 cases. The highest rate and number of notified cases were ������������������������ � � for males aged 25–29 and 30–34 years

� � respectively (figure 6).

������ ������ �������� �������� �������� �������� �������� �������� �������� �������� �������� Risk factors ����������������� The majority of notifications were received from laboratories rather than treating Table 3: Reported risk factors newly acquired hepatitis C infections in doctors, so risk factor information was not routinely provided. for newly acquired hepatitis C, Victoria. Victoria, 2004 Enhanced surveillance on all cases Hepatitis D notified to the department as acute, plus Risk factor* Number those with some clinical or laboratory Summary of notifications Injecting drug use 82 indication of being newly acquired and Sexual partner hepatitis C There were four notified cases of hepatitis 19 positive all hepatitis C cases notified to the D virus (HDV) infection in 2004 in three Incarceration 13 department of people aged between males and one female aged between 28 Piercing 13 16 and 19 years, has been performed and 48 years. This is a sharp decrease by the Burnet Institute on behalf of the Tattoo 11 from 2003 in which 13 cases were department since June 2004. Others 34 notified. The department has also funded a * Multiple risk factors may be reported Risk factors for each individual. collaborative sentinel surveillance project with the Burnet Institute, VIDRL and the Risk factor information is not routinely Outbreak and other investigations MSHC. Part of the project will examine collected. No outbreaks were identified. risk factors for hepatitis C infection in Outbreaks and other targeted locations. Comment investigations The majority of newly acquired hepatitis No outbreaks were identified. C infections are asymptomatic and, without serological assays that distinguish between acute and chronic infections, incident cases are difficult to identify. The four per cent of cases notified in 2004 as newly acquired infections almost certainly under represents the burden of Surveillance of notifiable infectious diseases in Victoria, 2004 9

Figure 6: Notified cases of not further specified hepatitis C, by age group, sex and rate per 100,000 population, Victoria, 2004

��� ��� ������

��� ��� ���� ���������������� ��� ��� ���������� �� ��� ���� �� ��� �� ������������������������ �� ��

� �

��� ������ ������ �������� �������� ���������������� ���������������������������������������������������������������������������������������� ������� �����������������

Comment HDV can be misdiagnosed as an exacerbation of chronic hepatitis B infection. HDV and hepatitis B virus may co infect, or HDV infection may occur in persons with chronic hepatitis B. Prevention of hepatitis B infection with vaccination therefore prevents infection with HDV. Chronic carriers of hepatitis B can avoid exposure to HDV by adopting safe sexual and injecting behaviours. 10 Surveillance of notifiable infectious diseases in Victoria, 2004

4. Enteric diseases

Campylobacter infection years (range: three days to 104 years) and Risk factors notification rates per 100,000 population Risk factor information was not routinely Summary of notifications were highest for children aged under five collected. The department received notifications for years (figure 7). Notification rates were 6,386 cases of Campylobacter infection in highest for the Gippsland region (figure 8). Outbreak investigations 2004, for 3,533 males (55 per cent) and As in previous years, notifications were There were three outbreaks of 2,838 females (44 per cent); sex was not generally more frequent during the warmer Campylobacter investigated in 2004. The specified for 15 cases (one per cent). The months. first outbreak of Campylobacter was in a median age of persons notified was 29 military facility. There were 15 cases; five were confirmed as Campylobacter and Figure 7: Notified cases of Campylobacter infection, by age group and onsets for cases ranged from 23 May to rate per 100,000 population, Victoria, 2004 13 June. It was not possible to conduct ��� ��� an analytical study for this outbreak as ����� ��� the cases could not be interviewed, so ���� ��� a source was unable to be determined.

��� ���������������� Given the spread of onsets, transmission ��� ��� for at least some of the cases was likely to ��� ��� have been person to person. ��� In September 2004, the department ��� ��� received nine notifications of ��� ������������������������ �� Campylobacter in residents of the same ��� aged care facility. Local government � � undertook an investigation at the facility ��� ������ ������ �������� ���������������� �������� �������� and determined that meals were provided �������� �������������������������������� ���������������������������������������� ������� ����������������� by an off site kitchen, which also provided meals to other sites. No illness was reported in residents or staff of any of Figure 8: Notified cases of Campylobacter infection, by region and these other facilities during this period. rate per 100,000 population, Victoria, 2004 Illness was only reported from residents ���� ��� and staff in one of the two areas in the ������ ���� facility and the investigation revealed that ���� ��� residents and staff from this area had ���� ���������������� attended a barbeque two days prior to ���� ��� the first onset of illness. A detailed food ��� history could not be obtained from the

��� ��� residents as many suffer from dementia or poor memory. ��� ������������������������ �� In total there were 24 cases (16 residents ��� and eight staff) of which 11 were � � confirmed with Campylobacter infection. ���� �������� ������ ����� Findings suggested that the most likely ��������� ������ ���������� ��������� ��������� ��������� source of illness for the majority of cases ������ was having attended and consumed food Surveillance of notifiable infectious diseases in Victoria, 2004 11

at the barbeque. Six cases (one resident Comment Comment and five staff) did not attend the barbeque Campylobacter is a major cause of enteric Travellers to endemic areas should be and it is suspected that these may have disease and is thought to be responsible advised to take special care to avoid been secondary cases as their onsets for the majority of food-borne disease potentially contaminated water and food were several days after the initial cases. in developed countries. Prevention of prepared with untreated water. This In December, the Communicable Disease infection depends on good personal and includes ice used by some hotels and Control Unit was notified of illness in a food hygiene, particularly the adequate restaurants to cool drinks. group of residents of an aged care hostel washing of vegetables and cooking of raw in rural Victoria. A total of six residents meats. Cryptosporidiosis and one staff member had been ill with Drinking unpasteurised milk and not Summary of notifications diarrhoea (100 per cent), abdominal pain washing hands after handling farm (43 per cent), nausea (26 per cent) and The department received notifications for animals have been documented as 305 cases of cryptosporidiosis in 2004, vomiting (14 per cent). Onsets of illness causing outbreaks of Campylobacter ranged over three days and duration a 43 per cent increase on the number of infection and other enteric diseases with cases for 2003. There were 168 males was from three to six days. Three of the more serious complications, such as four faecal specimens collected were (55 per cent) and 137 females (45 per verotoxin producing E. coli infections. The cent) notified. The median age was nine positive for Campylobacter jejuni. Council department’s brochure ‘Reducing the risk inspected the premises and reviewed years (range: six months to 74 years) of gastroenteritis at open farms, petting and notification rates were highest for food processes, which were found to zoos and animal exhibits’ is available at be satisfactory. As the residents were persons aged zero to four years (figure http://www.health.vic.gov.au/ideas/ 9). Notification rates were highest for the unable to be interviewed a summary regulations/animal.htm of symptoms and illness history was Gippsland region (figure 10). not collected. An analytical study was Cholera Risk factors unable to be conducted and therefore Risk factor information was not routinely no food source could be identified in Summary of notifications collected. this investigation. The water supply to There were two notified cases of cholera the facility was investigated and was in 2004. The first case was a 34-year- Outbreak and other investigations found to be an unreticulated, untreated old female who became unwell within There were no point source outbreaks of supply via rainwater tanks. Residents ate a few hours of arriving in Australia after cryptosporidiosis in 2004. In May a cluster meals in the dining room and water was travelling on a holiday to India. She most investigation of nine cases, who lived in provided in jugs during meals. Water was likely acquired her infection in Delhi. Vibrio the same geographical area of Melbourne, sampled directly from the rainwater tank cholerae O1 Ogawa bv El Tor was cultured was commenced to determine if they had that provided water to the dining room from her faecal specimen. The second any common exposures. Cases ranged and submitted for analysis. High levels case was a 33-year-old female who also in age from one to 34 years and there of bacteria, including E. coli were found acquired her infection whilst on holiday were six males and three females. Only in the water, but no Campylobacter was in India. Vibrio cholerae O1 Ogawa was eight cases could be contacted and it was isolated. The hostel has since removed cultured from her faecal specimen. Both determined that three cases swam at the the rainwater tank from operation and cholera cases also had mixed infections same pool during their incubation period replaced the drinking water with a with Campylobacter. and had onsets of illness within the same serviced purified water-dispensing unit in three-day period. Council investigated the dining room. Outbreak and other investigations the pool and found water quality and the No outbreaks were identified. pool’s test records to be in accordance with the standards. No further cases 12 Surveillance of notifiable infectious diseases in Victoria, 2004

Figure 9: Notified cases of cryptosporidiosis, by age group and rate Food- and water-borne illness per 100,000 population, Victoria, 2004 Medical practitioners are required to notify

��� �� the department of suspected cases or ����� outbreaks of food- and water-borne illness, �� ��� ���� regardless of aetiology. This allows for the �� ���������������� early investigation of possible sources of �� �� illness where food or water is suspected,

�� �� which is important for preventing further cases. These notifications are classified as �� �� ‘group A’ and must be notified within 24 �� hours. ������������������������ �� � Although the notification system was � � originally intended for situations of two ��� ������ ������ ���������������� ���������������� or more related cases, the department �������������������������������������������������������� ���������������� ���������������� ������� ����������������� often receives single notifications when a medical practitioner suspects a particular Figure 10: Notified cases of cryptosporidiosis, by region and rate food or water source was associated with the illness. Local government per 100,000 population, Victoria, 2004 environmental health officers investigate �� �� sporadic cases. Pathogens that are not ������ �� notifiable under the Health (Infectious ���� �� �� ���������������� Diseases) Regulations 2001, including rare gastrointestinal infections, are also �� �� recorded. Notifiable pathogens are �� covered in separate sections of this �� �� report.

��

������������������������ � Summary of notifications �� In 2004, the department received � � notifications for 905 cases of specific

���� �������� ������ organisms/agents (not reported ������ ����� ��������� ��������� ��������� ��������� ��������� ������ elsewhere) associated with gastrointestinal illnesses potentially linked to food or water (table 4). This total represented an linked to the pool were reported. from swimming in pools until symptoms increase of 90 per cent on notifications in have subsided, and ensuring swimming 2003. Comment pool owners are aware of pool hygiene Major outbreaks of cryptosporidiosis have procedures. Infection in rural areas been attributed to both contaminated appears to be predominantly associated drinking water and recreational water use. with contact with farm animals and is Sporadic cryptosporidiosis can be avoided more frequent during the calving season. by educating people about personal hygiene, excluding people with diarrhoea Surveillance of notifiable infectious diseases in Victoria, 2004 13

Table 4: Notified cases of food – There was a 174 per cent increase on Risk factors and water-borne illness, by the number of norovirus outbreaks Risk factor information was not routinely notified this year compared with 2003 causative organism/agent, collected. (57 outbreaks). Of these outbreaks, 144 Victoria, 2004 occurred in hospitals, disability or aged Outbreak and other investigations Organism/agent Number care facilities, and over 4,365 people were No point source outbreaks were identified affected. Norovirus 878 in 2004. A cluster of 14 cases of giardiasis Clostridium perfringens 5 Salmonella and Campylobacter, outbreaks notified to the department between early July and mid August, and who all lived in Rotavirus 10 are discussed further in the respective sections of this report. one metropolitan area of Melbourne, was Scombrotoxin 9 investigated to determine if there were any Vibrio parahaemolyticus 2 Giardiasis common exposures amongst cases. Cases Adenovirus 1 ranged in age from one to 69 years and Summary of notifications Total 905 there were five males and nine females. The department received notifications for Thirteen cases were interviewed but no Outbreak and other investigations 783 cases of giardiasis in 2004 (compared common exposures were identified. In 2004, the department was notified with 772 cases notified in 2003), 427 for of 263 outbreaks of gastrointestinal males (55 per cent) and 352 females (45 Comment illness affecting at least 6,242 people. Of per cent); sex was not specified for four Giardiasis spreads rapidly in childcare these outbreaks, 20 were considered to notifications. The median age of cases centres and institutions. Personal hygiene, be food-borne or probable food-borne was 28 years (range: four months to 101 particularly hand washing before eating outbreaks, with the majority of the years). Notification rates were highest and handling food, and after toilet use and remainder being spread by person-to- among those aged zero to four years, with changing nappies, is critical to the control person transmission. Settings in which a secondary peak in adults aged 30-34 of this disease. outbreaks were reported included aged years (figure 11). Notification rates were care facilities (151 outbreaks), hospitals highest for the Southern Metropolitan (48), commercial caterers (15), childcare region (figure 12). facilities (13), disability/rehabilitation centres (ten), restaurants/hotels (nine), Figure 11: Notified cases of giardiasis, by age group and rate private residences (six), overnight camps per 100,000 population Victoria, 2004 (three), holiday facilities (three), schools ��� �� (two), play centre (one), recreation (one), ����� ��� and a military institution (one). �� ��� ���� ���������������� Organisms/agents responsible for the ��� �� 263 outbreaks were norovirus (156 ��� �� outbreaks), Salmonella (seven), rotavirus ��� (six), Campylobacter (three), Clostridium �� ��

perfringens (one), scombrotoxin (one) ������������������������ �� �� and adenovirus (one). In 88 outbreaks, �� �� the organism/agent responsible was �� unknown, but 54 of these outbreaks were � � suspected to have been viral and seven ��� ������ ������ were suspected to have been caused by ������������������������������������������������������������������������������������������������������������������������ ������� Clostridium perfringens. ����������������� 14 Surveillance of notifiable infectious diseases in Victoria, 2004

Figure 12: Notified cases of giardiasis, by region and rate per 100,000 Comment population Victoria, 2004 Once a case is identified, person-to- person transmission must be prevented by ��� �� ������ being careful with personal hygiene and �� ��� excluding cases from food and beverage ���� �� ���������������� preparation. Infection can be prevented �� ��� by adequately cooking meat products �� (particularly minced beef) and not ��� �� consuming unpasteurised milk and dairy � ��� products. � ������������������������ � �� Table 5: Notified cases of � Verotoxin-producing E. coli � � (VTEC) and haemolytic uraemic ���� �������� ��������� ��������� ��������� ��������� syndrome (HUS), by serogroup ������������� ������ ��������������� and phage type, Victoria, 2004 Haemolytic uraemic Verotoxin-producing E. coli E. coli serogroup and syndrome and verotoxin- VTEC HUS Summary of notifications phage type producing E. coli The department received notifications E. coli O26:H11 1 0 Escherichia coli are common bacteria for four cases of VTEC in 2004, all of E. coli O5:H– 1 0 normally found in the gut of warm-blooded whom were females. The cases ranged in E. coli O157 H:– 1 0 animals. There are many strains of E. age from eight to 71 years (median age E coli O157:H7 1 0 No E. coli isolated clinical coli, most of which are harmless. Some of 23 years). Table five lists the various 0 1 diagnosis strains, however, can produce toxins serogroups and phage types. Total 4 1 that are pathogenic in humans; one type is known as verotoxin-producing E. coli Risk factors Haemolytic uraemic (VTEC), also referred to as shiga-like Two cases had contact with farm animals syndrome toxigenic E. coli (STEC). The most common during their incubation period and another symptom is diarrhoea, which can range case acquired her infection overseas. Summary of notifications from mild to severe, and may be bloody Risk factors for the fourth case included There was one notified case of HUS in and accompanied by stomach cramps. consuming unwashed berries and a 2004, in a 40-year-old male. VTEC was not Symptoms can be severe in children and hamburger in her incubation period. isolated from a faecal specimen, however people with reduced immunity. Samples of berries and soil from the farm Campylobacter was isolated. The case Haemolytic uraemic syndrome (HUS) is a where the berries were grown were tested was clinically diagnosed with haemolytic rare condition affecting the kidneys and and found to be negative for VTEC. uraemic syndrome and thombotic thrombocytopaenia purpura. bloodstream that can be caused by VTEC. Outbreak and other investigations Abdominal pains and bloody diarrhoea No outbreaks were identified and no links mark the onset of a prodromal illness, Risk factors were found among the cases. A source which progresses to kidney failure and The case had consumed salami and drank could not be positively identified for any of anaemia. In Victoria, if a case of HUS also from a private water supply during his the cases. meets the case definition of VTEC, it will incubation period. be counted only once (as a case of HUS). Surveillance of notifiable infectious diseases in Victoria, 2004 15

Outbreak and other investigations Hepatitis A Risk factors No outbreaks were identified. Summary of notifications Overseas travel was the most frequently identified risk factor, accounting for 29 In 2004, there were 73 notified cases of Comment cases (40 per cent) (table 6). Risk factor hepatitis A sporadically throughout the Children under five years of age are at information was available for 72 cases (99 year, (65 confirmed and eight probable) the greatest risk of developing HUS, and a decrease of 22 per cent compared with per cent) but in most cases the source of outbreaks have been associated with the 93 notifications in 2003 (figure 13). There the infection could not be identified. consumption of food contaminated with were 46 (63 per cent) notified cases in Table 6: Risk factors for acquiring VTEC. males and 27 (37 per cent) in females. Notification rates were highest for those hepatitis A infection, Victoria, 2004 aged five to nine years (figure 14). There Risk factor Per (suspected Number were 27 hospitalisations. cent source) Figure 13: Notified cases of hepatitis A, by month of notification, Overseas travel 29 39.7 Victoria, 2000–2004 Overseas travel and �� household contact 4 5.5 with a case �� Non household 1 1.4 contact with a case �� Men who have sex 1 1.4 �� with men Household contact �� 6 8.2 with case �����������

������������������������ Intravenous drug �� 1 1.4 users � Source unknown 30 41.0 � Unable to contact 1 1.4

������ ������ ������ ������ ������������ ������������������ ������ ������������ ������������ ������������ ������ ������������ ������ Total 73 100 ��������������������� Outbreaks and other Figure 14: Notified cases of hepatitis A, by age group and rate per investigations 100,000 population, Victoria, 2004 There were three family clusters of �� � hepatitis A investigated in 2004. ����� �� � The first cluster was investigated in May ����

�� ���������������� and it was determined that the index case �� � had an onset of illness in April during �� a family visit to Lebanon but was never � � tested for hepatitis A virus (HAV). This � � child met the definition for a probable ������������������������ � case. After returning to Australia, a sibling � � became unwell in May and was diagnosed � � as HAV positive. Two additional siblings ��� had onsets of illness in June and were ������ ������ ������������������������������������������������������������������������������������������������������������������������ confirmed with hepatitis A. ����������������� 16 Surveillance of notifiable infectious diseases in Victoria, 2004

