NNDSS Annual Report Working Group
In 2014, 69 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 275,581 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 22% on the number of notifications in 2013. In 2014, the most frequently notified diseases were sexually transmissible infections (105,719 notifications, 38% of total notifications), vaccine preventable diseases (101,400 notifications, 37% of total notifications), and gastrointestinal diseases (40,367 notifications, 15% of total notifications). There were 17,411 notifications of bloodborne diseases; 8,125 notifications of vectorborne diseases; 1,942 notifications of other bacterial infections; 615 notifications of zoonoses and 2 notifications of quarantinable diseases. Commun Dis Intell 2016;40(1):E48–E145.
Keywords: Australia, communicable diseases, epidemiology, surveillance
Australia’s notifiable diseases status, 2014, is an annual surveillance report of nationally notifiable communicable diseases. Communicable disease surveillance in Australia operates at the national, jurisdictional and local levels. Primary responsibility for public health action lies with the state and territory health departments. The role of communicable disease surveillance at the national level includes:
- identifying national trends;
- providing guidance for policy development and resource allocation at the national level;
- monitoring the need for and impact of national disease control programs;
- informing the response to national or multi-jurisdictional outbreaks;
- describing the national epidemiology of communicable diseases;
- meeting international reporting requirements, such as providing disease statistics to the World Health Organization (WHO); and
- supporting quarantine activities, which are the responsibility of the Australian government.
Australia is a federation of 6 states (New South Wales, Queensland, South Australia, Tasmania, Victoria and Western Australia) and 2 territories (the Australian Capital Territory and the Northern Territory).
State and territory health departments collect notifications of communicable diseases under their respective public health legislations. In September 2007, the National Health Security Act 20071 received royal assent. This Act provides a legislative basis for and authorises the exchange of health information, including personal information, between jurisdictions and the Australian Government. The Act provides for the establishment of the National Notifiable Diseases List,2 which specifies the diseases about which personal information can be provided. The National Health Security Agreement,3 which was signed by Health Ministers in April 2008, establishes the operational arrangements to formalise and enhance existing surveillance and reporting systems, an important objective of the Act. Under the Agreement, in 2014 states and territories forwarded de-identified notification data on 65 communicable diseases to the Australian Government Department of Health for the purposes of national communicable disease surveillance, although not all 65 diseases were notifiable in each jurisdiction. Data were electronically updated daily from states and territories. The system was complemented by other surveillance systems, which provided information on various diseases, including 4 that are not reported to the National Notifiable Diseases Surveillance System (NNDSS): human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS) and the classical and variant forms of Creutzfeldt-Jakob disease (CJD).
The NNDSS core dataset requires the following mandatory data fields: unique record reference number; notifying state or territory; disease code; confirmation status and the date when the jurisdictional health department was notified (notification received date). In addition, the following data fields were supplied where available: date of birth; age at onset; sex; Indigenous status; postcode of residence; disease onset date; date when the pathology service authorised a report or a medical practitioner signed the notification form (notification date); death status; date of specimen collection; and outbreak reference number (to identify cases linked to an outbreak). Where relevant, information on the species, serogroups/subtypes and phage types of organisms isolated, and on the vaccination status of the case were collected and reported to NNDSS. Data quality was monitored by the Office of Health Protection and the National Surveillance Committee (NSC) and there was a continual process of improving the national consistency of communicable disease surveillance through the daily, fortnightly and quarterly review of these data.
While not included in the core national dataset, enhanced surveillance information for some diseases (invasive pneumococcal disease, hepatitis B, hepatitis C, tuberculosis, donovanosis, gonococcal infection and syphilis < 2 years duration) were reported from states and territories to NNDSS. With the exception of hepatitis B and hepatitis C these enhanced data are not included in this report. These data, along with influenza enhanced data, are reported in separate (disease-specific) annual reports. Additional information concerning mortality and specific health risk factors for some diseases were obtained from states and territories and included in this annual report.
Newly diagnosed HIV infection and AIDS were notifiable conditions in each state or territory health jurisdiction in 2014. These data were forwarded to the Kirby Institute for Infection and Immunity in Society (Kirby Institute). Further information can be found in the Kirby Institute’s annual surveillance report.4
Surveillance for the classical and variant forms of CJD in Australia has been conducted through the Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR) since its establishment in October 2003. CJD is a nationally notifiable disease and by June 2006, CJD was notifiable in all states and territories. Further surveillance information on CJD can be found in surveillance reports from the ANCJDR.5
Information on communicable disease surveillance is communicated through several avenues. The most up-to-date information on topics of interest is provided at the fortnightly teleconferences of the Communicable Diseases Network Australia (CDNA). A summary of these reports is available online from the CDNA web site (http://www1.health.gov.au/internet/main/publishing.nsf/Content/cdnareport.htm).6
The Communicable Diseases Intelligence (CDI) quarterly journal publishes surveillance data, annual surveillance reports, short reports, and articles on the epidemiology and control of communicable diseases in Australia.
