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Rotaviral Gastroenteritis in the NT: a Description of the Epidemiology 1995-2001 and Future Directions for Research

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Rotaviral Gastroenteritis in the NT: a Description of the Epidemiology 1995-2001 and Future Directions for Research The Northern Territory Disease Control Bulletin Vol 8, No.3, September 2001 1 Vol. 8, No. 3 , September 2001 ISSN 1440-883X Rotaviral Gastroenteritis in the NT: a description of the epidemiology 1995-2001 and future directions for research Paul Armstrong, CDC Darwin and MAE program, NCEPH, ANU, Canberra Introduction after which it quickly established itself as second in importance to the G1 serotype 2. The emergence of In 2001, the Northern Territory (NT) experienced these serotypes has important implications for fu- the largest outbreak of gastroenteritis due to human ture vaccine development. rotavirus since surveillance records for the disease were begun in 1994. Epidemics of rotavirus are not Contents uncommon in the NT and sporadic infection con- tinues in the inter-epidemic periods. When gastro- Rotaviral gastroenteritis in the NT: a description of enteritis epidemics due to this organism do occur, the epidemiology, 1995-2001 and future directions for research ................................................................ 1 there is a severe strain on the health services. In a national study analysing hospitalisation rates for Knowledge and practices of sexually transmitted diseases by general practitioners in the Top End acute gastroenteritis in young children, the NT was of Australia ................................................................ 6 shown to have the highest admission rates for acute 1 Factors affecting hepatitis A vaccination uptake gastroenteritis and for rotavirus . The length of among childcare workers in the NT ........................ 10 hospital stay was 3 to 5 times longer than any of Hepatitis A outbreak in Darwin Aug—Dec 2000 ... 13 the states. The reasons for the higher hospitalisa- Firework related injuries during Territory Day tion rates and length of hospital stay have not been celebrations 2001 .................................................... 15 elaborated on since. Breast cancer month and Pink Ribbon Day ............ 17 Rotavirus is classified firstly by its serogroup Achievements in cervical cancer screening (A-G), with most human infections being caused practice in the NT ................................................... 18 by serogroup A. Group A rotaviruses can be further Anaemia in Aboriginal children—Issues and action workshop Miwatj Health Service June 2001 20 subdivided into serotypes (G1-G10), determined in the laboratory by monoclonal antibodies directed Iron deficiency in Aboriginal children in the NT ... 22 against the viral outer capsid glycoprotein VP7, the A THS mosquito survey of Dili, East Timor, and major epitope associated with a protective immune public health implications ....................................... 24 response. The majority of cases of severe disease in NT Malaria notifications April to June 2001 .......... 28 children are caused by serotypes G1-G4. It was Points to note regarding notifications on page 29. .. 28 against these 4 serotypes that the much heralded NT notifications of diseases by districts 1 April to rotavirus vaccine, released in 1998, was directed. 30 June 2001 and 2000 ........................................... 29 The vaccine was withdrawn from the market in Notified cases of vaccine preventable diseases in 1999 when it was linked with an increased risk of the NT by report date 1 April to 30 June 2001 and intussusception, and no replacement vaccine has 2000 ........................................................................ 30 since been marketed. In recent years there have NT wide notifiable diseases 1 April to 30 June been increasing reports of other serotypes emerging 2001 and 2000 ........................................................ 30 as important human pathogens. The G9 serotype is CDC staff update .................................................... 31 one of these. It first appeared in Australia in 1997, 2 The Northern Territory Disease Control Bulletin Vol 8, No.3, September 2001 Much remains unclear regarding the spread of communities. With Central Australia as the rotavirus and factors that facilitate transmission ‘epicentre’, the epidemic rapidly spread north- of rotavirus. The faecal-oral route is obviously ward to the Barkly, Katherine and Darwin important but there is also evidence that viral Health Districts (Figure 1). An outbreak of rota- transmission is also droplet-spread via the respi- virus in western Queensland in June was epide- ratory route or aerosolisation of infective fae- miologically linked to the NT outbreak. ces3. The seasonality of rotavirus in temperate regions, where a predictable winter peak occurs, Figure 1 Rotavirus rates per 100,000 suggests that climatic factors may play a role in by health district and month facilitating transmission. Investigators in the US Jan to Aug 2001 have demonstrated a clear pattern of regional movement that is repeated during the annual ro- tavirus epidemic4. A similar phenomenon has 300 5 250 Alice Springs been noted in Europe . Tropical regions are far Barkly less likely to have seasonal peaks 6. No distinct 200 Katherine Darwin seasonality was noted in rotavirus activity be- 150 East Arnhem tween 1993 to 1996, when all hospitalisations 100 were aggregated across different climatic re- Rate (/100,000) 50 gions. 