A second cluster of cases in a family was Hepatitis E Listeriosis investigated in June. There were five cases (four confirmed and one probable) that Summary of notifications Summary of notifications had onsets between 19 June and 29 June The department received notifications The department received notifications for after returning from Lebanon on 2 June. All for 11 cases of hepatitis E in 2004, in five 13 cases of listeriosis in 2004, in eight cases had contact with a jaundiced child females and six males, aged between males and five females. The median age of in Lebanon. 18 and 60 years. All diagnoses were cases was 52 years (range: 0 days to 84 years). There were three materno-foetal In July, a third cluster of cases in one confirmed by the detection of IgG in cases, with one foetal death reported, household group was investigated. The serum by enzyme immunoassay in the presence of a clinically compatible illness. giving a materno-foetal case fatality rate of index case became ill with jaundice 33 per cent. in March whilst in Iraq and was never Risk factors tested for hepatitis A. A sibling became Two of the ten non-materno-foetal cases The department was able to contact ten unwell in mid June just prior to returning died, corresponding to a case fatality rate of the cases and confirmed that six had to Australia and was later confirmed as of 20 per cent. Three cases presented with acquired their infection in India, one in HAV positive. This confirmed case may septicaemia, three cases presented with Vietnam, one in Thailand and two had meningitis and three cases presented with have acquired the infection from close travelled to multiple Asian countries meningitis and septicaemia (including one household contact with his brother or from including India. One case could not be who also had a brain abscess). The tenth an unknown source overseas. A further contacted but the doctor confirmed that case had Listeria monocytogenes isolated five siblings became unwell after arrival he had acquired his infection in India. from hip joint fluid. back in Australia, three with onsets in late July and two with onsets in early August. Outbreak and other investigations Risk factors These cases declined testing but were No links were identified among the cases. High risk foods identified in case follow-up counted as probable cases as they had an included sliced cold meats and soft epidemiological link to a confirmed case Comment cheese. Risk factors were identified for and had clinical hepatitis without a non- Hepatitis E is an acute enteric illness four of the ten non-materno-foetal cases. infectious cause. with a clinical course similar to that of These included cancer (one case), renal Comment hepatitis A. The diagnosis should be transplant (one case), steroid treatment considered in persons with acute hepatitis for ulcerative colitis (one case) and an Hepatitis A notified cases continued to and a history of travel to endemic areas. unknown immunosuppressive illness (one decline in Victoria in 2004 (figure 13). Persons intending to travel to endemic case). The reasons for this are unclear and may regions should be advised to take care reflect a greater awareness amongst Outbreak and other investigations with personal hygiene and avoid the travellers and other at-risk groups, consumption of undercooked foods and Two of the materno-foetal cases occurred and improved uptake of the vaccine. untreated water. in the same hospital, and both babies Vaccination should be encouraged for were born in the same delivery room, people intending to travel overseas and 27 hours apart. The possibility of cross- those in high-risk occupations such contamination was investigated. In the as childcare workers and health care earlier birth, both the mother and baby professionals. were unwell, the baby died soon after birth (at 27 weeks gestation). L. monocytogenes was cultured from a placental swab and a post-mortem blood sample. In the second birth the mother and baby were well (baby delivered at 28 weeks), but the Surveillance of notifiable infectious diseases in Victoria, 2004 17

placenta showed signs of inflammation, Comment Figure 16 shows the geographic and L. monocytogenes was cultured from Advice on food hygiene and appropriate distribution of cases across the nine a placental swab, while surface swabs, diet should be given to susceptible groups, departmental regions. Notification rates CSF, blood and gastric aspirate from the particularly pregnant women, the elderly were highest for the Barwon South baby, and urine and high vaginal swabs and the immunocompromised. Current Western region and the Grampians region from the mother were negative. Infection information available includes the National (31 and 29 per 100,000 respectively). control at the hospital investigated Health and Medical Research Council MDU performs identification of and it was found that the area where (NHMRC) statement on Listeria for medical Salmonella isolates in Victoria. In placentas are examined and weighed is practitioners. Pamphlets available include 2004, S. Typhimurium 9 was the most not routinely sanitised between deliveries, common serotype/phage type identified, the Food Standards Australia New Zealand giving a possible opportunity for cross accounting for 13 per cent of the total (FSANZ) pamphlet ‘Important health contamination from one placenta to the Salmonella notifications received for the next. This practice has now changed message, Listeria and pregnancy’ and the year (table 7). department’s Listeria poster and pamphlet, and the area is sanitised between every Table 7: Ten most common which are available in seven languages. delivery. The hospital laboratory checked types of Salmonella notified, their practices and were satisfied that no The department’s pamphlet is available breaches occurred in association with online at http://www.health.vic.gov.au/ Victoria, 2004 these two patients’ specimens. Repeated ideas/diseases/listeria_facts.htm. Salmonella Per testing of the placental swabs of the serotype and Number In recent years, notified cases of materno- cent phage type second case were negative. Since the foetal of listeriosis have fallen, likely as S. Typhimurium 9 145 13 placenta in the second case showed signs a result of the increase in information of infection, and no other pathogens were S. Typhimurium 170 137 12 provided to pregnant women about the cultured, the infection control physician risk of Listeria infection and the foods to S. Typhimurium 135 88 8 at the hospital confirmed the diagnosis of be avoided during pregnancy. In 2004, S. Typhimurium 197 59 5 listeriosis in this case, rather than cross- the department implemented a Listeria contamination of specimens. The third S. Infantis 43 4 awareness and education program for S. Typhimurium materno foetal case was also born in 36 3 carers of patients at high risk of acquiring u290 the same hospital although this was six S. Typhimurium 126 28 2 months earlier than these cases occurred. listeriosis. S. Virchow 8 26 2 To inform epidemiological investigations, Salmonellosis S. Typhimurium 12 23 2 Microbiological Diagnostic Unit (MDU) at The University of Melbourne routinely Summary of notifications S. Stanley 21 2 S. Typhimurium conducts molecular typing using pulse- The department received notifications 21 2 RDNC field gel electrophoresis (PFGE) on all for 1,130 cases of salmonellosis in 2004, Other 503 45 isolates from notified cases. PFGE is also a decrease of 11 per cent on the total in routinely conducted on any food samples 2003. Among the cases, the male-to- Total 1,130 100 submitted in relation to cases in which L. female ratio was 1:1.1 and the median age monocytogenes is detected. was 24 years (range: 20 days to 98 years). Ten isolates were forwarded to MDU in Notification rates were highest among 2004 and eight different patterns were those aged zero to four years (74 cases per found in these isolates. One PFGE type 100,000), accounting for 20 per cent of was shared by all three materno foetal the total notifications for the year (figure cases born in the same hospital however, 15). no source was identified for these or any of the other cases notified. 18 Surveillance of notifiable infectious diseases in Victoria, 2004

Figure 15: Notified cases of salmonellosis, by age group and rate Salmonella Enteritidis per 100,000 population, Victoria, 2004 S. Enteritidis is not endemic in Australia, ��� �� except for phage type 26, which occurs ����� �� in Queensland. It is a significant ��� ���� Salmonella serovar in that the organism �� ���������������� vertically transmits from the chicken to ��� �� the egg. Common overseas, it has been �� responsible for large outbreaks of disease

��� �� associated with undercooked eggs and

������������������������ products containing eggs. In Victoria, �� �� the department follows up all cases of �� S. Enteritidis to ascertain whether the � � infection was acquired overseas.

������ �������� �������� �������� �������� �������� �������� �������� �������� ������� The department received notifications ����������������� for 86 cases of S. Enteritidis in 2004, compared with 51 notifications in 2003 Figure 16: Notified cases of salmonellosis, by region and rate (an increase of 69 per cent). As in previous years, Indonesia was most frequently per 100,000 population, Victoria, 2004 reported as the country of acquisition, ��� �� accounting for 43 per cent of notifications ����� (table 8). �� ��� ���� ���������������� Table 8: Notified cases of �� ��� S. Enteritidis, by country of �� ��� infection, Victoria, 2004 �� Per ��� Country/region Number

������������������������ �� cent Indonesia 37 43 �� � Other Asian 26 30 � � countries European countries 11 13 ������� ���� ��������� ��������� ��������� ��������� European and Asian ������������� 5 6 ������ ��������������� countries Africa 2 2 Middle East 3 4 No overseas travel 2 2 identified Total 86 100

Outbreak and other investigations Three point source outbreaks of S. Typhimurium 9 (55 cases), one outbreak of S. Typhimurium 126 (six cases), one Surveillance of notifiable infectious diseases in Victoria, 2004 19

Table 9: Salmonellosis outbreaks, by Salmonella type, setting and Shigellosis source, Victoria, 2004 Summary of notifications Salmonella type Setting Source Published The department received notifications S. Typhimurium 9 Restaurant Chicken dishes VIDB vol. 7, Issue 2 for 64 cases of shigellosis in 2004, an S. Typhimurium 9 Community Unknown VIDB vol. 7, Issue 3 increase of 28 per cent from the number in S. Typhimurium 9 Restaurant Hollandaise Sauce VIDB vol. 7, Issue 3 2003. Whilst the number of notified cases S. Typhimurium 126 Conference centre Unknown No increased this year, Shigella notifications still remain low compared with previous S. Typhimurium 170 Restaurant Unknown No years. Of the 64 cases, 27 (42 per cent) S. Typhimurium 12a Conference centre Gourmet rolls No were for males and 37 (58 per cent) were S. Stanley Boarding school Unknown VIDB vol. 7, Issue 3 for females. The median age of persons VIDB = Victorian infectious diseases bulletin notified was 28 years (range: 1–77 years). outbreak of S. Typhimurium 170 (12 cases), and seven females. Cases had onsets Notification rates were highest among one outbreak of S. Typhimurium 12a (15 of illness ranging from 20 January to 22 those aged 30 to 34 years (figure 17). cases) and one outbreak of S. Stanley February. All cases were interviewed and The table below contains the species and (eight cases) occurred during 2004 (table six reported eating the same brand of type of Shigella (table 10). Notifications 9). Summaries of some of these outbreaks organic free-range eggs. Three of these occurred sporadically throughout the year, can be found in the Victorian Infectious cases ate raw eggs and one case used and no seasonal patterns were identified. Diseases Bulletin online at http://www. eggs as an ingredient of vegetable patties. Table 10: Notified cases of A sample of these left over uncooked health.vic.gov.au/ideas/surveillance/ shigellosis, by species and type, bulletin.htm patties was positive for S. Typhimurium 126. Of the remaining three cases, one Victoria, 2004 In addition, 21 separate cluster investigations reported eating organic eggs but could of Salmonella serovars were conducted. Species Number not recall the brand and two cases ate In this report, a ‘cluster’ is defined as Shigella sonnei biotype g 29 different brands of free-range eggs. Three an unusual number of notifications of a Shigella sonnei biotype a 6 weeks after the last case was notified, particular serovar either in time and/or two additional cases of S. Typhimurium Shigella flexneri 1a 1 place that are not, at the outset of the 126 were notified and interviewed. These Shigella flexneri 1b 6 investigation, clearly associated with a cases were friends and shared a raw egg Shigella flexneri 2a 8 point source. In 2004 serovar clusters drink together the day prior to the onset of Shigella flexneri 2b 2 investigated included S. Typhimurium 9, S. their symptoms on 16 March. These eggs Shigella flexneri 3a 2 Typhimurium 170 (four separate clusters), were also free range but were not any of Shigella flexneri 4a 3 S. Virchow 8, S. Typhimurium 12, S. the brands eaten by the previous cases. Shigella flexneri 6 1 Typhimurium 197 (three separate clusters), The Department of Primary Industries S. Cerro, S. Anatum, S. subsp I ser 16:1,v:- inspected the farm on the basis of the Shigella flexneri 7 1 , S. Typhimurium 126, S. Oranienburg, epidemiological association with the initial Shigella flexneri var y 1 S. Infantis, S. Typhimurium 135, S. six cases mentioned above. Samples of Shigella boydii 1 1 Mississippi, S. Birkenhead, S. Typhimurium eggs (dirty and cracked) and drag swabs Shigella boydii 2 1 6 and S. Agona. of the litter were taken during the visit but Shigella boydii 8 1 The S. Typhimurium 126 cluster were negative for Salmonella. Shigella untypable 1 investigation identified nine cases. A source of infection was not identified Total 64 Cases ranged in age from 11 months in the remainder of these cluster to 85 years and there were two males investigations. 20 Surveillance of notifiable infectious diseases in Victoria, 2004

Figure 17: Notified cases of shigellosis, by age group and rate Typhoid and paratyphoid per 100,000 population, Victoria, 2004 Summary of notifications �� ��� The department received notifications ����� �� ��� for 17 cases of typhoid in 2004. The age ����

���������������� range of cases was three to 80 years, and �� ��� the male:female ratio was 1:1.1. Fourteen � ��� cases acquired their infection overseas with the highest proportion of cases � ��� having acquired their infection in India

������������������������ � ��� (table 12).

� ��� Twenty-four cases of paratyphoid were notified in 2004. The age range of � ��� cases was three to 63 years, and the ��� ������ ������ ������������������������������������������������������������������������������������������������������������������������ male to female ratio was 1:3. All cases ����������������� of paratyphoid acquired their infection overseas with the highest proportion of Risk factors Table 11: Notified cases of cases having acquired their infection in Thirty-nine cases (61 per cent) were shigellosis, by risk factor, India (table 12). known to have acquired their infection Victoria, 2004 overseas (table 11), and one case most Risk factors likely acquired infection from close Risk factor Number Table 12 shows the country of acquisition contact with a returned overseas traveller Overseas travel for the cases. Three cases of typhoid who had been ill. Of the remainder, two Southern/South East Asia 25 reported no history of recent overseas travel. All cases were born overseas and cases occurred through sexual contact Pacific 4 and two cases were linked to the outbreak they are likely to have been long-term Middle East 2 described below. For the remaining carriers. These cases were born in Samoa, Europe 1 11 cases, the source of infection was Albania and Romania. unknown because four could not be Central/South America 2 Outbreak and other investigations contacted and seven had no obvious risk Africa 1 factors. Multiple countries 4 No outbreaks were identified. Other risk factors Outbreak and other investigations Comment Interstate travel 2 No outbreaks were identified. Effective immunisation is available for Unknown 11 travellers intending to travel to high-risk Comment Homosexual contact 2 areas, however medical practitioners must Contact with a confirmed remind their patients to exercise care in Shigellae have a low infectious dose. 4 Infection spreads when a person ingests case eating and drinking in endemic areas, Contact with ill overseas 4 regardless of immunisation status. bacteria through direct or indirect traveller contact with the faeces of a human case. Laboratory worker 2 Awareness of the need for increased Total 64 personal hygiene while travelling and at home will help prevent shigellosis. Surveillance of notifiable infectious diseases in Victoria, 2004 21

Table 12: Notified cases of typhoid and paratyphoid, by country of acquisition, Victoria, 2004

Country of Typhoid Paratyphoid acquisition Indonesia 4 3 India 5 9 Pakistan 1 1 Philippines 1 0 Cambodia 1 6 Albania 1 0 Bangladesh 1 2 China 0 1 Thailand/ Cambodia/ 0 1 Vietnam India and Sri 0 1 Lanka Carrier 3 0 Total 17 24 22 Surveillance of notifiable infectious diseases in Victoria, 2004

5. Legionellosis

Summary of notifications testing only which, unlike urinary antigen Seven deaths were attributable to testing, is unable to distinguish between Legionella infection, corresponding to a The department received notifications different L. pneumophila serogroups. The case fatality rate of seven per cent. Three for 102 cases of confirmed and probable method of diagnosis for Legionella cases in deaths were due to L. longbeachae, and legionellosis in 2004, representing a 13 2004 is described in table 14. one death each attributable to infections per cent increase on 2003. Of the 102 of L. pneumophila, L. pneumophila cases, 69 (68 per cent) were male and 33 Table 13: Notified cases of serogroup 1, L. micdadei and not (32 per cent) were female, with a male: legionellosis, by species/ otherwise specified Legionella. female ratio of 2.1:1. The notification serogroup, Victoria, 2004 rate was 2.1 per 100,000 population. The highest notification rates were for the The median age of cases notified was 62 Species/serogroup Number Per cent Hume, Eastern Metropolitan and North L. pneumophila and West Metropolitan regions (2.7, 2.6 years (range: 20-89 years). Age-specific 34 33 notification rates rose steadily with age serogroup 1 and 2.5 per 100,000). The lowest rate of from 0.3 per 100,000 people aged 20–24 L. pneumophila 0.9 cases per 100,000 was recorded in indeterminate 36 35 years, to 9.9 per 100,000 people aged serogroup the Grampians region (figure 19). 75–79 years (figure 18). L. longbeachae 26 26 Risk factors There were 34 cases of Legionella L. micdadei 4 4 Information on employment/occupational pneumophila serogroup 1 (33 per cent of Legionella not 2 2 status was available for 96 cases (94 per total notifications), the most commonly otherwise specified cent). Forty-four notified cases (43 per reported species and serogroup (table Total 102 100 cent) were retirees and/or pensioners. 13). There were 36 notified cases of L. The most common occupation nominated pneumophila in which a serogroup could by employed cases was trades and not be determined; a majority (92 per manufacturing (table 15). cent) of these were from serological Figure 18: Notified cases of legionellosis, by age group, sex and rate per 100,000 population, Victoria, 2004

�� �� ������ �� ���� �� ���������������� �� ���� � � � � � � ������������������������ � �

� �

��� ��� ��� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����������������� Surveillance of notifiable infectious diseases in Victoria, 2004 23

Table 14: Notified cases of legionellosis, by species/serogroup and method of diagnosis, Victoria, 2004

Method of L. pneumophila L. pneumophila L. longbeachae L. micdadei Legionella Total diagnosis serogroup 1 indeterminate not otherwise serogroup specified

Urinary antigen 21 1 0 0 1 22 Serology 0 33 23 3 1 61 Serology & urinary 5 1 0 0 0 6 antigen Serology & PCR 0 0 1 0 0 1 Culture & PCR 0 0 1 0 0 1 Urinary antigen & 3 0 0 0 0 3 culture Urinary antigen 3 0 0 0 0 3 and PCR Serology & culture 0 0 0 1 0 1 & PCR Serology & urinary 1 0 0 0 0 1 antigen & culture Serology & urinary 1 1 1 0 0 3 antigen & PCR Total 34 36 26 4 2 102

Figure 19: Notified cases of legionellosis, by region and rate per 100,000 population, Victoria 2004

