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.
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 the degree to which notification data reflect the true incidence of disease varies and is subject to a range of caveats.
The number of gonorrhoea notifications continued to rise. In 2016, there were 7,001 gonorrhoea notifications, a 28% increase on 2015. The number of gonorrhoea tests performed in NSW laboratories also increased in 2016, suggesting that at least part of the increase in notifications may be due to more screening. The transmission of gonorrhoea in NSW is mainly associated with male-to-male sex. However, in 2016 there was a higher relative increase in notifications in females compared to males, indicating that heterosexual transmission may be increasing.
Infectious syphilis notifications rose to 876 in 2016, higher than in previous years (760 in 2015). Infectious syphilis is predominantly notified in men living in metropolitan Sydney. The increase in notifications in 2016 is thought to be, at least in part, due to increased testing of men at higher risk of sexually transmitted infections enrolled in the EPIC-NSW pre-exposure prophylaxis trial to prevent HIV infection. More frequent testing and subsequent treatment of cases and their contacts has the potential to reduce the burden of syphilis infection in the community.
No cases of congenital syphilis were reported in NSW in 2016.
Chlamydia notifications (excluding congenital cases) increased to 26,041 in 2016, 15% higher than in 2015. A change in the chlamydia notification trend by gender was observed in 2016. In 2016, the rates of chlamydia notification in both males and females were very similar, whereas in previous years the chlamydia notification rate in females was consistently higher than in males. This change in the chlamydia notification trend was due to a 23% increase in the rate in males in 2016. The number of chlamydia tests performed in NSW laboratories also increased in 2016, suggesting that at least part of the increase in notifications may be due to more screening.
Lymphogranuloma venereum (LGV) notifications increased to 57 in 2016, the highest annual number since 2010. An investigation to determine if any common risk factors exist amongst cases is underway.
There were 4,232 hepatitis C notifications in 2016, 18% higher than in 2015. It is likely the increase in notifications is due to more people being tested as a result of increased availability of highly effective hepatitis C therapy. These medications, called direct acting antivirals (DAAs), were subsidised by the Pharmaceutical Benefits Scheme in Australia from 1 March 2016.
Hepatitis B notifications remained stable in 2016.
For more information see the NSW sexually transmitted infections surveillance reports.
Pre-exposure prophylaxis (PrEP) is the latest critical tool for HIV prevention. PrEP is recommended for people who do not have HIV but are at high risk of acquiring HIV. PrEP involves taking a pill (antiretroviral therapy) every day. On 1 March 2016, EPIC-NSW was launched as a time-limited public health trial to provide PrEP to people at a high risk of HIV infection in NSW. By 31 December 2016, 4,835 people had enrolled in EPIC-NSW, and recruitment is ongoing.
In 2016 there were 536,444 HIV serology tests performed in 15 laboratories in NSW, seven per cent more than in 2015 (n=499,966), 15% more than in 2014 (n=465,475), 20% more than in 2013 (n=447,297) and 28% more than in 2012 (n=419,968).
In 2016, 317 NSW residents were diagnosed with HIV, the lowest annual count since 2010, and nine per cent lower than the previous six years. The age and sex standardised new diagnoses rate in 2016 was 4.30 new diagnoses per 100,000 people, the lowest on record. Among the 317 new diagnoses, 259 (82%) reported being men who have sex with men (MSM), eight per cent less than the average annual new diagnoses count for MSM from 2010 to 2015 (n=282).
The latest six month follow-up data (people newly diagnosed from January to June 2016) showed substantial increases in the proportion on treatment by six weeks (60% of those diagnosed Jan to June 2016 versus 33% diagnosed Jan-Dec 2013) and within 6 months (87% versus 60%) after diagnosis.
The HIV Support Program (HSP) was implemented by HPNSW on 9 May 2013 to provide advice and support for doctors when they diagnose someone with HIV, to ensure the patient has access to five key support services. In 2016, 104 doctors across NSW were supported by an HSP Coordinator (HIV expert). For two-thirds of these diagnosing doctors it was their first time making an HIV diagnosis. Up until 31 December 2016, 465 diagnosing doctors had been recipients of the HSP, and the support had been well received.
The fall in the number of new notifications in 2016, in the context of continuing increases in HIV testing particularly among high risk groups, is reassuring and suggests that HIV transmission may be declining. Earlier diagnosis through more frequent testing, higher treatment coverage and the scale-up of HIV PrEP should all be contributing to preventing HIV transmission.
The goals and activities of the NSW HIV Strategy 2016-2020 drive the HIV related data reported publically each quarter and year. The reports, including the HIV 2016 annual data report, can be accessed on the NSW Health Ending HIV webpage.
Notable changes in the surveillance of enteric diseases in 2016 (compared to the five year annual average, 2011-2015) included:
The increases in notifications of enteric diseases was partially driven by the use of a more sensitive test that is now widely available in NSW.
Reported enteric disease outbreaks in 2016 included:
NSW Health continues to work closely with the NSW Food Authority in the control of outbreaks and prevention of food borne disease.
