Katrina E Knope, Nina Kurucz, Stephen L Doggett, Mike Muller, Cheryl A Johansen, Rebecca Feldman, Michaela Hobby, Sonya Bennett, Angus Sly, Stacey Lynch, Bart J Currie, Jay Nicholson, and the National Arbovirus and Malaria Advisory Committee
This report describes the epidemiology of mosquito-borne diseases of public health importance in Australia during the 2012–13 season (1 July 2012 to 30 June 2013) and includes data from human notifications, sentinel chicken, vector and virus surveillance programs. The National Notifiable Diseases Surveillance System received notifications for 9,726 cases of disease transmitted by mosquitoes during the 2012–13 season. The Australasian alphaviruses Barmah Forest virus and Ross River virus accounted for 7,776 (80%) of total notifications. However, over-diagnosis and possible false positive diagnostic test results for these 2 infections mean that the true burden of infection is likely overestimated, and as a consequence, the case definitions were revised, effective from 1 January 2016. There were 96 notifications of imported chikungunya virus infection. There were 212 notifications of dengue virus infection acquired in Australia and 1,202 cases acquired overseas, with an additional 16 cases for which the place of acquisition was unknown. Imported cases of dengue were most frequently acquired in Indonesia. No locally-acquired malaria was notified during the 2012–13 season, though there were 415 notifications of overseas-acquired malaria. There were no cases of Murray Valley encephalitis virus infection in 2012–13. In 2012–13, arbovirus and mosquito surveillance programs were conducted in most jurisdictions with a risk of vectorborne disease transmission. Surveillance for exotic mosquitoes at the border continues to be a vital part of preventing the spread of mosquito-borne diseases such as dengue to new areas of Australia, and in 2012–13, there were 7 detections of exotic mosquitoes at the border. Commun Dis Intell 2016;40(1):E17–E47.
Keywords: arbovirus; Barmah Forest virus, chikungunya, dengue, disease surveillance, epidemiology, flavivirus, Japanese encephalitis, Kunjin virus, malaria, mosquito-borne disease, Murray Valley encephalitis virus, Ross River virus, yellow fever, West Nile virus
This report describes the epidemiology of mosquito-borne diseases of public health importance in Australia during the period 1 July 2012 to 30 June 2013. It includes a summary of notified cases of disease caused by the alphaviruses Barmah Forest virus (BFV), chikungunya virus (CHIKV) and Ross River virus (RRV); the flaviviruses dengue virus (DENV), Murray Valley encephalitis virus (MVEV), West Nile virus (WNV) and the Kunjin lineage of West Nile virus (KUNV), Japanese encephalitis virus (JEV) and yellow fever virus (YFV); and malaria. Both locally acquired and overseas acquired cases are described. Vector, climate and sentinel chicken surveillance measures for arboviruses conducted by states and territories, and also at the international first ports of entry are described.
The National Arbovirus and Malaria Advisory Committee (NAMAC) provides expert technical advice on arboviruses and malaria to the Australian Health Protection Principal Committee (AHPPC) through the Communicable Diseases Network Australia (CDNA). Members of NAMAC have expertise in virus and disease surveillance, epidemiology, virology, vector ecology, vector control and quarantine, and represent agencies with a substantial interest in this area. NAMAC makes recommendations about surveillance and reporting systems, strategic approaches for disease and vector management and control, and laboratory support outlines research priorities. NAMAC develops and provides input to national guidelines and response plans. NAMAC assists in the detection, management and control of real or potential outbreaks of arboviruses or malaria and provides advice on the risk of these diseases or exotic vectors being imported from overseas and the potential impacts on Australia. NAMAC members participate in outbreak management teams as required.
Human cases of arbovirus infection and malaria are monitored using the National Notifiable Diseases Surveillance System (NNDSS). All Australian states and territories require doctors and/or pathology laboratories to notify cases of infectious diseases that are important to public health. The National Health Security Act 2007 (NHS Act 2007) provides the legislative basis for the national notification of communicable diseases and authorises the exchange of health information between the Commonwealth and the states and territories. The NHS Act 2007 provides for the establishment of the National Notifiable Diseases List, which specifies the diseases about which personal information can be exchanged between the states and territories and the Commonwealth. State and territory health departments transfer these notifications regularly to the NNDSS. The primary responsibility for public health action resulting from a notification resides with state and territory health departments.
This report presents data from a snap-shot of NNDSS taken during July 2015 and analysed by date of diagnosis. This derived field is the onset date, or where the date of onset was not known, for vectorborne diseases, it is the earliest of the specimen collection date, the notification date, or the notification received date. Since the data are from a snap-shot, numbers in this report may vary slightly from those reported elsewhere due to changes in diagnostic validation or classification. Data were verified with state and territory public health surveillance managers. Detailed notes on the interpretation of NNDSS are available in the 2013 NNDSS annual report.1 Case definitions for the diseases included in this report are available on the Australian Government Department of Health web site (http://www.health.gov.au/casedefinitions).
CHIKV infection became nationally notifiable in 2015, though a national case definition was implemented from 2010. Prior to this, CHIKV infections were notified under the disease category flavivirus (unspecified), and all notifications have now been included under CHIKV.
Data were analysed by financial year to reflect the seasonal cycle of arboviral activity in most areas of Australia. Crude notification rates or counts for the 2012–13 season were compared with those recorded over the previous 5 years. Notification rates were not calculated for diseases that are primarily acquired overseas because resident populations are not an appropriate denominator. Rates are not provided for rare diseases (n < 20) because these rates typically have large standard errors and therefore cannot be meaningfully compared across time or geographical location.
Notification rates were calculated using the Australian Bureau of Statistics estimated resident populations for Australia and each state or territory at June 2013.2 Population data are supplied as an estimate for calendar years; for this report, the population for the second half of the financial year was applied (2013 population applied to the 2012–13 financial year). Analyses were conducted using Microsoft Excel® and Stata SE version 13.
Due to a limitation of surveillance systems, Queensland notifies mixed infections of malaria as a separate notification for each infecting organism. For the 2012–13 season, additional information was collected to enable these mixed infections to be reported as 1 case for the purpose of this report, resulting in 3 fewer notifications than if the adjustment was not made.
Additional information on the details of some notifications was obtained from state and territory public health surveillance managers. Data on sentinel chicken surveillance and vector (including detection of exotic mosquitoes at the border) and virus surveillance are also reported here.
Vertebrate, vector and climate surveillance in states and territories
Sentinel chicken flavivirus surveillance programs aim to provide early warning of the endemic arboviruses MVEV and KUNV and where relevant, exotic flaviviruses such as JEV.3 Public health messaging or other response measures can be implemented in response to surveillance signals. Public health messaging may advise at-risk residents or target groups such as campers or fishermen of the need to take added precautions to avoid mosquito bites. Sentinel chicken flocks are an important component of the early warning system in several jurisdictions, and these are located geographically to detect flavivirus activity and provide a timely and accurate indication of the risk of transmission to people (Map).4 Detailed descriptions of the sentinel chicken, vector and virus surveillance programs, as well as contact details for jurisdictional arbovirus reference/research laboratories are included in the Appendix.
During the 2012–13 season, there were 9,726 notifications of mosquito-borne diseases in humans (Table 1). This represented a 16% increase from the mean of 8,404.2 notifications for the previous 5 years.
[Erratum: Barmah Forest virus rates figures corrected - 17 May 2016.]