�� ����� ��� �� ���� ���

�� ���������������� ��� ��

�� ���

�� ��� ������������������������ �� ��� �

� ���

������� ���� ��������� �������� ��������� ��������� ������������� ������ �������������� 24 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 15: Notified cases of A second outbreak in the metropolitan legionellosis, by employment/ area occurred in April among two male co-workers aged 55 and 58 although no occupation status, Victoria, 2004 source was identified. Occupation/ Number Per cent The third outbreak occurred in a regional employment status town during June and July and involved four Retiree/pensioner 44 43 cases (two males and two females) aged Office/sales worker 8 8 between 64 and 78 years, and a 20-year- Tradesperson/ 14 14 manufacturing old male. A cooling tower of a commercial premises that was within the common Home duties 12 12 exposure area identified by cases was Driver 6 6 found to be positive for L. pneumophila Unemployed 2 2 serogroup 1. Molecular subtyping of Not stated/unknown 9 9 isolates from the cooling tower and one of Healthcare worker 3 3 the cases was an exact match. Nurseryperson 1 1 Comment Vegetable grower 1 1 This year saw the first increase in Student 1 1 legionellosis cases since a peak in Farmer 1 1 2000. Low positive Legionella titres are Total 102 100 frequently found in patients who do not have acute infections, possibly reflecting Outbreak and other investigations past exposure or cross-reactivity with There were three outbreaks in 2004. All other organisms. Medical practitioners were L. pneumophila serogroup 1; two considering legionellosis in the differential occurred in the Melbourne metropolitan diagnosis are advised to consider area and the other in the Hume region. confirmation with a Legionella urinary The first outbreak occurred in March antigen test and to arrange collection of and involved three cases; all males a second (convalescent) serum sample aged between 56 and 65. All cases three to six weeks after the onset of had an association with a street in a symptoms. This second sample should light industrial area of Melbourne’s ideally be sent to the same laboratory as south-eastern suburbs where they had the first sample so that both samples can all conducted work duties. Molecular be tested in parallel. typing was conducted on L. pneumophila serogroup 1 isolates obtained from one case and three cooling towers in the common exposure vicinity. The molecular profiles of isolates from two cooling towers were related — but not an exact match — to that of a case and were unable to be excluded as the source of the outbreak. Surveillance of notifiable infectious diseases in Victoria, 2004 25

6. Invasive meningococcal disease

Summary of notifications There were six deaths, corresponding to by August and January (10, 13 per cent a case fatality rate of eight per cent. The respectively). The notification rate was In 2004, the department received median age of persons notified was 19 highest for the Barwon South Western notifications for 80 cases of confirmed years (range: two months to 83 years), region (figure 21). and probable invasive meningococcal with characteristically higher rates among disease, for 44 males (55 per cent) and There was greater than four times more those in the zero to four and 15-19 years 36 females (45 per cent). This compared serogroup B than serogroup C cases. age groups (figure 20). with 129 cases in 2003. The total Serogroup B was confirmed in 55 cases notification rate was 1.6 per 100,000. The highest number of cases were notified (an overall notification rate of 1.1 per in June (14, 18 per cent) followed 100,000), with five deaths (a case fatality rate of nine per cent). Serogroup C Figure 20: Notified cases of invasive meningococcal disease, by age was confirmed in 13 cases (an overall group and rate per 100,000 population, Victoria, 2004 notification rate of 0.3 per 100,000), with one death (a case fatality rate of eight per �� �� ����� cent). There were three serogroup Y cases � �� and one serogroup W135 case. Three ���� � ���������������� � further cases of unidentified serogroup �� � were laboratory confirmed (for example, �� � gram negative diplococci identified in � cerebrospinal fluid), and there were five �� cases notified on the basis of a clinical ������������������������ � � diagnosis only. � � Serogroup C disease occurred in an � � older age group (median age of 46 years) ��� ������ ������ compared to serogroup B disease (median ������������������������������������������������������������������������������������������������������������������������ ����������������� age of 17 years), and the proportion of cases aged less than 20 years was higher Figure 21: Notified cases of invasive meningococcal disease, by for serogroup B than for serogroup C (60 per cent and 23 per cent respectively). region and rate per 100,000 population, Victoria, 2004 The number of notified cases of invasive �� ��� ����� meningococcal group C disease in 2004 ��� was lower than that in 2003 (13 and 47 �� ���� ��� ���������������� respectively), a reduction of 72 per cent. ��� The reduction was evident in all age �� ��� groups, except the under one year old age ��� group. �� ���

������������������������ ��� Risk factors � ��� Risk factor data were not routinely ��� collected. � ���

���� ������� ��������� �������� ��������� ��������� ������ ������������� �������������� 26 Surveillance of notifiable infectious diseases in Victoria, 2004

Outbreak and other investigations No outbreaks were identified; no epidemiological links between cases were identified.

Comment Early treatment of meningococcal disease improves outcome, and administration of antibiotics should not be delayed for any reason. While no vaccines protect against serogroup B disease, there is an effective vaccine against serogroup C that is provided free for infants aged 12 months under the National Immunisation Program. The sharp decrease in cases of serogroup C disease was probably attributable to the introduction of the National Meningococcal C Immunisation Program for all children aged from one to 19 years in 2003. Meningococcal polysaccharide vaccine confers protection of limited duration against serogroups A, C, W135 and Y, and is recommended for persons over two years of age with inherited defects of properdin or complement, or functional or anatomical asplenia, those travelling to areas where epidemics of these serogroups are frequent, and pilgrims attending the Hajj in Saudi Arabia. Surveillance of notifiable infectious diseases in Victoria, 2004 27

7. Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease (CJD) is a rare Incident Panel was notified and expert national infection control guidelines, and and fatal disease with an occurrence advice requested. As a consequence, will draw on the outcomes of a Victorian rate in Australia of one person per million several actions were undertaken: 1,200 Advisory Committee on Infection Control head of population, comparable with patients from the hospital concerned consensus conference that discussed worldwide data. CJD was scheduled as a were notified of the incident; a hot interpretation of the guidelines and the notifiable disease in Victoria from 31 January line was established for patients and provision of consistent CJD advice for 2004. The Australian National CJD Registry general medical practitioners to contact various clinical situations. (ANCJDR), situated in the Department of the hospital for additional information Pathology at The University of Melbourne, and; CJD fact sheets were provided to Comment is contracted to provide surveillance and patients and placed on the Department In the health care setting, risk factors for investigation of CJD for the Department of Human Services and Australian CJD include past use of cadaver acquired of Human Services. Confirmation of a Government Department of Health and pituitary hormones and Lyodura (dura suspected case of CJD is reliant on post- Ageing websites. Patients who had mater) from cadavers with undiagnosed/ mortem investigations that may take up to undergone dura mater piercing procedures unrecognised CJD. These practices eight weeks to complete. within three months of the index case’s ceased in 1985/6. Another risk factor neurosurgical procedures were also mailed includes the surgical transmission from a The ANCJDR has established the total advice to provide for health providers CJD infected patient by instruments that Victorian figures for 2004 as five confirmed about infection control measures to be have not been processed adequately to cases, of which four were female and one undertaken in the event of the person remove prions. This type of transmission was male. The median age at death was requiring surgical procedures where the (neurosurgical) occurred overseas and 64 years (range: 38–76 years) and the potential for further possible intragenic the last reported incidents were over 30 age-standardised mortality rate in Victoria transmission may exist. years ago and there have been major for 2004 was 0.96 CJD deaths per million improvements worldwide in the cleaning, population. No cases of acquired CJD In addition, the destruction of all disinfection and sterilisation of reusable including iatragenic or variant CJD were neurosurgical and other instruments medical and surgical instruments and identified in Victoria during 2004. potentially used in either neurosurgical equipment since then. Information from procedure was considered appropriate the Australian Government Department of Risk factors as the health service was unable to track Health and Ageing about cadaver acquired The ANCJDR assesses risk factors during individual instruments to the patient. pituitary hormone recipients is available from investigation of all suspect cases of CJD Furthermore, patients involved in this http://www.health.gov.au/internet/wcms/ and notifies the department of its findings. incident will be followed over time, publishing.nsf/Content/health-pubhlth- In 2004 a possible case with a history although the risk of transmission is strateg-phi-index.htm of neurosurgery was considered a risk to considered to be very low. public health, the investigation of which is Variant CJD – resulting from the ingestion The investigation highlighted the discussed below. of infected meat products – has not importance of surgical instrument been reported in Australia to date. tracking systems to reliably identify those Outbreak and other investigations As a precaution against the possible patients at risk of iatrogenic transmission The department, together with a transmission of variant CJD through and the absence of a CJD investigation metropolitan health service, was involved blood products, the Australian Red Cross protocol for retrospective diagnoses in the in the investigation of possible iatragenic Blood Service (in alignment with most national Infection control guidelines for the transmission of CJD in 2004 when it countries in the world) will not accept prevention of transmission of infectious was recognised that a newly confirmed blood donations from people who have diseases in health care settings. The case had undergone two neurosurgical lived in the United Kingdom for a period of latter issue is being addressed through procedures. Although the risk was six months or more during the years 1980 a revision of the CJD chapter of the considered minimal, the national CJD to 1996. Information from the Australian 28 Surveillance of notifiable infectious diseases in Victoria, 2004

Government Department of Health and Ageing about Australia’s response to the possibility of Variant CJD in Australia is available from http://www.health.gov.au/ internet/wcms/publishing.nsf/Content/ bovine+spongiform+encephalopathy+%28B SE%29-1 Information about CJD is also available from the department’s website at http:// www.health.vic.gov.au/ideas/diseases/ cjd_facts.htm Surveillance of notifiable infectious diseases in Victoria, 2004 29

8. Sexually transmissible infections

Acquired immunodeficiency Summary of notifications Clinical presentation of those syndrome (AIDS) There were 38 individuals diagnosed with diagnosed with AIDS in Victoria in AIDS in Victoria in 2004 — 33 males and 2004 Surveillance case definition five females — a 25 per cent decrease on In 2004, 21 (55 per cent) people The current case definition for AIDS is the 51 cases in 2003. diagnosed with AIDS presented with published in the Interim Surveillance Case In 2004 the median age of males CD4 counts of less than 100 per µl. This Definitions for the Australian National diagnosed with AIDS was 45 years (range: proportion has remained fairly consistent Notifiable Disease Surveillance System and 21–73 years). Fifty-three per cent of over the last ten years (table 17). is available from http://www.cda.gov.au individuals diagnosed were aged between 40 and 49 years (table 16). Table 16: AIDS diagnoses, by age group and sex, Victoria, 1983 – 2004

Age group Year of AIDS diagnosis Total (years) Sex ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n M 3 0 0 0 0 0 0 0 0 0 3 0–12 F 3 0 1 0 0 0 1 0 0 0 5 M 6 1 0 0 1 0 0 0 0 0 8 13–19 F 1 0 0 0 0 0 0 0 0 0 1 M 271 19 11 8 3 4 2 4 2 1 3291 20–29 F 16 1 2 2 1 1 0 0 0 2 25 M 606 68 34 23 9 28 25 13 17 8 8311 30–39 F 22 2 4 1 1 2 4 2 3 0 41 M 395 39 16 20 7 20 15 15 15 17 559 40–49 F 4 1 1 0 1 0 2 1 2 3 15 M 123 17 11 9 10 8 5 6 6 4 2001 50–59 F 8 2 1 0 1 0 0 0 0 0 12 M 49 3 5 7 2 6 2 5 6 3 88 60+ F 3 0 0 0 0 0 0 0 0 0 3 Total 1,5191 153 86 70 371 69 571 46 51 38 2,1261 1 Includes 11 people whose sex was reported as transgender Table 17: AIDS diagnoses, by CD4 Count, Victoria, 1983−2004 CD4 count per µl Year of AIDS diagnosis Total at AIDS diagnosis ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n <100 480 86 43 38 21 35 27 26 27 21 804 100 to 199 129 13 13 11 6 10 15 8 8 7 220 200 to 499 64 19 11 7 5 13 6 7 8 4 144 ≥500 11 3 4 1 0 1 1 2 0 1 24 Unavailable* 835 32 15 13 5 10 8 3 8 5 934 Total 1,519 153 86 70 37 69 57 46 51 38 2,126 * Includes CD4 count which were not performed or available and counts performed greater than or less than three months from the date of diagnosis of AIDS. 30 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 18: AIDS diagnoses, by AIDS defining illness, Victoria, 1983–2004

AIDS defining Year of AIDS diagnosis Total illness <=1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n %1 PCP 603 48 29 24 9 28 25 19 12 13 810 34.3 Kaposi’s sarcoma 244 18 13 5 4 7 4 5 5 4 309 13.1 Oesophageal 190 27 13 15 6 17 9 10 11 7 305 12.9 candidiasis Herpes simplex 59 4 2 1 0 2 1 1 0 0 70 3.0 Toxoplasmosis 86 6 4 3 0 1 2 3 4 2 111 4.7 Mycobacterial disease 128 16 14 3 4 4 1 0 3 1 174 7.4 (non TB) Cytomegalovirus 66 14 1 4 4 2 1 0 0 3 95 4.0 Non-Hodgkin’s 71 16 4 4 4 4 4 2 5 5 119 5.0 lymphoma Myelopathy 70 6 8 1 2 4 0 2 2 2 97 4.1 Cryptosporidiosis 48 4 1 3 0 2 1 1 4 0 64 2.7 Cryptococcus 50 2 1 3 3 2 1 2 4 4 72 3.0 HIV encephalopathy 31 6 3 5 1 2 5 0 1 0 54 2.3 Pulmonary 2 1 3 3 1 5 4 3 3 3 28 1.2 tuberculosis2 Recurrent pneumonia2 2 0 3 1 0 0 2 1 0 1 10 0.4 Cervical cancer2 1 0 1 0 0 0 0 0 0 0 2 0.1 Other 16 3 1 8 2 2 6 4 0 2 44 1.9 Total 1,667 171 101 83 40 82 66 53 54 47 2,364 100.0

1 Proportion of all notifications with the AIDS defining illness. Individuals may have presented with more than one AIDS defining illness 2 Included as an AIDS defining illness in Australia from January 1993

Pneumocystis carinii pneumonia (PCP) as and Southern Metropolitan region (table high prevalence country increased from an AIDS defining illness was reported for 19). less than one per cent prior to 1996 to 13 28 per cent of those diagnosed during In 2004, the North and West per cent in 2004 (table 20). 2004. Oesophageal candidiasis was the Metropolitan DHS regions were merged; Of the 38 AIDS diagnoses notified in next most common, reported by 15 per previously the largest number of annual 2004, 20 individuals (53 per cent) were diagnoses were reported from the cent (table 18). These proportions have diagnosed within 12 months of their HIV Southern Metropolitan region. remained fairly consistent over time. diagnosis (table 21). Of these 20, 60 per People living with AIDS in Victoria Risk factors cent were among males reporting male-to- male sexual contact and 40 per cent were in 2004 The proportion of all AIDS diagnoses among individuals reporting heterosexual At the end of 2004, there were an in which male-to-male sexual contact contact as their primary exposure, the estimated 604 people living with AIDS (homosexual and bisexual) was reported latter group being overrepresented as in Victoria — 561 males, 41 females and as the primary risk factor for infection fell only 24 per cent of total AIDS diagnoses two transgender individuals. Of these, from 84 per cent prior to 1996 to 63 per 506 (84 per cent) resided in metropolitan in 2004 were attributed to heterosexual cent in 2004. The proportion of all AIDS Melbourne, with the largest numbers in contact (table 21). the North and West Metropolitan region diagnoses attributable to origin from a Surveillance of notifiable infectious diseases in Victoria, 2004 31

Table 19: People living with AIDS, by sex and region, Victoria, 31 December 2004

Sex Total Region Males Females n % Barwon-South Western 14 0 14 2.3 Grampians 9 0 9 1.5 Loddon Mallee 17 2 19 3.1 Hume 9 2 11 1.8 Gippsland 18 0 18 3.0 North and West Metropolitan 206 21 227 37.6 Eastern Metropolitan 82 2 851 14.1 Southern Metropolitan 180 13 1941 32.1 Unknown 26 1 27 4.5 Total 5611 41 6041 100.0

1 Includes two people whose sex was reported as transgender

Table 20: AIDS diagnoses, by sex and exposure category, Victoria, 1983–2004

AIDS exposure Year of AIDS diagnosis Total Category Sex ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n

Male homosexual/bisexual M 1,274 125 58 43 21 49 31 26 31 24 1,6821 Male homosexual/bisexual M 78 13 4 2 0 3 1 5 3 2 1111 and IDU

IDU M 14 0 1 3 0 4 3 0 1 1 27 F 6 1 2 1 1 1 0 0 1 0 13

Heterosexual contact M 33 4 4 11 5 2 6 6 6 3 80 F 37 5 5 1 3 1 2 1 4 1 60

Person from high M 8 1 3 0 2 4 2 5 2 1 28 prevalence country F 5 0 1 1 0 1 2 1 0 4 15

Haemophilia/coagulation M 33 2 1 1 1 1 1 1 0 0 41 Disorder F 1 0 0 0 0 0 0 0 0 0 1

Receipt of blood/tissue M 6 1 0 1 0 0 1 0 0 1 10 F 5 0 0 0 0 0 0 1 0 0 6

Other M 0 0 0 0 1 0 0 0 0 0 1 F 1 0 1 0 0 0 1 0 0 0 3

Unavailable M 7 1 6 6 2 3 4 0 3 1 33

F 2 0 0 0 0 0 2 0 0 0 4

Total 1,5191 153 86 70 371 69 571 46 51 38 2,1261

1 Includes 11 people whose sex was reported as transgender 32 Surveillance of notifiable infectious diseases in Victoria, 2004

Of the 38 AIDS diagnoses notified in Deaths following an AIDS Table 22: Deaths following AIDS 2004, 20 individuals (53 per cent) were diagnosis diagnosis, by sex, Victoria, 1983– diagnosed within 12 months of their HIV There have been a total of 1,522 deaths 2004 diagnosis (table 21). Of these 20, 60 per following diagnosis with AIDS notified in cent were among males reporting male-to- Victoria since 1983, in 1,452 males, 61 Year of Sex Total male sexual contact and 40 per cent were females and nine transgender individuals. death Males Females n % among individuals reporting heterosexual The annual number of deaths following <=1995 1,088 36 1,1291 74.2 contact as their primary exposure, the AIDS has steadily decreased over the last 1996 123 5 128 8.4 decade from 128 deaths in 1996 to 17 in latter group being overrepresented as 1997 67 6 741 4.9 2004 (table 22). only 24 per cent of total AIDS diagnoses 1998 41 3 451 3.0 in 2004 were attributed to heterosexual 1999 38 2 411 2.7 contact (table 21). 2000 29 1 30 2.0 2001 21 5 26 1.7 2002 12 0 12 0.8 2003 19 1 20 1.3 2004 15 2 17 1.1 Total 1,452 61 1,5221 100.0

1 Includes nine people whose sex was reported as transgender Table 21: Exposure category of individuals diagnosed with AIDS within 12 months of their HIV diagnosis Year of AIDS diagnosis Total AIDS exposure category Sex ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n Male homosexual/ M 253 24 22 15 2 16 14 9 13 12 3801 bisexual Male homosexual/ M 12 3 2 1 0 0 0 1 0 0 191 bisexual and IDU IDU M 2 0 0 0 0 2 1 0 1 0 54 F 2 0 1 0 0 0 0 0 0 0 15

Heterosexual contact M 20 2 1 7 4 2 5 6 5 2 19 F 9 1 1 0 0 0 1 1 1 1 8

Person from high M 4 0 1 0 2 3 2 4 2 1 6 prevalence country F 2 0 0 0 0 1 0 1 0 4 3