Notification rates for each notifiable disease were calculated using the estimated 2014 December resident population supplied by the Australian Bureau of Statistics (ABS) (Appendix 1 and Appendix 2).7 Where diseases were not notifiable in a state or territory, national rates were adjusted by excluding the population of that jurisdiction from the denominator. For some diseases, age adjusted rates were calculated using the direct method of standardisation with 2011 census data as the standard population. All rates are represented as the rate per 100,000 population unless stated otherwise.
Direct age standardised notification rates, using the method described by the Australian Institute of Health and Welfare,8 were calculated for Aboriginal and Torres Strait Islander and non-Indigenous notifications for relevant STIs for jurisdictions that had Indigenous status data completed for more than 50% of notifications over the period from 2007 to 2012. Where the Indigenous status of a notification was not completed, these notifications were counted as non-Indigenous in the analyses. These data, however, should be interpreted with caution, as STI screening may occur predominantly in specific high risk groups, including in remote Aboriginal and Torres Strait Islander populations. Recent studies have suggested that higher rates in Aboriginal and Torres Strait Islander populations may be attributable to higher prevalence and reinfection rates while others have suggested that they may be due to increased testing and contact tracing.9
In the national case definitions for chlamydial infection, gonococcal infection and syphilis the mode of transmission cannot be inferred from the site of infection. Infections in children may be acquired perinatally (e.g. congenital chlamydia).10 As such, notifications of chlamydial, gonococcal and non-congenital syphilis infections were excluded from analysis of age and sex distribution where the case was aged less than 13 years and the infection was able to be determined as non-sexually acquired through enhanced surveillance data where available.
Notes on interpretation
This report is based on 2014 data from each state and territory, agreed upon in June 2015, and represents a snapshot of the year after duplicate records and incorrect or incomplete data were removed. Totals in this report may vary slightly from the totals reported in CDI quarterly publications and state and territory reports.
Analyses in this report were based on the date of disease diagnosis in an attempt to estimate disease activity within the reporting period. The date of diagnosis is the onset date or where the onset date was not known, the earliest of the following dates: specimen collection date, the notification date, or the notification received date. In January 2014, the NSC redefined the diagnosis date methodology for hepatitis B (unspecified), hepatitis C (unspecified), leprosy, syphilis (unspecified) and tuberculosis. As considerable time can elapse between the initial infection, the onset of symptoms and the subsequent diagnosis, the diagnosis date for these 5 diseases is derived from the notification receive date.
When referring to NNDSS notification data throughout the report, the term ‘cases’ or ‘notified cases’ are used to identify individuals for whom ‘notification’ of a condition has been received by NNDSS. These notifications can only represent a proportion (the ‘notified fraction’) of the total incidence (Figure 1) and this has to be taken into account when interpreting NNDSS data. Moreover, the notified fraction varies by jurisdiction, over time and by disease. This caveat is particularly relevant to sexually transmissible infections (STIs), many or most of which are identified through screening programs (Figure 1 dashed line).
A survey of jurisdictional public health departments was conducted in 2014 to ascertain the source of each notification (Table 1). Whilst most jurisdictions have data on laboratory notifications, the percentage of notifications attributed to doctor only and laboratory and doctor for each state and territory are based on estimates deduced from the data that are available, noting that fields for these data may be incomplete.
|State or territory||Source of notifications|
|Laboratory only||Doctor only||Laboratory and doctor|
|* Not all percentages add up to 100% due to other sources of notifications and/or incomplete data for laboratory and medical notification fields.|
Methods of surveillance vary between states and territories, each having different requirements for notification by medical practitioners, laboratories and hospitals. Although the National Notifiable Diseases List2 was established, some diseases are not notifiable in all 8 jurisdictions (Table 2).
