The health outcomes in this report are measured mainly through routine surveillance data, derived from notifications of selected diseases from doctors, hospitals and laboratories to public health units under the NSW Public Health Act 2010.
Surveillance
Prevention activities
Disease control
References
Tables 1–6 show disease-specific data on notifiable conditions reported by: year of onset of illness; month of onset of illness; local health district of residence; and age group and sex. Note that tuberculosis is reported by year of diagnosis of illness and month of diagnosis of illness. The degree to which notification data reflect the true incidence of disease varies and is subject to a range of caveats.
Table 1 - Annual report 2015 - disease by year
Table 2 - Annual report 2015 - standard rate of disease per 100,000 population by year
Table 3 - Annual report 2015 - disease by month
Table 4 - Annual report 2015 - disease by Local Health District (LHD)
Table 5 - Annual report 2015 - standard rate of disease per 100,000 population by Local Health District (LHD)
Table 6 - Annual report 2015 - disease by age and gender
Since the Save the Date to Vaccinate advertising campaign began in 2013, there has been a noticeable increase in participation in vaccination programs in NSW, particularly among Aboriginal cohorts.
The campaign continues to educate and inform parents/carers on the importance of fully immunising children 'on time' and encourage them to download the smartphone reminder app to stay up to date with the schedule. Evaluation of the 2014 campaign showed that while target audiences are aware of the importance of ‘on time’ vaccinations, confusion exists on what constitutes ‘on time’ with almost 50% believing that ‘a few weeks late’ is acceptable. In 2015, campaign activities included television, outdoor advertising and social media.
Downloading the app is the primary call to action. It includes useful information on the importance of vaccinating on time; allows users to create a personalised schedule for their children; and also sends reminders to parents to book appointments for vaccinations.
In March 2015, Health Protection NSW established the Antenatal Maternal Pertussis Vaccination Program, offering free pertussis-containing vaccine to all pregnant women.
The National Health & Medical Research Council (NHMRC) recommends that all pregnant women receive pertussis vaccination in the third trimester of each pregnancy. Vaccination in the third trimester provides highly effective protection to infants with the passive transfer of antibodies likely to provide protection during the period before the infant can develop immunity through vaccination which begins at 6 weeks of age. Recent studies from the US and the UK on over 40,000 women have found the vaccine is safe during pregnancy.
This program is particularly important given the high number of pertussis notifications in NSW in 2015. By implementing this program, NSW is providing the best opportunity for parents to protect their new born children. The vaccination campaign has been supported by the development of a number of resources including posters, brochures, visual aids and a training module for midwives.
In 2012, a three year program was piloted, employing Aboriginal Immunisation Health Workers in all local health districts to develop local strategies to improve the timely vaccination of Aboriginal children and reduce the coverage gap with non-Aboriginal children. In 2015, recurrent funding was secured for the program, on the basis of positive impact on coverage rates for Aboriginal children.
In NSW in 2015, 91.2% of Aboriginal children aged 1 year were fully immunised, compared with 85.0% in 2008. Coverage for children in the general population in NSW has remained relatively stable at 90-92% over the same period. The gap between coverage rates for Aboriginal and non-Aboriginal children has reduced from 6.7% in 2008 to 1% in 2015.
In 2015, 95.3% of Aboriginal children in NSW aged 5 years were fully immunised, compared with 83.6% in 2008, an increase of 11.7%. Coverage for non-Aboriginal children in NSW has increased 5.9% over the same period, from 87% in 2008 to 92.9% in 2015. In 2013, 2014 and 2015, the immunisation rate in Aboriginal children aged 5 years was higher than the rate in non-Aboriginal children.
The greater gap in full immunisation rates between Aboriginal and non-Aboriginal children at 1 year compared with 5 years of age suggests delayed vaccination among Aboriginal children rather than lower participation in immunisation programs.
An evaluation by the National Centre for Immunisation Research and Surveillance found that the major strengths of the program were well-defined, measurable goals and methods, strong networks and support within local health districts. This in turn translated into investment in strengthening relationships with parents, providers and the community and a greater capacity to follow up due and overdue individuals. The most commonly reported challenges were errors in data on the Australian Childhood Immunisation Register, especially out-of-date contact details, missing immunisations and incorrect Indigenous status.
In the first quarter of 2015 there was an Australia-wide outbreak of 35 cases of locally acquired hepatitis A (genotype 1a) with a unique genetic sequence. Many of these cases reported consuming the same brand of mixed frozen berries. Seventeen of these cases were NSW residents, nine of whom reported consuming the implicated frozen berries, while five were secondary cases who acquired their infection from an outbreak case and one was a tertiary case. Two cases had the outbreak sequence but did not report consuming the implicated berries or have contact with a known case. The implicated frozen berries were recalled from sale on 14 February 2015. Hepatitis A with the outbreak sequence was isolated from an opened packet of mixed frozen berries of one of the cases. Testing of an unopened packet from the supermarket shelf resulted in a positive test for hepatitis A virus however there was not enough virus to perform typing.