Haemophilia/coagulation M 0 0 0 0 0 0 0 0 0 0 0 Disorder F 0 0 0 0 0 0 0 0 0 0 0

Receipt of blood/tissue M 3 0 0 0 0 0 0 0 0 0 3 F 1 0 0 0 0 0 0 0 0 0 1

Other M 0 0 0 0 1 0 0 0 0 0 1 F 1 0 0 0 0 0 0 0 0 0 1

Unavailable M 3 1 5 6 0 2 4 0 2 0 23 F 0 0 0 0 0 0 0 0 0 0 0 Total 3131 31 33 29 9 26 281 22 24 20 5351

1 Includes two people whose sex was reported as transgender Surveillance of notifiable infectious diseases in Victoria, 2004 33

Human immunodeficiency Collection of enhanced data such as Summary of notifications virus (HIV) ‘Clinical presentation at HIV diagnosis’ In 2004, 217 cases of HIV were diagnosed and ‘Reason for test’ commenced in in Victoria. This represents a four per cent Notes 1994; therefore the relevant tables do not decrease from the total of 225 in 2003 The HIV report refers to diagnoses rather include data prior to this time. and a 55 per cent increase on the 1999 than notifications as the surveillance total of 140 (figure 22). system utilises the specimen collection date for HIV rather than notification date Figure 22: Notified cases of HIV and AIDS diagnoses, Victoria, for reporting. 1983–2004 ��� The report describes annual diagnoses ��� from 1983 onwards and makes particular ��� ���� reference to the time frame between 1999 and 2004 as it includes the lowest ��� ������������������ numbers (140 notifications in 1999) and the subsequent upturn in notification ���

numbers. ��� ������������������������ Annual HIV numbers in this report may be ��� slightly different to previous reports due

to the receipt of new information enabling � identification of duplicate notifications and ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ongoing data cleaning. ����������������� Table 23: HIV diagnoses, by age group and sex, Victoria, 1983 to 2004

Year of HIV diagnosis Total Age group (years) Sex ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n M 31 0 0 0 3 0 0 1 0 0 35 0–12 F 9 0 0 0 1 0 2 0 0 1 13 M 86 5 1 6 1 6 6 1 3 2 117 13–19 F 9 0 2 0 0 0 1 1 1 0 14 M 1,269 56 43 37 38 54 38 44 47 37 1,663 20–29 F 70 7 4 5 4 9 7 7 4 11 128 M 1,155 68 72 48 50 62 87 95 88 80 1,805 30–39 F 43 4 2 1 5 8 8 11 10 7 99 M 487 28 30 28 20 32 45 40 40 53 803 40–49 F 15 1 6 1 1 1 5 2 3 5 40 M 160 17 20 12 10 16 13 20 21 12 301 50–59 F 12 1 1 0 1 0 0 1 1 1 18 M 44 4 7 10 6 6 4 6 7 7 101 60+ F 6 0 0 1 0 2 0 2 0 0 11 M 102 0 0 0 0 0 0 0 0 0 102 Unavailable F 1 0 0 0 0 0 0 0 0 0 1 Total 3,5361 191 188 149 140 1971 2181 2331 225 2171 5,2941

1Includes 20 people whose sex was reported as transgender and 23 people whose sex was unknown 34 Surveillance of notifiable infectious diseases in Victoria, 2004

Of the 217 cases, 191 (88 per cent) were Males diagnosed with HIV in infection in Australia (appendix 2, table males, 25 (12 per cent) were females 2004 45). Of the 147 males, 48 per cent were and one individual was transgender. The There were 191 males diagnosed with HIV reported to have acquired their infection median age at diagnosis was 36 years for infection in 2004 — seven per cent less from a casual or anonymous partner males (range: 19–73 years) and 30 years than the 2003 total of 206 (table 25). and 18 per cent from a regular partner for females (range: three to 58 years). The (appendix 2, table 42). largest proportion (n=87, 40 per cent) of Males who reported male-to-male diagnoses were among individuals aged sexual contact Males who reported heterosexual contact between 30 and 39 years (table 23). Male-to-male sexual contact (homosexual There were 24 males (13 per cent) who In 2004, 87 per cent of individuals and bisexual) was the most common reported heterosexual contact as a risk diagnosed with HIV reported residing in risk factor in 2004 (n=147, 77 per cent), factor in 2004, a nine per cent increase on Metropolitan Melbourne (table 24), with compared with 163 (72 per cent of total) in the 22 males in 2003 (table 25). the largest numbers in the North and West 2003 and 80 (57 per cent) in 1999. Metropolitan region (n=85, 39 per cent) Of the 147 males with a history of male- There was an increase in the number of and Southern Metropolitan region (n=77, to-male sexual contact in 2004, 128 (87 males diagnosed with HIV who originated 36 per cent). per cent) reported they had acquired their from a high prevalence country. These

Table 24: HIV diagnoses, by region and sex, Victoria, 1983 – 2004

Year of HIV diagnosis Total Region Sex ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n M 35 5 5 4 2 3 5 3 4 7 73 Barwon-South Western F 3 0 0 0 0 2 1 0 1 2 9 M 27 4 1 1 5 5 0 3 3 1 50 Grampians F 0 0 0 0 0 2 0 0 0 0 2 M 36 4 3 2 2 2 6 4 6 5 70 Loddon Mallee F 4 0 0 0 1 0 1 1 0 1 8 M 30 0 1 2 4 4 5 2 4 4 56 Hume F 7 0 1 1 0 0 0 0 0 0 9 M 21 3 2 4 4 5 0 2 1 4 46 Gippsland F 0 1 1 0 0 0 0 0 0 0 2 North and West M 581 60 65 53 44 69 73 87 70 73 1,175 Metropolitan F 38 8 6 2 5 7 9 9 10 12 106 M 248 26 27 20 12 21 21 21 27 23 446 Eastern Metropolitan F 23 2 4 1 1 2 2 5 1 3 44 M 646 69 64 40 39 55 73 80 86 73 1,225 Southern Metropolitan F 38 2 3 2 3 4 7 5 7 4 75 M 1,710 7 5 15 16 12 10 5 5 1 1,786 Unavailable F 52 0 0 2 2 3 3 4 0 3 69 Total 3,5361 191 188 149 140 1971 2181 2331 225 2171 5,2941

1Includes 20 people whose sex was reported as transgender and 23 people whose sex was unknown Surveillance of notifiable infectious diseases in Victoria, 2004 35

countries included those in sub-Saharan majority (n=ten, 91 per cent) reported four from a female partner with HIV and Africa, Cambodia, Myanmar, and certain they had acquired their infection overseas five reported heterosexual contact (no countries within the Caribbean where (appendix 2, table 45). further information provided) (table 26). HIV is transmitted predominantly by Of the 13 other males with a history of Of these 13 males, five (38 per cent) heterosexual contact. Eleven such males heterosexual contact (not born in a high reported they had acquired their infection (six per cent) were diagnosed in 2004, prevalence country); four were reported in Australia, and six (46 per cent) overseas compared with six (three per cent) in to have acquired their infection from a (appendix 2, table 45). 2003 (table 25). Of these 11 males, the partner from a high prevalence country,

Table 25: HIV diagnoses, by sex and exposure category, Victoria, 1983–2004

Year of HIV diagnosis Total Sex ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n Sex M 3,334 178 173 141 128 176 193 207 206 191 4,927 F 165 13 15 8 12 20 23 24 19 25 324 HIV exposure category M 2,772 145 137 98 80 126 150 162 163 147 3,980 Male homosexual F ------0 Male homosexual M 155 10 8 9 12 8 7 8 10 12 239 and IDU F ------0 M 88 2 5 5 5 11 8 4 8 7 143 IDU only F 30 2 2 1 0 1 2 0 2 1 41 M 92 11 14 16 16 13 17 19 16 13 227 Heterosexual contact F 98 10 7 6 4 7 12 13 10 13 180 Heterosexual contact M 29 9 3 5 9 11 5 12 6 11 100 (Person from high prevalence country) F 14 1 4 1 6 12 7 11 7 10 73 Haemophilia/ M 98 0 0 1 1 0 1 0 0 0 101 coagulation Disorder F 1 0 0 0 0 0 0 0 0 0 1 M 18 0 0 0 1 0 0 0 0 0 19 Receipt of blood/tissue F 12 0 1 0 2 0 0 0 0 0 15 M 2 0 0 0 1 0 0 1 0 0 4 Other F 7 0 0 0 0 0 2 0 0 1 10 M 80 1 6 7 3 7 5 1 3 1 114 Unavailable F 3 0 1 0 0 0 0 0 0 0 4 Total 3,5361 191 188 149 140 1971 2181 2331 225 2171 5,2941

1 Includes 20 people whose sex was reported as transgender and 23 people whose sex was unknown 36 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 26: HIV diagnoses reporting heterosexual exposure, by partner type, Victoria, 1983–2004 Year of HIV diagnosis Total Sex ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n Heterosexual contact, M 29 9 3 5 9 11 5 12 6 11 100 person is from high prevalence F 14 1 4 1 6 12 7 11 7 10 73 Heterosexual contact M 16 2 4 5 2 7 5 1 6 4 52 with person from high prevalence country F 9 3 2 1 1 2 6 2 2 3 31 Heterosexual contact M 1 0 0 0 0 0 0 0 0 0 1 with bisexual man F 27 5 1 2 1 1 1 3 3 3 47 Heterosexual contact M 7 1 0 0 0 0 0 1 1 0 10 with IDU F 14 0 1 0 0 3 0 1 0 0 19 Heterosexual contact M 11 0 0 2 0 0 1 0 1 4 19 with person with HIV with no specified risk F 22 0 3 0 0 1 0 1 3 1 31 Heterosexual contact M 7 1 0 0 1 0 0 0 0 0 9 with person with other specified risk F 7 1 0 1 1 0 2 3 0 1 16 Heterosexual contact, M 51 7 10 9 13 6 11 17 8 5 137 not otherwise specified F 18 1 0 2 1 0 3 3 2 5 35 Total 233 31 28 28 35 43 41 55 39 47 580 Females diagnosed with HIV partner from a high prevalence country, contact and eight reported IDU only. during 2004 three from bisexual men and five provided Of the eight individuals with a history of The number of new HIV diagnoses among no further information (table 26). Of these drug use only, five were born in Australia females in Victoria increased in 2004, 13 females, the majority (n=8, 62 per and the other three in Asia. Between 1999 with 25 cases notified compared with 19 cent) reported that they had acquired and 2004, there were 49 cases reported in 2003, and 12 in 1999. This increase their infection in Victoria (appendix 2, with a history of IDU only; of these, 22 was largely attributable to a greater table 45). (45 per cent) were born in Asia, 19 (39 number of notifications from women who HIV among sex workers per cent) in Australia and the remainder reported heterosexual contact as a risk in other countries (appendix 2, table 46). In 2004, there were four new HIV factor and women from high prevalence The median age of injecting drug users in diagnoses reported among sex workers in countries (table 25). 2004 (without male-male sexual contact) Victoria. Two were male, one female and was 31 years (range: 19–44 years). Of the 25 females, ten were born in a high one transgender. All reported a history prevalence country and were reported of having sex with men. The female sex Between 1983 and 2004, 186 people to have acquired their infection from a worker reported acquiring HIV infection (144 males and 42 females) reporting IDU partner born in a high prevalence country. in Australia from a male bisexual partner only as a risk factor for infection had been Of these ten females, the majority (n=9, who was HIV positive. notified with HIV, representing 3.5 per 90 per cent) reported they had acquired cent of all cases of HIV notified in Victoria their infection overseas (appendix 2, table HIV among injecting drug users (table 25). 45). During 2004 there were 21 individuals Incident infections Of the other 13 females with a history of (19 males, one female, one transgender) Notifications are classified as newly heterosexual contact (not born in a high diagnosed with HIV who reported a acquired (incident infections) on the basis prevalence country) three were reported history of IDU (table 25). Of these, 13 also of a previous negative HIV test and/or to have acquired their infection from a reported a history of male-to-male sexual Surveillance of notifiable infectious diseases in Victoria, 2004 37

a seroconversion illness within the 12 among MSM and to help interpret HIV Chlamydia months preceding HIV diagnosis. Incident case reporting (passive surveillance) infections provide information about who results. Summary of notifications is currently being infected with HIV. The objectives of the system were: The department received notifications for 7,634 cases of chlamydia in 2004, an 18 Of the 217 HIV diagnoses in 2004, 69 1) To describe the HIV and STI testing (32 per cent) were classified as incident per cent increase on the total for 2003. Of patterns in clinics with a high case load these cases, 3,153 (41 per cent) were male infections compared to 74 (33 per cent) in of MSM 2003. Of the incident infections in 2004, and 4,419 (58 per cent) were female; sex 63 were males, five were females and 2) To compare the sexual risk behaviour was unknown for 62 cases. The median one individual was transgender. Of the 63 between MSM who test positive for HIV age was 26 years for males (range: zero to males, 57 (90 per cent) reported male- and those that test negative. 80 years) and 22 years for females (range: zero to 71 years). Notification rates were to-male sexual contact (appendix 2, table The project included five clinics that have highest for those aged 20–24 years (figure 47). a high case load of MSM. All patients 23). Fifty-six notified cases were reported deemed by their clinician to require a HIV These results should be interpreted with as being of Aboriginal and/or Torres Strait test were asked a series of risk behaviour caution as the data rely on a history of Islander origin. a past negative test or seroconversion questions. This information was then illness which is biased by health seeking linked with the patient’s HIV test results. behaviour and HIV testing practices in The project concluded in March 2005 and clinics. results for this project should be available soon. Outbreaks and other investigations Figure 23: Notified cases of chlamydia, by age group, sex and rate per Case-control study among men who 100,000 population, Victoria, 2004 have sex with men (MSM), 2002–2004 ���� ��� In response to the increasing number ������ ���� of HIV diagnoses among MSM, a case- ��� ���� ���� control study commenced in 2002. ��� ���������������� ���� The aim of the study was to gain ���� ��� ���� further information about risk behaviour ��� ���� among MSM recently diagnosed with ��� ��� HIV to inform public health strategies. ��� ������������������������ ��� Recruitment was completed in May 2003 ��� ��� and results are available at ��� ��� http://epi.burnet.edu.au/downloads � �

��� Linked HIV sentinel surveillance among ������ ������ ������������������������ ���������������� �������������������������������������������������������� �������� ���������������� ������� MSM: A pilot study, 2004–2005 ����������������� In April 2004 a pilot HIV sentinel surveillance project was implemented in Victoria. The project was conducted on behalf of the Victorian AIDS Council and the department to aid in the evaluation of a campaign to increase HIV/STI testing 38 Surveillance of notifiable infectious diseases in Victoria, 2004

Notifications were received sporadically Table 27: Reported reason for • persons born in Australia (n=2,170, 77 throughout the year. The highest chlamydia testing, Victoria, 2004 per cent) number and rate of notified cases were • persons who reported a sexual partner Reason for testing Number Per cent for residents of the North and West of the opposite sex (n=2,253, 80 per Metropolitan region (figure 24). These Screening 1,379 49 cent) data should be interpreted with caution, Presented with 923 33 as residential addresses were not always symptoms • persons who acquired the infection from provided. Contact tracing 361 13 their regular partner (n=1,303, 46 per cent) Despite the legislative requirement Other/not stated 153 5 for both clinicians and laboratories to Total 2,816 100 • persons who acquired their infection in notify chlamydia cases, the department Victoria (n=2,293, 81 per cent) Risk factors received 636 notifications (eight per cent) Comment from clinicians alone without laboratory Victoria has a passive surveillance system The department is establishing a sentinel evidence. These cases have historically for chlamydia, which is enhanced by surveillance project for chlamydia in clinics been included as confirmed notifications. the collection of risk factor information obtained from clinicians. Laboratories with a high case load of young people, The reason for testing was obtained for send a departmental questionnaire to women and indigenous Australians, and 2,816 cases (37 per cent), with screening diagnosing doctors to complete on behalf will collect information about testing (49 per cent) reported as the most of their patients. There were 2,818 (37 per and risk factors. The Burnet Institute will common reason, followed by clinical cent) questionnaires returned in 2004. coordinate the project in collaboration presentation (33 per cent) and contact with VIDRL and the Melbourne Sexual Of the cases for which enhanced data tracing (13 per cent) (table 27). These data Health Centre. should be interpreted with caution as they were received, the majority were for: are based on a sample of total notified cases that in turn is a sample of all cases in Victoria. Figure 24: Notified cases of chlamydia, by region and rate per 100,000 population, Victoria, 2004

���� ��� ����� ��� ���� ����

��� ���������������� ��� ���� ��� �� ���� �� ������������������������ ��� �� �� � �

���� �������� ������� ����� ��������� ������ ��������� ��������� ��������� ���������� ������

* Excludes 770 notifications with missing data Surveillance of notifiable infectious diseases in Victoria, 2004 39

Gonorrhoea median age was 33 years for males and Neisseria. gonorrhoeae isolates from 28 years for females. Eighty per cent of 771 cases (69 per cent) were tested for Summary of notifications male cases were aged 20–44 years (figure ciprofloxacin resistance (table 28). Among The department received notifications 25). Cases were clustered in Melbourne those acquired in Australia by males who for 1,112 cases of gonorrhoea in 2004, metropolitan regions, with notification reported a male sexual partner, resistance corresponding to a notification rate of 22 rates highest for the North and West to ciprofloxacin was reported in 28 per per 100,000 population; a five per cent Metropolitan region (figure 26). Seven cent, a marked increase from one per decrease compared to 2003 (n=1,165). cases (0.6 per cent) were reported as cent and 14 percent in 2002 and 2003 Of the total, 1,010 (91 per cent) were being of Aboriginal and/or Torres Strait respectively. Among infections acquired male and 101 (nine per cent) were female; Islander origin. heterosexually in Australia, the prevalence sex was not specified for one case. The of ciprofloxacin resistant strains was 48 Figure 25: Notified cases of gonorrhoea, by age group, sex and rate per cent. Isolates from 746 cases (67 per 100,000 population, Victoria, 2004 per cent) were tested for ceftriaxone resistance; all were sensitive. ��� �� ������ ��� �� Risk factors ��� ���� ���������������� Enhanced data on cases of gonorrhoea ��� �� ���� were collected via a questionnaire sent ��� �� to all notifying doctors. In 2004, 864 ��� (78 per cent) enhanced surveillance �� �� questionnaires were returned, although

������������������������ �� �� not all questionnaires were complete. �� �� �� Information on the sex of partners was � � available for 716 males (71 per cent),

������ ������ of whom 77 per cent (n=550) reported �������� �������� ���������������� �������� ���������������� �������� �������� ���������������� �������� �������� ������� having a male sexual partner and 166 (23 ����������������� per cent) reported having a female sexual Figure 26: Notified cases of gonorrhoea, by region and rate per partner. This information was available 100,000 population, Victoria, 2004 for 69 females (68 per cent); 99 per cent ��� �� (n=68) reported contact with a male ����� ��� partner and only one reported contact ���� �� with a female partner. ��� ����������������

��� Complete enhanced data on the reported �� source of the infection were available for ��� 710 cases (64 per cent) (table 29). Of �� ��� these, 77 per cent (n=383) of males who ������������������������ ��� reported having a male sexual partner � �� acquired their infection from a casual sexual partner, as did 69 per cent (n=109) � � of males who reported having a female ���� ������� ��������� �������� sexual partner. In contrast, the majority of ��������� ��������� ������ ������������� �������������� infections of women were attributed to a * Excludes 385 notifications for which the postcode was unknown, interstate or regular sexual partner. overseas. 40 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 28: Susceptibility of N. gonorrhoeae isolates to ciprofloxacin, by Syphilis — infectious sex, sex of partner and place of acquisition, Victoria, 2004* Summary of notifications Ciprofloxacin less Ciprofloxacin Sex of Place sensitive resistant Number of In 2004, the department received Sex partner acquired (MIC > 0.5 mcg/ (MIC > 1.0 mcg/ isolates notifications for 421 cases of syphilis, of mL) mL) which 83 (20 per cent) were classified Australia 4 109 394 Male as infectious syphilis, a 51 per cent Male Overseas 1 2 6 increase on the 55 infectious cases Australia 2 39 79 notified in 2003. Among the infectious Female Overseas 2 33 49 syphilis cases, the median age was Australia 0 16 36 35 years (range: 18–70 years) and 76 Female All Overseas 0 4 7 (92 per cent) were male. Two cases of

*Excludes where place of infections acquired and gender was not known. infectious syphilis were identified as of MIC: Minimum inhibitory concentration. Aboriginal and/or Torres Strait Islander origin. Symptomatic infection and sexually Table 29: Notified cases of gonorrhoea, by sex, sex of partner, partner transmissible infection screening were the type and place of acquisition, Victoria, 2004* most common reasons for testing reported Place acquired Sex Sex of partner Partner type by clinicians (table 30). Three of the Australia Overseas infectious syphilis cases were detected Male Male Casual partner 378 5 on antenatal screening; two were born Regular partner 104 2 overseas. Sex worker 2 0 Client (case is a sex worker) 6 0 Table 30: Notified cases of Female Casual partner 71 38 infectious syphilis, by reason for Regular partner 18 7 Client (case is a sex worker) 1 0 testing, Victoria, 2004 Sex worker 7 15 Reason for testing Number Per cent Casual partner 16 1 Symptomatic Female All 34 41 Regular partner 30 7 infection Sex worker 0 0 Sexually transmissible 33 40 Client (case is a sex worker) 2 0 infection screen * Excludes notifications with incomplete information. Sexual contact with 6 7 infected partner Abnormalities on 4 5 examination Antenatal screen 3 4 Comment Other 1 1 Resistance to ciprofloxacin among men Unknown 2 2 who have sex with men has increased Total 83 100 considerably in the last several years, underscoring the importance of treating gonococcal infections with ceftriaxone, as recommended by both the department and the Venereology Society of Victoria. Surveillance of notifiable infectious diseases in Victoria, 2004 41

Risk factors Comment Risk factor information was obtained from The increasing number of infectious treating clinicians for all infectious syphilis syphilis cases in Victoria, particularly cases. Of the 76 male cases, 62 (82 per among MSM is concerning. Research cent) reported a male sexual partner and demonstrates evidence that syphilis ten (13 per cent) reported a female sexual facilitates the transmission of HIV and partner. Five of the seven female cases may be important in contributing to HIV reported a male partner; sex of partner acquisition among high-risk groups where was unknown for the other two. infection rates are high. The department Infection was reported as acquired continued efforts to increase community in Victoria for 49 cases (59 per cent), awareness of syphilis (and sexually compared with 42 per cent of cases in transmissible infections in general) in 2003. Infection was acquired overseas 2004. This was done in collaboration with and interstate for 14 (17 per cent) and six various stakeholders through campaigns (seven per cent) cases respectively, while such as ’Check it Out’ to promote sexual for 16 cases the place of acquisition was health and testing among men who have unknown. sex with men, and syphilis awareness and outreach at sex-on-premises venues. Casual sexual partners were reported as The department also has an ongoing the source of 59 infections (71 per cent), syphilis alert with information for general while regular partners were reported for 12 practitioners and other healthcare infections (14 per cent). A sex worker was workers that can be accessed from the reported as the source for three infections web at http://www.health.vic.gov.au/ (three per cent). This information was chiefhealthofficer/alerts/syphilis.htm reported as unknown for eight cases (ten per cent). 42 Surveillance of notifiable infectious diseases in Victoria, 2004

9. Mycobacterial infections

Mycobacterium ulcerans Risk factors Tuberculosis The most significant risk factor for infection Summary of notifications developing Mycobacterium ulcerans Summary of notifications infection appears to be living in an There were 326 notified cases of Mycobacterium ulcerans became a identified endemic area and experiencing tuberculosis (TB) made to the department notifiable infection in January 2004. This some form of skin abrasion or puncture in 2004. This is an average increase of was in response to increasing evidence of wound. Little is known about the mode ten per cent in cases from the mid to localised clusters of ulcerans infection in of transmission of infection, risk factors late 1990s. The notification rate of TB in some coastal regions of Victoria and an or incubation period. There is increasing Victoria has now been greater than or apparent shift in the foci of disease. The evidence that biting insects may play a equal to seven per 100,000 population disease was first noted in East Gippsland, role, however the route of transmission per year since 2002, the highest in the last however clusters have now occurred in remains unclear. The most important decade. Of the 326 cases, 150 (46 per Westernport, Mornington Peninsula and public health measures in the prevention cent) were female and 176 (54 per cent) Hastings with a large outbreak occurring and management of ulcerans infections were male. Patients aged 20 and 30 years on Phillip Island from 1992 to 1994. More is to avoid insect bites by the use of had a notification rate of 14.8 per 100,000 recently the focus has shifted further repellents and protective clothing, to wash (figure 27). In addition, older patients over westward with an outbreak in St Leonards and cover skin abrasions and to seek early the age of 70 years had a notification rate on the Bellarine Peninsula in 2001 and medical advice for any ulcer or lesion that of 13.3 per 100,000. Sixteen children aged currently in the small township of Point is slow to heal. younger than 15 years were notified with Lonsdale where there has been 35 cases TB. confirmed by PCR and/or culture at VIDRL Comment Most notified cases were from since 2002. The department is currently sponsoring metropolitan Victoria (93 per cent), research into the risk factors and In 2004 there were 26 notified cases of with the highest rate and number of transmission of M. ulcerans through the M. ulcerans, of which 17 were associated notifications from the North and West Public Health Research Grants. with the Point Lonsdale outbreak. Of the Metropolitan region (51 per cent). Eastern 26 cases, 14 were female and 12 were and Southern Metropolitan regions male with ages ranging from two years had similar notification rates, however to 87 years; 14 cases were aged over 50 the lowest numbers were from Eastern years (ten of these were part of the Point Metropolitan region. Fifteen notified cases Lonsdale outbreak). Most ulcers were were from rural and regional Victoria located on lower limbs (arms and legs), (figure 28). however there were some ulcers located on the trunk, including buttocks and scapula. Ulcers ranged in size from very small to extensive with significant tissue damage, depending on diagnostic delay. Surveillance of notifiable infectious diseases in Victoria, 2004 43

Figure 27: Notified cases of tuberculosis, by age group, sex and rate Pulmonary disease accounted for fifty-two per 100,000 population, Victoria, 2004 per cent of all notified cases (n=171); 25 of these notified cases noted sites other �� �� ������ than the lungs (table 31). Pleural disease �� �� was the most common additional site, ���� �� ���������������� however, three patients had miliary TB and �� �� ���� seven had TB isolated in lymph nodes. �� �� One patient was identified as having �� �� pharyngeal TB, confirmed on pharyngeal � swab, which was smear positive for acid-

������������������������ � �� fast bacilli. Extra pulmonary disease was � � reported in 48 per cent of notified cases � —the most common sites being lymphatic � � ��� (54 per cent), bone/joint (12 per cent) and ������ ������ ������������������������������������������������������������������������������������������������������������������������ pleural (nine per cent). Of the 83 lymph ����������������� node cases, 13 were mediastinal nodes and two were identified as primary lymph Figure 28: Notified cases of tuberculosis, by region and rate per node disease in children, (table 31). 100,000 population Victoria, 2004 Table 31: Notified case of ��� �� ����� tuberculosis, by site of disease, ��� �� Victoria, 2004 ����

��� ���������������� �� Site Number ��� Pulmonary ��� � Pulmonary only 146 �� � Bone/joint 1 �� Genito/urinary 1 ������������������������ � �� Lymph nodes 7 � �� Miliary 3 � � Other 2

���� Peritoneal 1 ������� ��������� �������� ��������� ��������� Pleural 10 ������ ������������� �������������� Extra pulmonary only Lymph nodes 83 Pleural 14 Bone/joint 18 Peritoneal 7 Meningeal 8 Genitourinary 5 Miliary 3 Other 17 Total 326 44 Surveillance of notifiable infectious diseases in Victoria, 2004

Risk factors Comment In 2004, the most significant risk factor Four cases were in child contacts of for TB in Victoria was having migrated TB cases identified by contact tracing. from a high prevalence country (defined All were siblings or children of recently as having a rate of tuberculosis greater arrived migrants. An additional four than 100 per 100,000). In 2004, 12 per children were recent arrivals from refugee- cent (39 of 326) of notified cases were like backgrounds. Cultural perceptions in Australian born people; an incidence and stigmatisation of TB can create rate of just over one per 100,000. There significant barriers to identifying those were no notifications of TB in Indigenous at risk of infection and disease. Health Australians. However, the notification care providers should be aware of the rate in overseas born people was 27 per increased risk of TB in newly arrived 100,000. Of the overseas born cases, refugees and migrants, and of the cultural a total of 64 per cent of patients were issues that influence their health seeking born in countries from the Horn of Africa behaviours. They should also consider the (n=47), India (n=59), Philippines (n=13), possibility of TB in any patient from a high- Vietnam (n=45), or China (n=21). risk group who presents with symptoms or An associated risk factor for the signs compatible with the disease. Early development of TB is time since migration, investigation of contacts is imperative to with most cases being diagnosed within a minimise the risk of progression to primary few years after arrival. In 2004, information disease, particularly in young children. about date of arrival was known for 275 of The department’s Management, control the 287 overseas born patients. Of these, and prevention of tuberculosis: guidelines 11 per cent were notified with TB following for health care providers (2002–2005) arrival in Australia during 2004, and 21 per is available from the department’s cent were diagnosed within one year of Communicable Disease Control Unit arrival. Sixty-one per cent were diagnosed (telephone 1300 651 160) or at http:// within ten years of arrival in Australia. www.health.vic.gov.au/ideas Five patients are known to have HIV and TB co-infection, however information about testing for HIV was known for only 14 per cent of cases. Surveillance of notifiable infectious diseases in Victoria, 2004 45

10. Vaccine preventable diseases

Haemophilus influenzae Influenza investigations. type b (Hib) infection (laboratory confirmed) Notifications of laboratory confirmed influenza in 2004 were characterised Summary of notifications Summary of notifications by lower numbers and a later peak In 2004, the department received one The department received notifications compared to previous years (figure notified case of Haemophilus influenzae for 206 cases of influenza in 2004, a 30). Note that Figure 30 includes only type B (Hib) infection. This case occurred 69 per cent decrease from the 658 those cases notified sporadically (i.e. in an eleven-year-old female who notifications in 2003. Most cases (141, not those notified as part of VIDRL’s presented with septicaemia. The trend 68 per cent) were notified sporadically, sentinel surveillance program or as part of in Hib notifications from 1999 to 2004 is a further 47 (23 per cent) and 18 (nine outbreaks) to maximise the comparability per cent) were notified as a result of the shown in table 32. of notifications over time. The department sentinel surveillance scheme operated received 69 per cent of the 2004 sporadic Risk factors by the VIDRL and outbreak investigations notifications between September and respectively. A slight majority (54 per There was no evidence that the case had November. received Hib vaccine. cent) of notified cases were among males; 43 per cent were in females and the Influenza virus type was reported for Outbreak and other investigations remainder were unknown. The median all 206 notifications. Of these, 141 (68 The single case in 2004 was sporadic. age was 27 years (range: one month to per cent) were influenza A and 65 (32 90 years). Notification rates were highest per cent) were influenza B. Subtype Comment for children aged zero to four years, with information was not routinely reported. The dramatic decline in Hib notifications secondary peaks in adolescents aged over the past decade can be attributed to 15–19 years and adults aged 25–29 years, the introduction of the conjugate vaccine. 45–49 years and over 60 years (figure 29). Notifications were received from all regions Hib is now a rare disease, and sustaining except Hume, with the highest notification high immunisation coverage is critical to rate in the Southern Metropolitan region maintaining low levels of infection and (6.7 per 100,000). These data reflect transmission in the community. Early health care seeking behaviours, the detection and treatment of the rare diagnostic practices of clinicians and cases that occur are critical in preventing those diagnosed as part of outbreak mortality. Table 32: Notified cases of Haemophilus influenzae type b, by manifestation, Victoria, 1999–2004

1999 2000 2001 2002 2003 2004 Pneumonia 1 0 0 1 0 0 Epiglottitis 0 1 0 0 0 0 Meningitis 3 1 0 0 0 0 Septicaemia 1 1 2 0 0 1 Other 0 0 0 1 1 0 Total 5 3 2 2 1 1 46 Surveillance of notifiable infectious diseases in Victoria, 2004

Figure 29: Notified cases of influenza, by age group and rate Risk factors per 100,000 population, Victoria, 2004 Other than the vaccination status of cases aged over 65 years, risk factor information �� �� ����� �� was not routinely collected. There were �� �� 21 cases aged over 65 years notified ���� �� ���������������� �� with influenza. The immunisation status �� �� was known for 12 cases (57 per cent) �� � and of these, eight cases had a validated immunisation history. �� �

������������������������ �� � Outbreak and other investigations �� � � Two outbreaks were identified in 2004, � � both in the same military facility in July and

��� ��� ��� October. The first outbreak resulted in 95 ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����������������� cases (12 were laboratory-confirmed) and the second outbreak involved six cases (all laboratory-confirmed). Figure 30: Notified cases of influenza, by month, Victoria, 2001–2004 Comment ��� ���� Influenza is a major cause of morbidity ���� and mortality, particularly for high-risk ��� ���� groups such as infants, the elderly and ���� those with pre-existing medical conditions. ��� Influenza vaccination is recommended for persons aged 65 years and over, ��� Indigenous persons aged 50 years and

������������������������ over and persons with certain medical �� risk factors. It is also recommended for other population groups, such as health � care workers and other essential services ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� workers, staff of institutions, travellers ��������������������� in large tourist groups and HIV infected persons. Surveillance of notifiable infectious diseases in Victoria, 2004 47

Invasive pneumococcal Ninety-one per cent (n=353) of notified cent) of a known serotype from those disease cases were hospitalised. There were aged 65 years or over (for whom 23- 28 deaths attributable to invasive valent polysaccharide vaccine [23vPPV] Summary of notifications pneumococcal disease, corresponding is funded in Victoria). Of these, 98 (91 per The department received notifications to a case fatality rate of seven per cent. cent) were serotypes contained in 23vPPV. for 388 cases of invasive pneumococcal The case fatality rate was highest among Risk factors disease (IPD) in 2004 for 223 males (57 persons aged 65 years or over (16 per per cent) and 165 females (43 per cent). cent). There were three deaths in infants Information about risk factors was The overall notification rate was 7.8 per aged less than one year (case fatality rate obtained for 359 notified cases 100,000, but was highest among the very of seven per cent). (93 per cent). Chronic disease and immunocompromised (62 and 19 per cent young and the elderly (figure 31). Rates Information on the clinical manifestation respectively) were the most commonly were particularly high for children aged of 371 (96 per cent) of the cases was reported risk factors for cases aged 65 under two years and 85 years or older available. Pneumonia was the most years or older. Among those aged under (69.3 and 32.6 per 100,000) respectively. common clinical presentation among two years, unknown or no risk factors were The number of notified cases was highest adults, whereas bacteraemia without a reported for a majority (82 per cent). Nine in the winter months (n=139, 36 per cent). focus of infection was more common cases (12 per cent) had an identified risk among children aged less than five years Seven cases (two per cent) were in factor. persons identified as Aboriginal or Torres (table 33). Strait Islander; all were female. The age Serotype data were available for 358 Vaccination status range of these cases was ten months to isolates (92 per cent). Serotype was There was one case aged less than five 44 years, with a median age of 37 years. known for 81 isolates (95 per cent) from years who had received 7vPCV and was Three cases were children aged two years cases aged less than two years. Of these, infected with a serotype (19F) contained or less. Indigenous status was unknown 71 (88 per cent) were serotypes contained within the vaccine; therefore, one per cent or not stated for 24 notifications (six per in the seven-valent conjugate vaccine of cases in this age group were the result cent). (7vPCV). There were 108 isolates (95 per of vaccine failures. There were 34 fully vaccinated cases aged 65 years or older Figure 31: Notified cases of invasive pneumococcal disease, by age infected with a serotype contained within group and rate per 100,000 population, Victoria, 2004 the vaccine. This indicates that 35 per cent of cases in people aged 65 years or ��� �� older infected with a serotype contained ����� �� within 23vPPV were the result of vaccine ��� ���� failures. There were eight each of serotype �� ���������������� �� 9V and 14 infections, four each were �� serotypes 3 and 19F, three were 6B, two �� �� were serotype 4 and 9N, and one each �� were serotypes 11A, 17F, 22F, and 23F. �� ������������������������ Eight vaccine failures occurred in persons �� �� who were immunocompromised. �

� � ��� ��� ��� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����������������� 48 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 33: Notified cases of invasive pneumococcal disease, by age group and clinical presentation, Victoria, 2004 Age group (years) <2 2–<5 5–49 50–64 >65 Total Clinical presentation n % n % n % n % n % n %