|Disease||Data received from|
|NEC Not elsewhere classified.|
|Hepatitis B (newly acquired)||All jurisdictions|
|Hepatitis B (unspecified)||All jurisdictions|
|Hepatitis C (newly acquired)||All jurisdictions, except Queensland|
|Hepatitis C (unspecified)||All jurisdictions|
|Hepatitis D||All jurisdictions|
|Campylobacteriosis||All jurisdictions, except New South Wales|
|Haemolytic uraemic syndrome||All jurisdictions|
|Hepatitis A||All jurisdictions|
|Hepatitis E||All jurisdictions|
|Shiga toxin producing Escherichia coli||All jurisdictions|
|Typhoid fever||All jurisdictions|
|Highly pathogenic avian influenza in humans||All jurisdictions|
|Severe acute respiratory syndrome||All jurisdictions|
|Viral haemorrhagic fever||All jurisdictions|
|Yellow fever||All jurisdictions|
|Sexually transmissible infections|
|Chlamydial infections||All jurisdictions|
|Gonococcal infection||All jurisdictions|
|Syphilis < 2 years duration||All jurisdictions|
|Syphilis > 2 years or unspecified duration||All jurisdictions|
|Syphilis – congenital||All jurisdictions|
|Vaccine preventable diseases|
|Haemophilus influenzae type b||All jurisdictions|
|Influenza (laboratory confirmed)||All jurisdictions|
|Pneumococcal disease (invasive)||All jurisdictions|
|Rubella – congenital||All jurisdictions|
|Varicella zoster (chickenpox)||All jurisdictions, except New South Wales|
|Varicella zoster (shingles)||All jurisdictions, except New South Wales|
|Varicella zoster (unspecified)||All jurisdictions, except New South Wales|
|Arbovirus infection (NEC)||All jurisdictions|
|Barmah Forest virus infection||All jurisdictions|
|Dengue virus infection||All jurisdictions|
|Japanese encephalitis virus infection||All jurisdictions|
|Kunjin virus infection||All jurisdictions|
|Murray Valley encephalitis virus infection||All jurisdictions|
|Ross River virus infection||All jurisdictions|
|Australian bat lyssavirus||All jurisdictions|
|Lyssavirus (NEC)||All jurisdictions|
|Q fever||All jurisdictions|
|Other bacterial infections|
|Meningococcal disease (invasive)||All jurisdictions|
Changes in surveillance practices may have been introduced in some jurisdictions and not in others, and must be taken into consideration when comparing data between jurisdictions. In this report, some additional information was obtained from states and territories to assist in the interpretation of the 2014 data. These include changes in surveillance practices, screening practices, laboratory practices, and major disease control or prevention initiatives.
Postcode information reflects the residential location of the case, but this does not necessarily represent the place where the disease was acquired.
Data completeness was assessed for cases’ Indigenous status and place of acquisition, and reported as the proportion of complete notifications. The completeness of data in this report is summarised in the Results.
The percentage of data completeness was defined as:
Percentage of data completeness = (total notifications – missing or unknown) / total notifications x 100
The Indigenous status was defined by the following nationally accepted criteria:11
1=Indigenous – (Aboriginal but not Torres Strait Islander origin);
2=Indigenous – (Torres Strait Islander but not Aboriginal origin);
3=Indigenous – (Aboriginal and Torres Strait Islander origin);
4=Not Indigenous – (not Aboriginal or Torres Strait Islander origin);
For the purposes of this report, an Indigenous person includes responses 1, 2 or 3 with non-Indigenous including response 4 only.
Place of acquisition is where the disease is believed to have been acquired; either locally or overseas. The country of acquisition is determined by the Standard Australian Classification of Countries (SACC) from the ABS.12 A notification is complete if a valid value from the SACC is entered.
For some diseases, changes in surveillance and testing practices should be taken into account when interpreting national trends.
In interpreting STI notification data it is important to note that changes in notifications over time may not solely reflect changes in disease prevalence as changes in screening programs,13,14 the use of less invasive and more sensitive diagnostic tests15 and periodic public awareness campaigns16 may influence the number of notifications that occur over time. Rates for STIs are particularly susceptible to overall rates of testing, with low testing rates resulting in an underestimation of disease and increased testing potentially causing an increase in notifications.17
The differences in rates between females and males for STIs should be interpreted with caution, as rates of testing, symptom status, health care-seeking behaviours, and partner notification differ between the sexes.18
Notes on case definitions
Each notifiable disease is governed by a national surveillance case definition for reporting to the NNDSS. These case definitions were agreed by CDNA and implemented nationally in January 2004 and were used by all jurisdictions for the first time in 2005. These case definitions are reviewed by the Case Definitions Working Group (CDWG) as required.
The national surveillance case definitions and their review status are available from the Australian Government Department of Health web site (http://www.health.gov.au/casedefinitions).