The implicated berries were packed in China and originated from farms in China and Canada. Food Standards Australia New Zealand worked closely with the Department of Agriculture who were responsible for working with Chinese Government authorities to investigate farm and food handling practices.
In February 2015 a public health unit was notified of four separate cases of suspected scrombroid poisoning. Cases presented with red face, headache, tingling, sweating, vomiting and palpitations. The subsequent investigation identified a total of seven cases. All seven cases consumed a tuna salad from the same local food outlet. Onset of symptoms was within 10-15 minutes of tuna consumption. The NSW Food Authority initiated an investigation that found the tuna product in use was a canned product imported from Thailand that had a small distribution to some restaurants and cafés. A trade level recall was conducted on the implicated product.
Also in February 2015, a public health unit (PHU) was notified of an outbreak of salmonellosis in an aged care facility (ACF). An outbreak investigation was initiated by the PHU in conjunction with Health Protection NSW and the NSW Food Authority. In total, the outbreak affected 33 residents across ten ACFs in NSW and the ACT. The ACFs were managed by the same organisation and shared common food suppliers. All 33 residents tested positive for Salmonella Bovismorbificans, 30 were further characterised as phage type 14 (the remaining three were not phaged typed). Illness onsets were between 21 January and 23 February 2015. An additional case occurred on 24 March 2015, this was classified as a secondary case likely to have been infected through contact with a case who had prolonged excretion of Salmonella. Facility based attack rates ranged from 0.6 -7.5 per cent. The environmental investigation identified Salmonella Bovismorbificans phage type 14 at the premises of a baked dessert supplier to the ACFs and on food samples. The NSW Food Authority required the supplier to close until they could meet food safety standards. While definitive food histories were difficult to obtain, desserts from this supplier were consumed by the majority of affected residents.
In May interviews with four children from Western Sydney LHD notified with Salmonella Typhimurium MLVA 3-14-9-13-523 revealed that they all attended the same childcare centre and became ill at about the same time. The centre catered for 82 children and had 12 staff. The PHU conducted an environmental assessment. An inspection of the kitchen, observing serving processes and discussions with the cook revealed that the kitchen and food was unlikely to be the source of infection. There were however other potential vectors for Salmonella contamination:
Immediate action to mitigate these potential sources of Salmonella was commenced.
An outbreak of Salmonella Agona was investigated in May and June 2015. Sixteen cases were interviewed with six found to have consumed sushi from one of two sushi outlets in the same shopping centre. No links were found between the other ten cases. For the cases related to the shopping centre, consumption dates ranged from 7 April 2015 to 23 June 2015, four from sushi outlet A and two from sushi outlet B. Both venues were inspected by the NSWFA and were reported to have potential for cross contamination of ready to eat foods. It was reported no ingredients or staff were shared between the shops but records were not available to confirm this. Samples were taken from both venues, with sushi outlet A returning positive Salmonella Agona results from sushi rolls. The venue was prohibited from selling the cooked tuna-based sushi rolls until it showed evidence of Salmonella clearance. Whole genome sequencing was performed on all Salmonella Agona isolates for this time period as well as ten food source isolates obtained during the outbreak and from retail samples of chicken meat earlier in the year. The sequencing showed all six people who reported eating at the two sushi outlets had identical sequencing to five others who did not report the sushi restaurant or were not interviewed. All of the S. Agona isolates from sushi outlet A were also identical to these cases. These were also very similar to two raw retail chicken isolates. This analysis suggests the source of the S. Agona in this cluster may have been chicken meat, with a common source of chicken for the two sushi venues likely at the time of the outbreak and environmental contamination from raw chicken the source of the Salmonella in the businesses.
A complaint was received by the NSW Food Authority about illness in a group of people who had consumed food together at a training event from 25 to 27 August 2015. The event was catered by a local bakery. The investigation subsequently identified a second cluster of illnesses involving individuals who attended a staff lunch catered for by the bakery on 27 August 2015. One other case, not associated with either cluster, was identified through a GP practice. This individual also reported consuming food from the Bakery on 27 August 2015. A total of 18 people became ill, out of a potential 19. Symptoms of fever, nausea, vomiting, diarrhoea and abdominal cramps occurred on average 31 hours after the events. One person was hospitalised. Samples were taken from two people, of which one was positive for norovirus. The foods consumed were sandwiches and salads made fresh at the bakery. Salad items were consumed by all cases, the one well member that attended the events ate only tuna and egg sandwiches with no salad. The bakery was inspected by the local council and it was reported a staff member who was involved in making the sandwiches had fallen ill on 24 August 2015. The source of the illness was not confirmed, however, it is suspected that an ill food handler may have contaminated produce items prepared for salads and sandwiches sold on 27 August 2015.