For more details, see the 2016 OzFoodNet Annual Report.
In 2016, 136 Legionella cases were notified. Predominantly, cases were caused by L. pneumophila (93), with two notable outbreaks occurring in the Sydney CBD. Altogether 13 people were linked to these outbreaks. A thorough investigation was conducted with L. pneumophila SG1 isolated from several cooling towers. Organisms from two of these cooling towers were found to be genetically indistinguishable from organisms from five of the cases. Of the remaining notifications, although all were thoroughly investigated, only one further possible source was identified in the Kogarah area.
For information on the NSW Health response, go to Legionella in environmental health.
There was another severe influenza season during winter in 2016, characterised by high rates of influenza-like illness presentations to hospital emergency departments and general practice, and over 250 institutional outbreaks of influenza. Over 35,000 cases of influenza were reported. In 2016 influenza A (H3N2) was the dominant circulating strain. Influenza A (H1N1) and two influenza B strains also circulated at low levels.
For more information, see the December 2016 Influenza Monthly Surveillance Report.
2016 was the first complete year of rheumatic heart disease surveillance in NSW.
Eight cases of acute rheumatic fever and seven cases of rheumatic heart disease were notified.
During 2016 the Rheumatic Fever Register, which facilitates adherence to preventive management of people with rheumatic fever, also commenced operation, supported by a network of Rheumatic Heart Disease Coordinators in Local Health Districts across NSW.
For more information see the NSW Health Rheumatic fever and rheumatic heart disease webpage.
In 2016, 534 cases of tuberculosis (TB) were notified. The number of cases notified in NSW varies substantially from year to year. Between 440 and 533 cases were notified between 2011 and 2015.
89% of notifications were in people born overseas, of whom 93% were born in a country with a high burden of tuberculosis (>40 cases per 100,000).
Of the 60 Australian-born cases notified in 2016, 20% had spent more than three months in a high TB burden country.
There were seven cases of TB notified in Indigenous Australians (rate three per 100,000 people).
For more information see the detailed periodic NSW Tuberculosis Reports.
Zika virus infection emerged as a major public health concern in 2016 following the extensive outbreak observed in Latin America and the Caribbean, and the confirmation of the link between infection during pregnancy and a range of birth defects, including microcephaly. There were 32 notifications of Zika virus infection in 2016 compared to just one notification in 2015. All of the cases were believed to have been acquired overseas during travel to areas affected by Zika virus outbreaks, particularly Brazil, Mexico and Tonga. There were no reports of congenital Zika virus infection.
Following relatively low Ross River Virus activity for most of the year, notifications rose markedly in December 2016, well above the historical average for this period, and predominantly affecting residents in southern and central parts of inland NSW. This followed the wettest September on record for large parts of inland NSW, which in turn led to ideal mosquito breeding conditions.
There was a notable rise in dengue notifications with Indonesia, particularly Bali, continuing to be the most common location where dengue was acquired, accounting for 56% of notifications.
Malaria notifications rose slightly compared to 2015 but remained lower than the historical average. India and Papua New Guinea exposures accounted for the highest number of notifications, with substantial notifications coming from sub-Saharan Africa. Plasmodium falciparum was identified in 62 per cent of notifications where species information was available, twice the proportion that was found to be due to P. vivax.
For more details see the Vector-borne diseases annual report 2016.
NSW observed a slight increase in the number of brucellosis and Q fever notifications in people in 2016 compared to the five-year annual average. In the same period, fewer notifications of leptospirosis and continued low rates of psittacosis in people were reported.
No human infections of anthrax, avian/animal influenza, Hendra virus, rabies/ABLV or tularemia were reported.
Substantially higher numbers of people exposed to animals at risk of rabies and ABLV requiring assessment and prophylactic treatment were reported in 2016. While the number of wildlife workers exposed to bats in Australia decreased, the number of tourists exposed to potential rabid animals overseas increased.
Sporadic animal infections with anthrax, brucellosis, Hendra virus, equine chlamydiosis and ABLV were reported in NSW, requiring public health investigation of exposures and interventions to prevent human infections.
For more details see the 2016 Zoonoses Annual Report.
In 2016 the percentage of children fully vaccinated at one and five years of age continued to increase, each reaching 93.3%.
For the first time, the percentage of Aboriginal children fully vaccinated at each age milestone was higher than for non-Aboriginal children. Vaccination uptake among Aboriginal children has been increasing steadily since the Aboriginal Immunisation Health Care Worker Project commenced in 2012.
The Save the Date to Vaccinate campaign was delivered for the fourth year, including television, social and digital media components.
Zostavax® was introduced to the National Immunisation Program In November 2016 for people at 70 years of age, with a five-year catch-up for people up to 79 years of age. Zostavax® is expected to reduce the incidence of shingles in elderly people, and reduce the likelihood of post-herpetic neuralgia (a painful, debilitating condition that often follows shingles) for those who do develop shingles.