Pneumonia 13 15 6 21 59 56 33 59 70 61 181 47

Meningitis 11 13 1 4 8 8 4 7 5 4 29 7

Pneumonia and meningitis 0 0 0 0 0 0 0 0 2 2 2 1

Bacteraemia/septicaemia 54 64 19 68 29 28 16 29 34 30 152 39

Other 5 6 0 0 2 2 0 0 0 0 7 2

Not stated/unknown 2 2 2 7 7 7 3 5 3 3 17 4

Total 85 100 28 100 105 100 56 100 114 100 388 100

Comment Measles Outbreak and other investigations In 2003, 7vPCV was included on the Two of those who had acquired measles Summary of notifications Australian Standard Vaccination Schedule overseas transmitted it to three others as a recommended vaccine for all The department received notifications in Victoria upon their return. There were Australian children (as a three dose series for 15 cases of confirmed measles in four locally acquired cases in a university at two, four and six months of age). The 2004, for 12 males (80 per cent) and setting; however, an epidemiological link National Immunisation Program (NIP) three females (20 per cent). The median to an overseas-acquired infection was funds this vaccine for all Indigenous age of cases was 26 years; one case was unable to be established. There was also children up to the age of two years, and aged two years and the remainder aged one case who acquired measles in Victoria for children up to the age of five years with between 18 and 34 years. from a returned traveller that was notified some specific medical conditions and Risk factors in late 2003. anatomical abnormalities. From 2005, the No cases reported a history of measles NIP will fund this vaccine for all children Comment vaccination; six (including the two- born from 1 January 2003 and those Enhanced measles surveillance in year-old) were not vaccinated and the less than five years of age with specified Victoria continues to facilitate the early vaccination status of the remainder was medical risk factors which puts them at identification and improved management unknown. Seven cases acquired measles higher risk of pneumococcal infection. of measles clusters in the community. overseas; all in Southeast Asia. Repeated outbreaks in recent years In Victoria, 23vPPV is available free of demonstrate that young adults remain the charge to all adults aged 65 years and group at highest risk of measles infection over, all indigenous persons aged 50 in Victoria. Mumps–measles–rubella years and over, indigenous persons aged vaccine is available free of charge for 15–49 years with certain health risks, people born from 1966 onwards and and all public hospital outpatients and should be especially encouraged in high inpatients at high risk of complications risk groups such as healthcare workers from influenza. and travellers. Surveillance of notifiable infectious diseases in Victoria, 2004 49

Mumps Pertussis in these age groups as a proportion of total notifications has been declining Summary of notifications Summary of notifications since 2000, whereas the proportion of The department received notifications for In 2004, the department received 870 notifications in those aged 20 years or three cases of confirmed mumps in 2004. notified cases of confirmed and probable over has been increasing (figure 33). Cases were in two females aged 32 and pertussis, corresponding to a notification Consistent with previous years, infants 45 years and one male aged 29 years. rate of 17 per 100,000. The majority had the highest notification rate (63 (59 per cent) of notified cases were in Risk factors per 100,000) in 2004. There was one females. death attributable to pertussis reported None of the persons notified had a There were 79 cases (nine per cent) in a one-month-old infant. By region, the validated history of mumps vaccination. aged less than five years. The highest notification rate was highest for Gippsland Outbreak and other investigations numbers of cases were in the 10–14 residents, although those living in the and 15–19 years age groups, which metropolitan regions comprised the No outbreaks were identified. comprised 15 per cent (n=130) and ten highest numbers of cases (figure 34). Comment per cent (n=91) of total cases respectively Prior to enhanced surveillance all clinical (figure 32). Despite this, the notifications notifications were counted in the dataset. Enhanced surveillance has shown that Figure 32: Notified cases of pertussis, by age group and rate clinical notifications (based on parotitis) per 100,000 population, Victoria, 2004 are not a good indicator of mumps activity ��� �� in times of high mumps–measles–rubella ����� vaccination coverage. Parotitis is likely ��� �� ���� to be due to causes other than mumps. ���������������� ��� �� Without laboratory confirmation, clinical diagnosis alone overestimates the �� �� incidence of mumps. �� ��

������������������������ �� ��

�� ��

� � � � � � � ��� ��� ����� ����� ���������� ������������������������������ ����� ���������� ����� ����� ����������������� 50 Surveillance of notifiable infectious diseases in Victoria, 2004

Figure 33: Notified case of pertussis, by year and age group as a Risk factors proportion of total cases, Victoria, 2004 There were 39 notifications in those aged less than one year (35 were aged six ��� ����� ��� ��� months or less). Among the 39 infants, ��� 16 were aged less than two months �� and were therefore ineligible to receive �� vaccine. Of the remaining 23 infants, 15 �� were fully vaccinated for age, six were �� partially vaccinated for age and two were �� unvaccinated. �� �� Outbreak and other investigations �� No outbreaks were identified. ���������������������������� �� Comment � ���� ���� ���� ���� ���� Infants too young to be vaccinated are �������������������� those most at risk of severe disease, and Figure 34: Notified cases of pertussis, by region and rate per 100,000 prevention depends on high vaccination population, Victoria, 2004 coverage in older infants and children. Waning immunity leaves teenagers and ��� �� ����� young adults susceptible and a likely �� source of infection for infants. ��� ���� �� ���������������� An adult vaccine (Boostrix®) is ��� �� recommended for the following groups who have completed a primary (childhood) ��� �� course of vaccine: �� ���

������������������������ • adolescents in Year ten or age equivalent �� �� • adults before planning pregnancy, or � both parents as soon as possible after � � birth ���� ������� �������� ��������� ��������� ��������� • adults working with young children, ������ ������������� �������������� especially healthcare workers and childcare workers in contact with infants • any adult wishing to receive a dose of Boostrix® vaccine. Boostrix® is provided free to adolescents in Year ten (or age equivalent). While it is strongly recommended for the other groups outlined above, it is not funded. Surveillance of notifiable infectious diseases in Victoria, 2004 51

Immunisation coverage in six years of age has not yet reached 90 The Regional Data Quality Officer program Victoria, 2004 per cent, and further effort is needed to ensures quality and completeness of improve coverage in this age group. immunisation data. This program reduces Immunisation coverage in Victoria remains duplication and error in the data stored on The key influences on the increase in at a high level at 12 months and two years, ACIR and identifies children for catch up coverage of the last year have been with little variation across departmental immunisation when they are overdue for the continuation of parent and provider regions. Despite many new initiatives in missed doses. incentives for immunisation and ongoing the immunisation program, and increasing The following tables (table 34, 35 and emphasis on accurate and timely complexity, the high level of coverage 36) group immunisation coverage by submission of data to the Australian has been maintained, to the credit of departmental region for the three age Childhood Immunisation Register (ACIR). all immunisation providers. Coverage at cohorts. Table 34: Immunisation coverage at 12–<15 months of age, by region, Victoria, 2004 DHS region DTP* Polio* HIB* Hep B* Fully immunised % % % % % Barwon South Western 92 92 94 94 92 Eastern Metropolitan 93 93 95 94 92 Gippsland 93 92 95 95 91 Grampians 93 93 96 96 93 Hume 92 92 94 94 91 Loddon Mallee 92 92 95 95 91 North West Metropolitan 93 93 95 95 92 Southern Metropolitan 92 92 94 93 90 Victoria 93 93 95 94 91 *DTP = three doses of diphtheria-tetanus-pertussis vaccine received *Polio = three doses of polio vaccine received *HIB (Haemophilus influenzae) = two doses of HIB vaccine received *Hep B (Hepatitis B) = two doses of hepatitis B vaccine received (this does not include the birth dose.)

Table 35: Immunisation coverage at 24–<27 months of age, by region, Victoria, 2004 DHS region DTP* Polio* HIB* Hep B* MMR* Fully immunised % % % % % % Barwon South Western 98 98 97 98 97 97 Eastern Metropolitan 96 96 95 96 95 93 Gippsland 97 96 95 97 95 94 Grampians 97 97 95 96 95 94 Hume 96 97 95 97 95 94 Loddon Mallee 96 96 94 96 95 93 North West Metropolitan 95 95 93 96 94 92 Southern Metropolitan 94 95 93 95 93 91 Victoria 96 96 94 96 94 93 *DTP = three doses of diphtheria-tetanus-pertussis vaccine received *Polio = three doses of polio vaccine received *HIB (Haemophilus influenzae) = three doses of HIB vaccine received *Hep B (Hepatitis B) = three doses of hepatitis B vaccine received *MMR = first does of measles-mumps-rubella vaccine received 52 Surveillance of notifiable infectious diseases in Victoria, 2004

Tables 36: Immunisation coverage at 72–<75 months, by region, months of age to the dose due at four Victoria, 2004 years of age. The result from one less dose of DTPa vaccine assisted to increase the Polio* DHS region DTP* MMR* Fully immunised coverage rates at the 24–<27 months and % % % % 72–<75 months age cohorts. Barwon South Western 90 89 89 89 Eastern Metropolitan 88 88 88 86 Immunisation coverage – school Gippsland 89 89 89 88 entry Grampians 90 90 90 89 A proxy measure of coverage at Hume 89 89 89 88 school entry has traditionally been the Loddon Mallee 89 89 89 88 measurement of immunisation status as North West Metropolitan 87 86 87 85 recorded on school entry immunisation Southern Metropolitan 85 84 84 83 certificates and required by the Health Victoria 87 87 87 86 (Immunisation) Regulations 1999. Each year, data have been collected via the *DTP = four doses of diphtheria-tetanus-pertussis vaccine received routine school census on the presentation *Polio = four doses of polio vaccine received of certificates in the preparatory year *MMR = two doses of measles-mumps-rubella vaccine received at government and Catholic schools. Data cited in this report are based on the infants and children are protected against In 2004 the school entry immunisation ACIR coverage report. The data presents vaccine preventable diseases at an age certificate census showed that complete immunisation coverage at 31 December when they are most vulnerable. This is immunisation coverage in government 2004 for children aged 12–<15 months, achieved through educational updates schools was 80 per cent. 24–<27 months and 72–<75 months such as seminars and newsletters to all As a result of the ACIR-provided history of age calculated at 30 September immunisation providers. statement to parents, there will be a 2004. Only vaccines administered In September 2003 the Australian reduced requirement for local government before 12 months of age were included Government removed the 18-month-old to provide school entry immunisation in the coverage calculation for the first dose of diphtheria, tetanus and acellular status certificates to families enrolling age group, and only those vaccines pertussis (DTPa) from the National a child into primary school. Local administered before 24 and 72 months Immunisation Program. This was due to government will only be required to of age were included in the coverage a small increase in severe local reactions provide a school entry immunisation calculation for the second and third age at the injection site following either the status certificate for a child for whom groups respectively. fourth or fifth dose of DTPa vaccine, and there is a conscientious or medical The administration of vaccines in a the demonstration of adequate ongoing objection to immunisation. timely manner is encouraged to ensure immunity from the third dose due at six Surveillance of notifiable infectious diseases in Victoria, 2004 53

Meningococcal C vaccination cases of meningococcal C disease Adolescent/adult diphtheria, program dropped from 88 in 2002 (prior to the tetanus and acellular program), to 47 in 2003 and 13 in 2004. In 2004/05, the department completed Deaths from meningococcal group C pertussis booster vaccine the co-ordination of the Victorian part of disease have declined from ten in 2002, to On 1 January 2004 the Australian the National Meningococcal C Vaccination six in 2003 and one in 2004. Government funded the introduction of Program, which has achieved 87 per cent the adolescent/adult diphtheria, tetanus There were no notified cases of group C coverage in Victorian school children from and acelluar pertussis (dTpa) booster invasive meningococcal disease that are Prep to Year 12. This was achieved 12 vaccine (Boostrix®) for adolescents 15 vaccine failures. months ahead of the national schedule, to 17 years of age. In Victoria, Boostrix® thanks to the efforts of Victoria’s local Figure 35 indicates the notified cases vaccine is given in a school based government immunisation teams. of invasive meningococcal serogroup C program for children in Year ten of The health benefits for Victorians have disease for 2000 to 2004. secondary school. Boostrix® vaccine been clearly demonstrated by the 95 replaces the diphtheria/tetanus (ADT) per cent reduction in notifications of vaccine program for Year ten students. In meningococcal C disease in the vaccine 2004 the coverage for dTpa vaccine of eligible age groups. The number of notified students in Year ten of secondary school was 78 per cent. Figure 35: Notified cases of invasive meningococcal serogroup C Infants and young children are frequently disease, by year and age group, Victoria, 2000–2004 infected from adults and adolescents who have a mild infection of pertussis. ��� ��� �� �� ��������� �� �������� �� �� ������� �� �� �� ������������������������ �� �� � ���� ���� ���� ���� ���� �������������������� 54 Surveillance of notifiable infectious diseases in Victoria, 2004

Older persons influenza program Influenza vaccine is recommended by the National Health and Medical Research Council to be given routinely every year to persons at high risk of the complications of influenza. The target population are all persons aged 65 years and over and Aboriginal and Torres Strait Islanders aged 50 years or older. Influenza immunisation has been shown to reduce mortality and save medical and hospital admission costs. There are four separate influenza vaccination programs in Victoria: • Persons aged 65 and over (funded by the Australian Government as part of the National Immunisation Program) • Indigenous persons aged 50 and over, and aged 15–49 with risk factors (funded by the Australian Government Office of Aboriginal and Torres Strait Islander Health) • Victorian hospital program for patients under 65 with risk factors (funded through the Winter Emergency Demand Management Strategy) • Victorian hospital program for direct care staff (funded through the Winter Emergency Demand Management Strategy). In 2004 the influenza vaccine coverage for persons aged 65 years and over in Victoria was 82 per cent, compared to the Australian average of 79.1 per cent. The Australian Government Adult Vaccination Survey, a computer assisted telephone survey of self reported vaccination status, was used to measure coverage. Surveillance of notifiable infectious diseases in Victoria, 2004 55

11. Vector-borne diseases

Arbovirus infections Barmah Forest virus disease Kunjin virus disease The most commonly reported arbovirus Summary of notifications Summary of notifications infections in Victoria are the alphaviruses: The department received notifications There was one notified case of Kunjin virus Ross River virus disease and Barmah for fourteen cases of Barmah Forest virus disease in 2004 in a 35-year-old female Forest virus disease (table 37). Both disease in 2004; a continuation of the low from metropolitan Melbourne. This was diseases are endemic throughout much numbers observed in 2003. Five females the first case notified since 2001. of the state, and are important as a result and nine males were notified, and the of their frequency and the disabling median age of cases was 48 years (range: Risk factors rheumatic symptoms they can cause. 16–79 years). Eight notifications (57 per The case did not report any likely Flavivirus infections include Murray Valley cent) had an exposure in the Gippsland exposures in Victoria but had travelled encephalitis, Kunjin virus encephalitis, region. extensively overseas, from where it is dengue fever and Japanese encephalitis. assumed she acquired her infection. Risk factors The last case of Murray Valley encephalitis reported as acquired in Victoria was Risk factor information was routinely Outbreak and other investigations in 1974. Four cases of Kunjin virus collected and revealed the most common The single case in 2004 was sporadic. encephalitis have been reported since risk factor to be living or holidaying in the 1991. No cases of dengue fever or Gippsland region. Comment Kunjin virus disease is sporadically Japanese encephalitis have ever been Outbreak and other investigations detected in Victoria; the most recently reported as acquired in Victoria, although No outbreaks were identified. imported cases of dengue fever are notified were one case in 2001 and two occasionally notified. Comment cases in 1991. Preventive measures are Minimising exposure to mosquito bites the same as for other mosquito-borne is the best prevention method. Wearing diseases. long, loose fitting clothing, preferably light in colour, and using a suitable mosquito repellent on any exposed skin will decrease the chance of being infected with a mosquito-borne disease. Mosquitoes are most active at dusk and dawn, although some species are present throughout the day, particularly in coastal regions. Table 37: Notified cases of arbovirus, by type, Victoria, 1999–2004 1999 2000 2001 2002 2003 2004 Ross River virus 227 313 357 33 14 91 Barmah Forest virus 13 18 19 59 9 14 Flavivirus– dengue 0 2 6 11 15 9 Flavivirus– not further specified 1 11 10 2 3 3 Flavivirus– Kunjin 0 0 1 0 0 1 Arbovirus– not further specified 45 16 5 0 0 0 Sindbis 1 0 0 0 0 1 Total 287 360 398 105 41 119 56 Surveillance of notifiable infectious diseases in Victoria, 2004

Ross River virus disease Figure 36: Notified cases of Ross River virus disease, by month of notification, Victoria, 1999–2004 Summary of notifications The department received notifications ���

for 91 cases of Ross River virus disease ��� in 2004. This was an increase on totals in 2002 and 2003, but still considerably ��� lower than in the period 1999-2001 (figure �� 36). Fifty-one notified cases were female �� and 39 were male (for one person the sex ����������� was not stated). The median age of cases ������������������������ ��

was 43 years (range: eight to 80 years). ��

Risk factors �

������ ������������ ������ ������ ������ ������ ������ ������ Exposures to Ross River virus disease ������������ ������ ������������������ ������������������ ������������������ ������ ������ ������ were mainly distributed across rural and ��������������������� regional areas of the state (figure 37). The highest number of cases and rates Figure 37: Notified cases of Ross River virus disease, by reported were reported for Loddon Mallee (n=24), exposure region and rate per 100,000 population, Victoria, 2004 Gippsland (n=18), Hume (n=13) and Grampians (n=7). There were 25 cases �� � ����� with interstate exposures, of which 11 � �� were in New South Wales and eight were ����

� ���������������� in Queensland. �� � � Outbreak and other investigations �� No outbreaks were identified. � �� �

Comment ������������������������ � Preventive measures are the same as for � � other mosquito-borne diseases. � �

���� ������� �������� ��������� ��������� ��������� ������ ������������� �������������� Surveillance of notifiable infectious diseases in Victoria, 2004 57

Flavivirus infections Malaria Table 39: Notified cases of malaria, by country of acquisition, Summary of notifications Summary of notifications Victoria, 2004 The department received notifications for The department received notifications for 13 cases of flavivirus infection in 2004, 63 cases of malaria in 2004, similar to the Country or region Number of which nine were identified as dengue number of cases in 2003. Fourteen cases Papua New Guinea 28 fever. These cases were in six males and were in females and 49 (79 per cent) were India 5 three females, with a median age of 32 males. The median age was 27 years Indonesia 4 years (range: 19–72 years). (range: three to 66 years) (figure 38). Uganda 4 Plasmodium vivax was the most common Vanuatu 4 Risk factors type of malaria notified, accounting for East Timor 3 Overseas travel within the incubation 45 cases (table 38). No mixed infections Ghana 3 period was reported for all cases. Three were reported. Kenya 2 cases reported travel to Thailand, two Nigeria 2 had travelled to Indonesia, and one case Table 38: Notified cases of Pakistan 2 respectively to East Timor, India, Malaysia malaria, by species, Victoria, 2004 Madagascar 1 and Sri Lanka. Type Number Per cent Malaysia 1 Pl. vivax 45 71 Outbreak and other investigations Philippines 1 Pl. falciparum 14 22 No outbreaks were identified. South Africa 1 Pl. ovale 4 6 Egypt 1 Total 63 100 Comment Liberia 1 People travelling to endemic areas must The most common countries in which Total 63 be aware of the risks and take appropriate malaria was acquired were Papua New precautions. Vaccinations are not available Guinea (44 percent), India (eight percent), except for Japanese encephalitis, and and Indonesia, Uganda and Vanuatu with preventive measures are the same as for six percent each (table 39). other mosquito-borne diseases. Figure 38: Notified cases of malaria, by age group and rate per 100,000 population, Victoria, 2004

�� ��� ����� �� ��� ���� �� ��� ���������������� ��� �� ��� � ��� � ��� ������������������������ � ��� � ��� � ���

��� ������ ������ ������������������������������������������������������������������������������������������������������������������������ ����������������� 58 Surveillance of notifiable infectious diseases in Victoria, 2004

Risk factors Malaria prophylaxis of some form was taken by 31 (49 per cent) of notified cases. Twenty-three (35 per cent) of these had taken the prophylaxis regularly, while eight had taken it intermittently. Seventeen cases did not take any form of prophylaxis. Information regarding prophylaxis was not available for 15 cases.