In November a public health unit (PHU) received a report of a person who was hospitalised with gastroenteritis and tested positive to Salmonella. This person reported others who ate a meal with him at a restaurant on 29 October 2015 also experienced symptoms. The PHU initiated a cohort study and found 40 of 69 attendees reported illness after the dinner with onset between 29 October 2015 to 4 November 2015. Seven diners submitted stool samples which were positive for Salmonella Typhimurium (MLVA 3-26-13-8-523). The meal was a six course degustation and consumption rates were high for most items, however a significant risk ratio was found for one item, a coriander mayonnaise (RR=3.58, CI:1.04-12.26, p<0.001). This mayonnaise was made with raw egg and on inspection found to be made with insufficient acidifying ingredient to neutralise any Salmonella present. Environmental and food samples were taken by the NSW Food Authority but all were negative for pathogens, however the food available to sample was received 12 days after the dinner. The cause of the outbreak was likely the use of contaminated raw egg mayonnaise. The restaurant has been advised to cease serving raw egg foods.
Also during November 2015, a large public health response ensued when a bat carer brought a juvenile flying-fox to a function, and allowed several attendees (including children) to play with the animal. This and other bats in care subsequently died, prompting testing which confirmed Australian Bat Lyssavirus infection. Public health units followed up over 100 individuals who may have been exposure to the infected animals, of which 20 had high risk exposures and were provided post-exposure treatment.
An outbreak of Q fever was investigated in remote rural town in Western NSW LHD during 2015. Fourteen confirmed cases were identified, with most being town residents, who did not work in a high-risk occupation, and did not participate in any high-risk activities prior to their illness onset. A source of this outbreak could not be confirmed. Investigations suggest infection may have occurred via inhalation of aerosols or dust contaminated by Coxiella burnetii, dispersed through the town from either an unidentified animal facility or from excreta of native wildlife or feral animals. Alternatively transmission may have occurred via companion animals or tick vectors.
The NSW HIV Support Program (HSP) provides expert advice and support for doctors when they diagnose someone with HIV to ensure the diagnosed person has access to the five key support services: appropriate clinical management including access to treatment; psychosocial support; counselling about prevention of transmission; support for partner notification, and; linkage to specialist, community and peer support services. In 2015 the HSP supported 120 HIV-inexperienced doctors at the time they diagnosed a person with HIV infection. Since the start of the HSP on 9 May 2013 to 31 December 2015, 383 doctors have been supported.
For more information see the 2015 HIV Report.
There is an ongoing gap between the incidence of TB in Aboriginal and Torres Strait Islander and Australian born non-indigenous Australians, with TB incidence being approximately six times higher in Aboriginal and Torres Strait Islander Australians, both nationally and in NSW[1,2]. In NSW the gap in TB incidence between Aboriginal and non-indigenous people is driven primarily by an ongoing cluster of TB, focused around Northern NSW. One new case was reported in early 2015, compared to five in 2014; bringing the total number of NSW cases in the cluster since 2000 to 37 at the end of 2015.
The NSW TB Program continues to work towards reducing TB transmission in Aboriginal communities. This is done by engaging with local Aboriginal communities to understand barriers to early diagnosis and uptake of preventive treatment, raising awareness of TB within communities and amongst healthcare providers, and working with Aboriginal Medical Services to offer more opportunities for TB screening.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in a person aged less than 35 years were added to the list of diseases notifiable under the NSW Public Health Act 2010 on 2 October 2015. ARF and RHD are not common in NSW, but are important public health issues as they cause serious illness, impact mainly children and young adults, disproportionately affect Aboriginal and Torres Strait Islander people and migrant communities, and are preventable diseases.
ARF is a complication which can occur after a bacterial infection, usually a throat infection with group A Streptococcus. Episodes of ARF can cause permanent damage to the heart valves, which is known as RHD. People with ARF and RHD need long-term treatment to prevent repeat episodes of ARF that may cause further damage to the heart. Preventive treatment involves antibiotic (benzathine penicillin G) injections every 3-4 weeks. This treatment is recommended for a minimum of 10 years after the last episode of ARF. Regular contact with health care providers, including cardiac services, over the recommended follow up period is important for monitoring heart health and minimising risk factors for other acute or chronic disease.
Due to the complex and long-term nature of RHD, other jurisdictions both interstate and overseas have established registers for people with ARF and RHD. These registers have been found to improve long-term follow–up and treatment of people with ARF and RHD. NSW Health is establishing a register for people diagnosed with ARF and RHD to assist patients and their doctor manage adherence to regular penicillin prophylaxis and clinical reviews. Notification of people diagnosed with ARF and RHD aged less than 35 years is the first step in accessing the NSW RHD Register.