1 0 Jan Feb Mar Apr May Jun Jul Aug Unlike other Australian states and territories, ro- Month tavirus is a notifiable disease in the NT, and reli- able data have been collected since 1995. Sero- Epidemiology of Rotaviral Gastroenteritis typing data from the National Rotavirus Refer- in the NT, 1995-2001 ence Centre is available for the past decade. We therefore have a unique opportunity to study a Since 1995, the NT has experienced an epidemic number of aspects of the epidemiology of this of gastroenteritis due to rotavirus on a biennial disease in the NT. The aim of this preliminary basis, 1995,1997,1999 and 2001. In the interepi- report is to use these data to describe and analyse demic periods of those years, and in non- the 2001 outbreak of rotavirus as well as the epi- epidemic years, rotavirus has been endemic. The demiology of rotavirus in the NT since 1995, 4 epidemics analysed in this study have each and to look for ways of addressing unanswered lasted between 2 and 4 months. The months of questions in future studies of rotavirus in the NT. peak activity during these epidemics were Au- gust, July, April and June, respectively. Description of the 2001 Outbreak The crude notification counts and rates during The first case of rotavirus during the outbreak the 2001 outbreak have been the highest since was noted in a 23 month old girl from Alice rotaviral gastroenteritis became a notifiable dis- Springs during April 2001. She was admitted to ease (Figure 2). The age distribution of cases Alice Springs Hospital on 17/01/2001 with diar- was typical of rotavirus epidemics, with the rhoea, vomiting and mild dehydration. Disease highest notification rates occurring in the under spread was rapid, with cases reported in both the 1 year age group, and 95% of all cases in the less township of Alice Springs itself and simultane- than 5 year age group. The notification counts by ously in a number of widely separated remote gender showed a slight male preponderance; Editor: Vicki Krause Email: [email protected] Assistant Editors: Sandra Downing Centre for Disease Control David Peacock Block 4, Royal Darwin Hospital Tarun Weeramanthri PO Box 40596 Peter Markey Casuarina Alex Brown Northern Territory 0811 Production Design: Sandra Downing Website: http//www.nt.gov.au/nths/cdc/bulletin/index.shtml The Northern Territory Disease Control Bulletin Vol 8, No.3, September 2001 3 52.1% compared to 47.9%. Throughout the NT Discussion in the 2001 epidemic, notification rates among Aboriginal people were approximately 5 times By notification counts, the rotavirus epidemic in higher than for non-Aboriginal people. This NT this year has been the largest, and has lasted higher notification rate amongst Aboriginal peo- longer than any of the 4 epidemics recorded ple has been apparent each year since 1995 since rotavirus surveillance records were begun (Figure 3). Notification rates were higher in in 1994. It caused a large, though unquantified, Aboriginal children in 2001 in all health districts burden on the health resources. In Alice Springs, except Barkly. where the epidemic began and where notification rates were the highest of any health district, hos- The predominant serotype of rotavirus in the pital administrators were forced to temporarily 2001 outbreak was G9. This strain was deter- recruit nurses from Darwin because of the strain mined in 72% of samples tested, the remainder on the health services there. Reports from some being G1 (21.2%) and 6.7% were untypeable. In remote communities suggest very high attack previous years G1 has predominated, comprising rates in young children. Laboratory notification 56.3% of 970 samples collected between August data represent only a fraction of the true inci- 1989 and December 2000 for which there is se- dence of rotaviral infection. Hospitalisation data rotyping data available. Of the remainder, 4.2% can be collected to quantify part of the monetary were G2, 0.2% G4, 1.3% G9 and 37.9% were cost but to quantify the true burden of disease, untypeable. both in monetary and human terms, the attack rates in the communities must first be estimated. Figure 2 Crude notification counts and rates We plan to do this by analysing clinic records of for rotavirus in the NT by year* a number of remote communities, and Emer-
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