Outbreak and other investigations No outbreaks were identified.

Comment The best prevention is to avoid being bitten by mosquitoes. All travellers to tropical and malarious areas should cover exposed skin with long sleeves and long pants. They should treat exposed areas of skin with insect repellents that contain diethyl toluamide (DEET) or picaridin. Impregnated bed nets and screening of accommodation are also recommended. Before travelling, people should seek reliable advice on malaria prophylaxis. No prophylaxis is 100 per cent effective; malaria may still occur and prompt medical care should be sought if a fever develops. Up-to-date information on recommended anti-malarial chemoprophylaxis can be obtained from specialist travel medicine clinics or the World Health Organization publication International travel and health 2005, available at www.who.int/ith Surveillance of notifiable infectious diseases in Victoria, 2004 59

12. Zoonoses

Brucellosis Leptospirosis Outbreak and other investigations No outbreaks were identified. Summary of notifications Risk factors The department received notifications for There were eight cases of leptospirosis Discussion and comment three cases of brucellosis in 2004. There notified in 2004 among people aged Farmers can minimise infection by was one case of Brucella abortus in a from 27 to 53 years; seven were males. ensuring they appropriately vaccinate 20-year-old female and two cases of B. Leptospirosis is predominantly a disease stock. Vaccines are available for dairy melitensis biotype 1 in males aged 30 and associated with rural areas (table 40). cows, sheep, goats and deer. Calves over 49 years. Five of the six cases from rural regions three months of age and adult cattle were dairy or cattle farmers and the other should receive two doses four to six weeks Risk factors was a cattle and sheep transporter. The apart, with annual boosters thereafter. Brucellosis is predominantly an two cases from metropolitan Melbourne Leptospirosis can be difficult to diagnose occupational disease of farm and abattoir both reported river kayaking during their and should be considered in persons workers and veterinarians. Infection can incubation periods, but one also reported from high risk populations presenting with also occur through the consumption a possible occupational exposure during meningitis, encephalitis or influenza-like of unpasteurised soft cheeses and inspection (without protective clothing or a illness. other dairy products. The only plausible mask) of rat-infested roofs. exposure source for the 20-year-old female was cows in Macedonia before Table 40: Notified cases of her arrival in Australia ten months prior leptospirosis, by region and to diagnosis. Both cases of B. melitensis rate per 100,000 population, infection reported consumption of Victoria, 2004 unpasteurised dairy products in the L. Other Total Region Middle East and Eritrea respectively as the hardjo species (rate) most likely source of exposure. Barwon South 2 0 2 (0.6) Western Outbreak and other investigations Eastern 0 0 0 No outbreaks were identified. Metropolitan Gippsland 4 0 4 (1.6) Comment Grampians 0 0 0 People can avoid becoming infected with Hume 0 0 0 Brucella by not consuming unpasteurised Loddon Mallee 0 0 0 dairy products. Those in high-risk North and West 1 1 2 (0.1) occupations should be educated about Metropolitan Southern the disease and the appropriate protective 0 0 0 Metropolitan measures required when exposed to Total 7 1 8 (0.2) infected animals and/or carcasses. 60 Surveillance of notifiable infectious diseases in Victoria, 2004

Psittacosis Figure 39: Notified cases of psittacosis, by age group, sex and rate per 100,000 population, Victoria, 2004 Summary of notifications

The department received notifications �� � ����� for 155 cases of confirmed and probable � psittacosis in 2004, a 74 per cent increase �� ���� ���������������� on the 89 cases notified in 2003. The � median age of cases notified was 53 years �� � (range: 16–88 years), with the highest � rates generally in those aged 55 years and �� �

over (figure 39). Ninety-eight cases (63 ������������������������ � per cent) were in males. The notification � rate was highest for the Grampians region �

(14 per 100,000) but this was almost � �

exclusively due to an outbreak (figure 40). ��� ��� ��� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� ����� Eighty-one cases (52 per cent) were ����������������� hospitalised although there were no deaths attributable to psittacosis. Figure 40: Notified cases of psittacosis, by region and rate per Risk factors 100,000 population, Victoria, 2004 Risk factor data, including occupational �� �� ����� exposure and contact with domestic and �� �� wild birds, are collected for notified cases ���� �� ���������������� of psittacosis. Forty-four people (28 per �� cent) reported an occupational exposure. �� There were 82 cases (53 per cent) who �� � reported contact with wild birds and 58 � cases (37 per cent) who reported an �� ������������������������ exposure to domestic psittacines. Among � �� those reporting contact with domestic �

psittacines, 22 (38 per cent) were � � purchased in the previous 12 months. ������� ���� ��������� �������� Outbreak and other investigations ��������� ��������� ������ ������������� �������������� There were two outbreaks of psittacosis was a maintenance worker. On the advice In May 2004 a seroprevalence and case identified and investigated in 2004. of a consultant veterinarian, the birds control study was performed to identify Although it was identified in February, were commenced on oxytetracycline in risk factors associated with working at the first outbreak at a poultry farm was their drinking water in December 2003 the site. The study found that there were determined to have started in November and in their feed in January 2004. The multiple sites of exposure throughout 2003 and continued until the following company, in conjunction with a number the abattoir but workers who were in the July. A total of 26 cases (14 confirmed and of Victorian Government authorities, de-feathering and killing area were more 12 probable) were notified, of which five developed and implemented a risk prone to pneumonia. New workers were (19 per cent) were hospitalised. Twenty- management plan in February 2004. also much more likely to contract severe four cases had worked in the onsite An environmental clean up was also disease. abattoir, one was a farm worker and one performed but cases continued to occur. Surveillance of notifiable infectious diseases in Victoria, 2004 61

Additional control measures implemented Q fever Outbreak and other investigations prior to the cessation of the outbreak No outbreaks were identified. included: the commencement of all- Summary of notifications in/all-out farming practices and bird The department received notifications for Comment proofing of duck sheds; completion of a 27 cases of Q fever in 2004, an increase of Q fever is not endemic in Victoria, but barrier between an amenities building and 50 per cent on the 18 cases in 2003. The many of the cattle, sheep and feral goats hanging area in the abattoir; improvement median age of cases notified was 43 years handled in abattoirs or on farms are in hygiene at the abattoir; enforcement of (range: 18–81 years), and 22 (81 per cent) from interstate. Q fever vaccination is the use of P1/P2 masks at the abattoir; were males. Fourteen persons (52 per recommended, therefore, for all abattoir enhancements to the mechanical cent) were hospitalised for their illness, but workers, maintenance workers (such ventilation of the factory and; relocation of no deaths were reported. as engineers and plumbers) and truck approximately two-thirds of the poultry to drivers who work or visit abattoirs. About satellite farms. Risk factors 20 per cent of people who acquire The second outbreak involving four Q fever is predominantly a disease acute Q fever will develop a post Q fever poultry processing workers occurred associated with abattoirs and farming, and fatigue syndrome or suffer long-term at a game processing plant between this link is reflected in the regions where consequences of their disease, which may March and September. The three males those notified lived (figure 41), and in their produce recurring symptoms for years. and one female were aged from 37 to occupations (table 41). Although vaccine 56 years (median 51 years); two were failures are known to occur, no cases hospitalised. The Communicable Disease of Q fever were reported in vaccinated Control Unit liaised with the local individuals. Regional Environmental Health Officer to implement control measures, alerted local medical practitioners about the outbreak Figure 41: Notified cases of Q fever, by region and rate per 100,000 and developed a fact sheet for poultry population, Victoria, 2004 processing workers. �� ��� ����� Comment ��� �� ����

People can contract psittacosis via ��� ���������������� contact with wild or domestic birds. � ��� Medical practitioners should remind ��� their patients about the risk of feeding � ��� and handling wild birds. Birds kept domestically should have their cages and � ��� ������������������������ ��� feeding bowls regularly cleaned. When � cages are being cleaned, a facemask and ��� gloves should be used. Wetting down the � ��� area before cleaning will prevent dust ������� ���� �������� formation. If a bird has been ill, then its ��������� ��������� ��������� cage, bowl and so on should be cleaned ������ ������������� �������������� with a 1:100 diluted solution of household bleach. People are also advised to use a mask or grass catcher when mowing the lawn. 62 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 41: Notified cases of Q fever, by occupation, Victoria, 2004

Primary occupation Female Male Total Meat tradesperson, labourer 0 2 2 Agricultural worker 0 2 2 Farmer, farm manager, farm hand 2 7 9 Truck driver 0 2 2 Other labourers and related workers 0 3 3 Computer technician 0 1 1 Nurse 1 0 1 Veterinarian 1 1 2 Unemployed 0 3 3 Retired 1 0 1 Unknown 0 1 1 Total 5 22 27 Surveillance of notifiable infectious diseases in Victoria, 2004 63

13. Public health project funding 2003–04 The Public Health Branch of the department funded a number of projects in communicable diseases in 2003/04. The projects are listed below:

An investigation into the effect of income inequality, social capital and socioeconomic status on smoking Topic behaviour Investigators Dr Mohammad Siahpush, Dr Ron Borland Organisation Cancer Council Victoria Funding $75,000 Topic The positioning of health impact assessment in Local Government in Victoria Investigators Ms Mary Mahoney Organisation Deakin University, Faculty of Health and Behavioural Science Funding $75,000 Topic The social processes of peer influence among gay men in Melbourne Investigators A/Professor Anthony Smith, Professor Marian Pitts Organisation La Trobe University, Australian Research Centre in Sex, Health & Society Funding $74,528 Topic Perceptions and understandings of HIV transmission among culturally and linguistically diverse communities Investigators Dr Stephen McNally, Professor Marian Pitts, Dr Jeffrey Grierson Organisation La Trobe University, Australian Research Centre in Sex, Health & Society Funding $63,236 Topic Reducing the risk of transmission of HIV/AIDS in African and Arabic-speaking communities in Victoria Investigators A/Professor Beverley-Ann Biggs, Dr Margaret Hellard, Dr Alan Street Organisation Melbourne Health, Department of Medicine, Royal Melbourne Hospital Funding $75,627 Topic Emergency management risk communication Investigators A/Professor Rae Walker, Professor Vivian Lin, Dr Priscilla Robinson, Dr John Tebbutt Organisation La Trobe University, School of Population Health Funding $72,882 Topic Occupational asthma - detection, surveillance and prevention of the disease burden Investigators A/Professor Malcolm Sim, A/Professor Michael Abramson, A/Professor Anthony LaMontagne, Dr Rosalie Aroni Organisation Monash University, Occupational & Environmental Health Unit Funding $71,274 Gear up: Motivators and barriers to personal protective equipment (PPE) wearing by youth skaters (in-line Topic skaters and skateboards) Investigators Ms Erin Cassell, Dr Rosalie Aroni, A/Professor Susan Sawyer Organisation Monash University, Accident Research Centre Funding $69,953 Topic Barriers to child poisoning prevention: Why does child resistant packaging fail? Investigators Professor Joan Ozanne-Smith, Dr Jenny Sherrard, Mr Jeff Robinson Organisation Monash University, Accident Research Centre Funding $54,287 64 Surveillance of notifiable infectious diseases in Victoria, 2004

Investigating the over-representation of older persons in do-it-yourself home maintenance injury and barriers to Topic prevention Investigators Professor Joan Ozanne-Smith. Ms Karen Ashby Organisation Monash University, Accident Research Centre Funding $33,041 Doesn’t everyone have poison in the kitchen cupboard? Investigating socio-cultural differences in child Topic unintentional poisoning Investigators Ms Lisa Gibbs, A/Professor Elizabeth Waters, Dr Simon Young Organisation Murdoch Children’s Research Institute, Centre for Community Child Health Funding $74,280 Topic Cultural safety in nursing practice: professional, educational, organisational and consumer perspectives Investigators Professor Olga Kanitsaki, Professor Megan-Jane Johnstone Organisation Royal Melbourne Institute of Technology, Department of Nursing & Midwifery Funding $72,650 Topic Beyond the bedside: What contribution can nurses make within a regional HACC agency? Investigators Professor Linda Johnston, Organisation The University of Melbourne, Victorian Centre for Nursing Practice Research Funding $73,142 Surveillance of notifiable infectious diseases in Victoria, 2004 65

14. Reports and publications

Peer review journals Li J, Roche P, Spencer J, Bastian I, Conference presentations Christensen A, Hurwitz M, Konstantinos A, Andrews RM, Counahan ML, Hogg GG, Birbilis, E, Csutoros, D, & Dawood, F, June Krause V, McKinnon M, Misrachi A, Tallis McIntyre PB, Effectiveness of a publicly 2004, Zoonoses, avian influenza and G, Waring J, Tuberculosis notifications in funded pneumococcal vaccination influenza pandemic planning, Regional Australia 2003. Commun Dis Intell, 2004 program against invasive pneumococcal Animal Health Conference, Echuca. Vol 28(4):464–73. disease among the elderly in Victoria. Lalor K, October 2004, Gastro survey of Australia. Vaccine, 2004 Vol 23(2):132–8. Robotin MC, Copland J, Tallis G, Coleman D, Giele C, Carter L, Spencer J, Kaldor JM, General practitioners, Australian Institute Counahan M, Andrews R, Buttner P, Dore GJ, Surveillance for newly acquired of Environmental Health, Victorian Division Byrnes G, Speare R, Head lice prevalence hepatitis C in Australia. J Gastroenterol State Conference. in primary schools in Victoria, Australia. Hepatol, 2004 Vol 19(3):283–8. Lester R on behalf of the National J Paediatr Child Health, 2004 Vol Immunisation Committee, August 2004, 40(11):616–9. Roche P, Krause V, Bartlett M, Coleman D, Cook H, Counahan M, Davis C, Del Fabbro The national meningococcal C vaccination Dalton CB, Gregory J, Kirk MD, Stafford L, Giele C, Gilmore R, Kampen R, Young program, Ninth National Immunisation RJ, Givney R, Kraa E, Gould D, Foodborne M, Hogg G, Murphy D, Watson M, Invasive Conference, Cairns. disease outbreaks in Australia, 1995 pneumococcal disease in Australia, 2003. Madin S, November 2004, Legionellosis in to 2000. Commun Dis Intell, 2004 Vol Commun Dis Intell, 2004 Vol 28(4):441– Victoria, Hume Region Infection Control 28(2):211–24. 54. Practitioners seminar. Genobile D, Gaston J, Tallis GF, Gregory The OzFoodNet Working Group. Moran R, October 2004, Development of JE, Griffith JM, Valcanis M, Lightfoot D, Foodborne disease investigation across best practice guidelines for health and Marshall JA, An outbreak of shigellosis in a Australia: Annual report of the OzFoodNet body art businesses, Australian Institute child care centre. Commun Dis Intell, 2004 network, 2003, 2004 Vol 28(3). of Environmental Health, Victorian Division Vol 28(2):225–9. Tomnay J, Hatch B, Pitts M, Carter T, State Conference. Greig JE, Carnie JA, Tallis GF, Ryan NJ, Fairley C, HIV partner notification: a 2002 Moran R, November 2004, Regulating Tan AG, Gordon IR, Zwolak B, Leydon Victorian audit. International Journal of STD Health and Body Art Businesses, Twelfth JA, Guest CS, Hart WG, An outbreak of & AIDS, 2004 Vol 15(9): 629–631. National Symposium on Hepatitis B and C, Legionnaires’ disease at the Melbourne Tomnay J, Pitts M, Fairley C, Partner Melbourne. Aquarium, April 2000: investigation and notification: preferences of Melbourne Moran, R, August 2004, Victoria: Arbovirus case-control studies. Med J Aust, 2004 Vol clients and the estimated proportion activity update, Sixth Mosquito Control 180(11):566–72. of sexual partners they can contact. Association of Australia Conference, International Journal of STD & AIDS, 2004 Guy RJ, Di Natale R, Kelly HA, Lambert SB, Noosa. Tobin S, Robinson PM, Tallis G, Hampson Vol 15(6): 415–418. AW, Influenza outbreaks in aged-care Tomnay J, October 2004, HIV partner facilities: staff vaccination and the Public health bulletins notification: a 2002 Victorian audit, emerging use of antiviral therapy. Med J Carter, K and Wang J, Salmonella and Partner notification: preferences of Aust, 2004 Vol 180(12):640–2. Typhimurium 9 outbreak linked to a Melbourne clients and the estimated Melbourne pizza restaurant. Victorian proportion of sexual partners they can Guy RJ, Andrews RM, Kelly HA, Leydon contact, IUSTI Conference on sexually JA, Riddell MA, Lambert SB, Catton MG. Infectious Diseases Bulletin, 2004 Vol 7 (2): 30–32. transmitted infections, Island of Myconos, Mumps and rubella: a year of enhanced Greece. surveillance and laboratory testing. Moloney, M, Acute hepatitis B in Victoria Epidemiol Infect, 2004 Vol 132(3):391–8. 1997–2003. Victorian Infectious Diseases Bulletin, 2004 Vol 7 (3): 58–59. 66 Surveillance of notifiable infectious diseases in Victoria, 2004

Communicable diseases Mosquito identification & control Medical Officers of Health training programs/workshops training course conference The department undertook its A one-day conference was held in Gastroenteritis investigation annual training program for mosquito October 2004 for Medical Officers of training for environmental health identification and control in Swan Hill in Health. Twenty-one doctors attended officers November 2004. The department has the conference, with sessions covering Two 2-day courses were conducted for been running these training courses surveillance of vaccine preventable local government Environmental Health since 1974. The course is open to any diseases, Mycobacterium diseases, Officers on investigating sporadic cases employee of council who may deal with immunisation, waste water reuse and and outbreaks of gastroenteritis. Staff issues relating to mosquitoes so that contact tracing and knowing and reckless of OzFoodNet and the ESAC team were the necessary skills and expertise to legislation. Medical Officer of Health Dr involved in the development and delivery investigate and control local problems Greg Rowles delivered a session on rubella of this training program. can be gained. Other groups, such as and measles in adults. the Australian Army, also regularly send Listeria awareness program participants. Staff of OzFoodNet and MDU conducted Twenty-four participants attended the eight Listeria awareness presentations 2004 course including six officers from for aged care residential facilities and South Australia and two from New South meals on wheels programs around Wales. The course addressed the following metropolitan Melbourne. The aim of the key areas: public health and mosquitoes, presentation was to raise the awareness monitoring of breeding sites, species of the risks of listeriosis in the elderly, identification, biological and chemical immunocompromised and those with control, environmental management/ cancer, AIDS, diabetes and liver or kidney modification, occupational health and disease, and to provide information on safety and education strategies. foods that should be avoided due to the possible presence of Listeria. Education sessions for general practitioners Health guidelines for personal care and body art industries Training was provided to general training practitioners in sessions conducted at Sale, Shepparton, Colac, Terang, Nine training sessions on the Health Warrnambool and Hamilton. Topics guidelines for personal care and body varied between sessions and included art industries, one in each departmental gastroenteritis, new emerging pathogens region, were conducted for Environmental (SARS and avian flu), and notification of Health Officers of local councils. A total infectious diseases. of 207 people attended with 69 out of 78 councils represented. The sessions Education session on sexually covered the legislative context of the transmissible infections for guidelines and various aspects of the secondary school nurses guidelines including sterilisation and Training was provided to secondary school cleaning, inspection of premises and risk nurses employed by the department. management. Training covered chlamydia and other STIs. Surveillance of notifiable infectious diseases in Victoria, 2004 67

15. Resources

Infectious Diseases Epidemiology & Surveillance (IDEAS) www.health.vic.gov.au/ideas Aimed at health professionals, the IDEAS website provides information on the prevention and control of infectious diseases, regulations and guidelines, surveillance of infectious diseases and notification procedures. Information about immunisation is available at www.health. vic.gov.au/immunisation

Better Health Channel www.betterhealth.vic.gov.au The Better Health Channel provides the community with access to online health related information which is quality assured, reliable, up-to-date and locally relevant.

Health Translations Directory www.healthtranslations.vic.gov.au The Health Translations Directory provides access to translated health information available online.

Clinicians Health Channel http://www.health.vic.gov.au/clinicians Provides access to critical knowledge bases for clinicians in the public health care sector in metropolitan, regional and rural Victoria. This includes the electronic dissemination of information and access to various electronic resources such as citation databases, drug and prescribing information and clinical guidelines. 68 Surveillance of notifiable infectious diseases in Victoria, 2004

Appendices

Appendix 1: Department of Human Services regions by Local Government area, Victoria.

Region Local Government Region Local Government Region Local Government Barwon South Colac-Otway (S) Hume Alpine (S) Southern Bayside (C) Western Corangamite (S) Benalla (RC) Metropolitan Cardinia (S) Glenelg (S) Mansfield (S) Casey (C) Greater Geelong (C) Greater Shepparton (C) Frankston (C) Moyne (S) Indigo (S) Glen Eira (C) Queenscliff (B) Mitchell (S) Greater Dandenong (C) Southern Grampians (S) Moira (S) Kingston (C) Surf Coast (S) Murrindindi (S) Mornington Peninsula (S) Unincorporated Vic Strathbogie (S) Port Phillip (C) Warrnambool (C) Towong (S) Stonnington (C) Wangaratta (RC) Wodonga (RC)

Eastern Boroondara (C) Gippsland Bass Coast (S) Grampians Ararat (RC) Metropolitan Knox (C) Baw Baw (S) Ballarat (C) Manningham (C) East Gippsland (S) Golden Plains (S) Maroondah (C) Latrobe (C) Hepburn (S) Monash (C) South Gippsland (S) Hindmarsh (S) Whitehorse (C) Wellington (S) Horsham (RC) Yarra Ranges (S) Moorabool (S) Northern Grampians (S) Buloke (S) Banyule (C) Loddon Mallee North and West Pyrenees (S) Campaspe (S) Metropolitan Darebin (C) West Wimmera (S) Central Goldfields (S) Hume (C) Yarriambiack (S) Gannawarra (S) Moreland (C) Greater Bendigo (C) Nillumbik (S) Loddon (S) Whittlesea (C) Macedon Ranges (S) Yarra (C) Mildura (RC) Brimbank (C) Mount Alexander (S) Swan Hill (RC) Hobsons Bay (C) Maribyrnong (C) Melbourne (C) Melton (S) Moonee Valley (C) Wyndham (C)

S = Shire C = Council RC = Rural Council B = Brog Surveillance of notifiable infectious diseases in Victoria, 2004 69

Appendix 2: Supplementary data – Sexually transmissible infections, Victoria, 2004 Table 42: Reported partner type (from whom HIV was reported to be acquired) in males reporting homosexual contact, Victoria, 1997–2004

1997 1998 1999 2000 2001 2002 2003 2004 Partner type n % n % n % n % n % n % n % n % Regular 26 19.0 22 22.2 34 42.5 32 25.4 36 24.0 56 34.6 26 15.9 27 18.4 Casual 33 24.1 23 23.2 16 20.0 28 22.2 58 38.7 50 30.9 50 30.7 26 17.7 Anonymous 65 47.4 38 38.4 20 25.0 59 46.8 38 25.3 42 25.9 45 27.6 44 29.9 Any combination of 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 17 10.5 29 19.7 above Unknown 13 9.5 16 16.2 10 12.5 7 5.6 18 12.0 14 8.6 25 15.3 21 14.3 Total 137 100 99 100 80 100 126 100 150 100 162 100 163 100 147 100.0

NB Data collected since 1997

Table 43: Clinical presentation at HIV diagnosis, Victoria, 1994–2004

Year of HIV diagnosis Total Clinical presentation Sex ≤1995# 1996 1997 1998 1999 2000 2001 2002 2003 2004 n M 15 11 19 9 14 20 16 35 34 24 197 Symptoms of acute HIV F 0 1 1 0 3 3 1 1 1 0 11 M 220 108 92 73 83 90 122 122 131 132 1,173 Asymptomatic F 21 7 10 7 8 13 13 15 16 18 128 M 11 5 3 3 6 4 3 12 5 4 56 Lymphadenopathy F 2 0 0 0 0 0 2 1 0 1 6 Other HIV related M 40 23 26 21 9 35 21 17 12 11 215 symptoms F 0 4 0 1 1 2 4 6 1 1 20 M 63 26 32 29 11 20 24 15 20 18 258 AIDS F 5 1 3 0 0 2 3 1 1 5 21 M 1 0 0 0 3 5 4 5 2 1 21 Other i.e. died F 0 0 0 0 0 0 0 0 0 0 0 M 18 5 1 6 2 2 3 1 2 1 41 Unknown F 3 0 1 0 0 0 0 0 0 0 4 Total 399 191 188 149 140 1971 2181 2331 225 2171 2,1571 NB Data collected since 1994 1 Includes six people whose sex was reported as transgender 70 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 44: HIV diagnoses, by sex and reason for testing, Victoria, 1994–2004

Year of HIV diagnosis Total Reason for test Sex ≤1995# 1996 1997 1998 1999 2000 2001 2002 2003 2004 n M ------Antenatal screen F 1 0 0 1 2 6 2 1 3 2 18

Earlier diagnosis M 15 14 9 14 5 6 13 21 21 10 128 (confirmation) F 2 1 1 2 3 1 4 1 2 2 19 M 1 1 1 0 1 0 0 2 0 1 7 Donation screen F 1 0 0 0 1 0 0 0 0 0 2 M 7 4 3 3 7 4 4 4 5 8 49 Immigration F 3 1 0 0 1 1 0 2 4 2 14 M 5 0 0 0 0 3 1 2 0 0 11 Insurance F 0 0 0 0 0 0 0 0 0 0 0 M 2 2 2 1 2 0 1 1 1 1 13 Occupational F 0 0 0 0 0 0 0 0 0 0 0

Other i.e. patient request, M 19 7 5 10 26 13 20 20 16 23 159 post-mortem F 3 1 1 1 3 3 5 5 1 5 28 M 3 4 2 2 2 3 2 1 2 1 22 Prison F 0 1 0 0 0 0 0 0 0 1 2 M 2 0 0 0 0 1 0 1 2 0 6 Presurgical F 0 0 0 0 0 0 0 0 0 1 1 M 204 102 97 78 66 100 110 103 109 93 1,062 Sex/IDU F 9 5 8 4 2 8 7 9 7 6 65 Symptomatic M 93 43 53 31 19 45 42 50 50 52 478 F 10 4 4 0 0 1 4 6 2 5 36 M 17 1 1 2 0 1 0 2 0 2 26 Unknown F 2 0 1 0 0 0 1 0 0 1 5

Total 399 191 188 149 140 1971 2181 2331 225 2171 2,1571

NB Data collected since 1994 1 Total includes six people whose sex was reported as transgender

Surveillance of notifiable infectious diseases in Victoria, 2004 71 1 1 7 1 4 5 8 5 6 6 n 11 22 72 29 15 15 18 99 44 30 111 118 176 145 133 1070 Total 2157 ------F 1 1 9 1 0 0 0 8 0 5 0 0 0 0 0 0 0 25 1 117 11 10 11 10 192 2004 M 9 0 0 1 7 0 0 0 4 1 6 2 0 0 1 0 0 0 1 0 F ------2 0 0 0 7 1 2 0 0 0 6 1 0 0 0 0 0 19 1 117 14 21 11 M 8 2 0 0 1 1 4 2 4 0 8 4 0 0 6 0 1 0 0 2 0 206 2003 24 F ------0 0 0 0 8 0 3 2 1 1 7 2 0 0 0 0 0 119 18 11 11 M 20 5 7 1 0 0 2 0 1 1 1 3 4 0 0 1 1 0 1 0 0 209 2002 F ------1 0 0 1 6 1 3 2 0 0 7 0 0 1 1 0 0 23 1 108 19 12 11 195 M 5 2 0 0 5 1 2 0 6 1 8 2 1 0 4 0 1 1 1 3 0 2001 12 F ------1 0 0 0 5 0 2 0 0 0 0 0 0 0 0 0 20 1 177 100 10 11 10 2000 M 5 3 3 1 1 7 0 3 1 4 1 7 1 1 0 0 1 1 0 5 0 12 F ------0 0 0 0 2 0 2 0 1 0 5 0 2 0 0 0 0 62 11 128 M 8 6 4 0 1 0 1 1 2 1 7 1 6 2 0 0 8 1 3 0 2 1 0 1999 F ------0 1 0 0 2 1 2 1 0 0 1 0 0 0 0 0 0 8 141 66 10 13 M 9 3 5 1 0 2 0 3 0 5 0 9 2 0 0 4 1 0 1 1 6 0 1998 15 F ------2 0 0 0 4 0 1 2 0 0 4 0 1 0 0 1 0 173 100 17 10 10 M 5 2 0 1 3 1 1 0 5 0 8 1 0 0 3 0 1 0 0 5 0 1997 13 F ------0 2 0 0 7 0 2 1 0 0 1 0 0 0 0 0 0 178 102 17 11 15 1996 M 5 4 0 1 1 0 1 0 3 1 5 2 0 0 9 0 0 0 0 1 0 31 11 F ------2 0 0 1 7 2 0 0 0 6 0 1 1 0 0 0 # 179 14 10 368 Year of diagnosis of Year ≤ 1995 M 35 34 3 1 1 6 4 1 1 6 4 6 2 0 0 0 3 0 0 4 1 53 Interstate Interstate Interstate Probable Probable Victoria Victoria Victoria Victoria Victoria Victoria place infection acquired Overseas Unknown Overseas Unknown Overseas Unknown Overseas Unknown Overseas Unknown Overseas Unknown All Interstate Interstate Interstate Total includes six Total people whose sex was reported as transgender Heterosexual Heterosexual Heterosexual Exposure category Male homosexual Male homosexual and IDU IDU Contact contact from (Person high prevalence country) Other Unknown NB Data collected since 1994 1 Total Table 45: HIV diagnoses, by exposure category, probable place infection acquired and sex, Victoria, 1994–2004 1994–2004 Victoria, sex, and acquired infection place probable category, exposure by diagnoses, HIV 45: Table 72 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 46: HIV diagnoses in IDUs (excluding MSM), by region of birth and sex, Victoria, 1994–2004

Year of HIV diagnosis Total Region of birth Sex ≤1995# 1996 1997 1998 1999 2000 2001 2002 2003 2004 n M 0 2 1 1 2 4 5 3 5 2 25 Asia F 0 0 0 0 0 0 1 0 0 1 2 M 9 0 2 2 1 4 3 0 2 5 28 Australia F 3 2 2 1 0 1 1 0 2 0 12 M 2 0 2 2 0 1 0 0 1 0 8 Europe F 0 0 0 0 0 0 0 0 0 0 0 M 0 0 0 0 1 0 0 0 0 0 0 Other Oceania (i.e NZ) F 0 0 0 0 0 0 0 0 0 0 0 M 0 0 0 0 0 0 0 1 0 0 1 United Kingdom/Ireland F 0 0 0 0 0 0 0 0 0 0 0 M 1 0 0 0 1 2 0 0 0 0 4 Unknown F 0 0 0 0 0 0 0 0 0 0 0 Total 15 4 7 6 5 12 10 4 10 8 81

NB Data collected since 1994 Table 47: Diagnoses of newly acquired HIV infection by year, HIV exposure category and sex, Victoria, 1983–2004

HIV exposure Year of diagnosis Total category Sex ≤1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 n Male homosexual M 307 47 40 30 29 50 59 67 62 57 748 Male homosexual and M 17 0 3 3 4 2 1 5 4 3 42 IDU M 10 1 0 1 0 5 2 1 1 1 22 IDU F 7 1 0 0 0 1 1 0 1 0 11 M 5 2 2 1 2 3 1 2 3 2 23 Heterosexual contact F 13 2 4 0 1 2 2 0 1 5 30 Heterosexual contact M 1 0 0 0 2 0 0 1 0 0 4 (Person from high prevalence country) F 2 0 0 0 3 0 1 2 2 0 10

Receipt of blood/ M 1 0 0 0 0 0 0 0 0 0 1 tissue F 0 0 0 0 1 0 0 0 0 0 1 M 4 0 0 0 0 1 0 0 0 0 5 Unavailable F 0 0 0 0 0 0 0 0 0 0 0 Total 367 53 49 35 42 64 67 791 74 691 8991

1 Total includes two individuals whose sex was reported as transgender Surveillance of notifiable infectious diseases in Victoria, 2004 73 1 9 9 7 4 4 6 0 6 n 12 19 14 14 21 42 74 22 16 15 15 18 10 25 25 23 70 36 46 30 20 30 112 261 523 186 223 204 Total 2157 ------F 1 1 1 1 1 2 2 1 4 0 0 0 0 0 5 3 0 3 0 0 0 0 0 0 25 1 2004 1 1 1 1 2 2 2 1 1 1 4 4 4 4 3 3 0 3 0 0 0 0 3 3 0 0 0 0 0 0 M 12 21 21 27 10 56 192 ------F 1 1 1 2 2 1 2 2 2 1 4 0 0 0 0 0 0 0 0 0 0 0 0 19 1 2003 2 1 1 2 1 2 1 1 2 1 1 2 1 1 1 4 4 4 0 0 0 3 8 0 0 0 0 0 0 0 M 12 62 27 16 23 23 206 ------F 2 2 2 2 2 1 4 4 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 24 2002 2 1 1 1 1 1 1 1 1 1 1 1 1 1 4 4 5 0 0 0 0 0 3 0 6 8 0 0 0 0 M 19 19 67 14 21 22 209 ------F 1 1 2 2 1 1 2 0 0 0 0 0 0 3 5 0 0 0 5 0 0 0 0 0 23 1 2001 1 1 2 2 1 1 2 1 1 1 1 2 2 1 2 4 0 0 0 0 5 0 0 0 0 0 0 0 0 3 M 11 10 23 58 20 38 195 ------F 1 2 2 1 2 1 1 2 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 20 1 2000 2 1 2 1 2 7 1 1 1 1 4 4 0 5 0 0 3 5 3 0 0 3 0 3 0 0 0 0 0 6 0 0 M 19 31 21 50 177 ------F 2 1 1 2 1 1 1 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 12 1999 2 1 1 2 2 1 2 2 1 2 2 2 4 4 0 6 0 0 0 0 0 0 0 0 3 0 0 0 0 0 6 M 11 12 14 28 20 128 ------F 1 2 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 1998 1 1 1 1 1 1 1 1 7 0 8 3 0 0 0 3 3 0 0 0 3 0 0 0 0 0 3 0 0 0 0 M 16 13 18 26 30 141 ------F 1 1 1 1 1 1 1 1 1 1 1 4 0 0 0 0 0 0 0 0 0 0 0 0 15 1997 1 1 1 2 2 2 2 1 1 1 2 8 3 0 3 0 0 0 0 0 8 0 0 0 3 0 0 0 0 0 3 M 27 27 22 13 40 173 ------F 1 1 2 2 1 1 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 13 1996 7 2 1 1 1 1 1 1 2 1 1 1 1 2 1 2 1 3 3 0 0 0 0 0 6 0 3 0 0 0 0 0 M 17 47 34 38 178 ------F 1 1 1 7 1 2 1 1 2 1 1 4 0 0 0 0 0 8 0 0 0 0 0 0 31 ≤ 1995 2 1 2 2 2 1 2 1 2 2 1 4 4 6 3 3 3 0 5 0 0 0 0 3 0 0 0 0 5 M 21 59 13 45 85 58 33 368 c c c c c c b b b b b b a a a a a a 1 to <3 yrs to 1 Positive < 1 year < 1 year < 1 year < 1 year < 1 year < 1 year < 1 1 to <3 yrs to 1 <3 yrs to 1 Positive Time between diagnosis and HIV and/ negative test seroconversion or illness >=3 yrs NPNT Unknown >=3 yrs NPNT Unknown >=3 yrs NPNT Unknown >=3 yrs NPNT Unknown >=3 yrs NPNT Unknown >=3 yrs NPNT Unknown Positive 1 to <3 yrs to 1 Positive Positive 1 to <3 yrs to 1 Positive 1 to <3 yrs to 1 category Exposure Total includes six Total people whose sex was reported as transgender Male homosexual Male and homosexual IDU IDU contact contact from (Person high prevalence country) Other a No previous negative test b test was positive Last HIV (diagnosed interstate/overseas) c Includes previous previous test unknown, test date unknown previous or test result unknown 1 Heterosexual Heterosexual Heterosexual Total Table 48: Diagnoses of HIV by time since last negative test or seroconversion illness and exposure category, Victoria, 1994–2004 Victoria, category, exposure and illness seroconversion or test negative last since time by HIV of Diagnoses 48: Table 74 Surveillance of notifiable infectious diseases in Victoria, 2004

Table 49: Total HIV tests performed and HIV rate per 100,000 tests by year, 1995 to 2004

Year of HIV diagnosis

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 HIV diagnoses (n) 174 191 188 149 140 197 218 233 225 217 Total HIV tests (n) 119,692 124,547 129,180 132,438 141,498 143,061 159,347 183,981 181,125 193,927 Rate per 100,000 145.4 153.4 145.5 112.5 98.9 137.7 136.8 126.6 124.2 111.9 tests Note: In 2004 the Burnet Institute upgraded the HIV testing surveillance system. This involved the establishment of a central HIV testing database, importation of all data into this database, development of a data dictionary, comprehensive data clean, request from all laboratories to provide any outstanding data since 1998 and a cross-check of data with the National Serology Reference Laboratory (NRL). A detailed report of the data analysis can be found at http://www.health.vic.gov.au/ideas/downloads/hivaids_ testingreport2004.pdf. HIV testing data reported in annual reports will now originate from data at the Burnet Institute instead of the NRL, which may mean that previous data reported may differ from data reported here.