Infectious syphilis outbreak

This page provides information regarding the infectious syphilis outbreak affecting Aboriginal and Torres Strait Islander people living in northern Australia.

Page last updated: 25 October 2019

Outbreak

There is an ongoing outbreak of infectious syphilis affecting young Aboriginal and Torres Strait Islander people, predominately aged between 15 and 29 years, living in northern, central and southern Australia.

Increased notifications associated with the outbreak in northern Australia were first reported in January 2011 in northwest Queensland (Qld), followed by the Northern Territory (NT) in July 2013, and the Kimberley region of Western Australia (WA) in June 2014. In March 2017, South Australia (SA) declared an outbreak in the Far North and Western and Eyre regions from November 2016. In August 2018, WA declared that the outbreak had spread to the Pilbara region with the first syphilis notification in this region in February 2018. In January 2019, SA declared the outbreak had spread to Adelaide with the first notification in this region reported in February 2018. In May 2019, WA declared the outbreak had spread to the Goldfields region with the first notification in this region reported in January 2019.

Multi-jurisdictional Syphilis Outbreak Surveillance Reports

Current outbreak data to 30 September 2019 is included in the surveillance report below. For historical data, please refer to the Historical Reports section below.

Response

The Australian Health Protection Principal Committee (AHPPC) Governance Group has developed a National strategic approach for an enhanced response to the disproportionately high rates of STI and BBV in Aboriginal and Torres Strait Islander people (Strategic Approach).

This is working to address the disproportionately high rates of syphilis and other Blood-Borne Viruses (BBV) and Sexually Transmissible Infections (STI) in regional and remote Indigenous communities.

The Strategic Approach was endorsed by the Australian Health Ministers’ Advisory (AHMAC) Council on 8 December 2017.

Supporting the Strategic Approach is an Action Plan, which is the Enhanced response to addressing STI (and BBV) in Indigenous populations.

The Action Plan will outline activities that are or will be undertaken to respond to the syphilis outbreak. The Action Plan was also endorsed by AHMAC on 8 December 2017.

The Australian Government has committed $21.2 million over four years (2017-18 to 2020-21) to fund an augmented health workforce and point-of-care testing in targeted Aboriginal Community-Controlled Health Services (ACCHS) within the affected outbreak regions. The funding also includes the development and dissemination of a multi-strategy Aboriginal and Torres Strait Islander community awareness, education and testing campaign for syphilis and other STI/BBV. For further information, please refer to Community Engagement and Health Resources section of this page.

The Enhanced Response is being implemented in a phased approach to manage the high number of infectious syphilis cases across the affected outbreak regions.

  • The first phase commenced from June 2018 in; Darwin (NT) and Townsville & Cairns (Qld).
  • The second phase commenced from October 2018 in; the Katherine Region, Nhulunbuy (NT) and the East Kimberley Region (WA).
  • The third phase commenced from 4 April 2019 in; Western Arnhem Land (NT), Western, Eyre, Far North and Adelaide Regions (SA), and the Pilbara and Western Kimberley Regions (WA).

The Australian Government Department of Health is currently working to extend the use of Point-of-Care Testing and relevant training to 11 additional ACCHS located in outbreak regions. As per the previous phases, the sites were selected in consultation with the National Aboriginal Community-Controlled Health Organisation (NACCHO) and relevant state/territory health directorates. The extended program will commence from September 2019 in the following locations; Broome (two services), Kalgoorlie and Roebourne (WA); Mount Isa, Mareeba, Innisfail, Yarrabah, and Bamaga (Qld) and Alice Springs and Tennant Creek (NT).

Updated Guidance

Affected jurisdictions are also responding to the outbreak in accordance with the recently updated 2018 National Guidelines for Syphilis.

The Syphilis Chapter of the Pregnancy Care Guidelines has also been updated to provide strengthened advice to health care professionals on testing and treatment for pregnant women.

The disease control interventions that are being implemented or enhanced include:

  • opportunistic and community screening/testing, particularly among young sexually active people aged less than 29 years;
  • immediate treatment of people who are symptomatic (e.g. genital ulceration), have tested positive for syphilis or are sexual contacts of cases;
  • reinforcement and focus on antenatal screening for syphilis, with particular attention paid to recommended guidelines for the ‘at risk’ population;
  • public health alerts, health protection education and campaigns; and
  • active follow up of cases.

Supporting Structure

Multi-jurisdictional Syphilis Outbreak Working Group

In April 2015, a Multijurisdictional Syphilis Outbreak Working Group (MJSO) of the Communicable Diseases Network Australia (CDNA) was formed in response to this on-going outbreak among young Aboriginal and Torres Strait Islander people living in remote areas of northern Australia.

The MJSO, with representatives from affected jurisdictions, sexual health physicians, experts in Aboriginal and Torres Strait Islander sexual health and the Australian Government Department of Health, meets regularly with the objective of advising governments on co-ordinating the public health response for outbreak control and preventing transmission of syphilis from infected women to their babies, through rigorous antenatal testing and care.

Syphilis Enhanced Response Governance Group

The Governance Group was established by AHPPC in September 2017 to oversee the enhanced response, including short-term actions to address immediate priorities. The Governance Group will also take into consideration a long-term approach to a sustainable response to STI and BBV.

The Chair of the Governance Group is the Commonwealth Chief Medical Officer (First Assistant Secretary, Office of Health Protection (FAS OHP) (proxy)), including the following members:

  • Chair MJSO Working Group;
  • Representative from the National Aboriginal Community-Controlled Health Organisation (NACCHO);
  • Representative from the South Australian Health and Medical Research Institute (SAHMRI); and
  • Chief Health Officers or senior decision makers from Queensland, Northern Territory, Western Australia, and South Australia.

The Governance Group is supported as needed by the various areas within the Commonwealth (including Department of Health and the National Indigenous Australians Agency), as well as the AHPPC sub-committees and technical working groups, as outlined below:

  • Communicable Diseases Network Australia: national public health coordination and leadership, including through the Series of National Guidelines (SoNGs);
  • MJSO: surveillance, reporting, workforce issues related to the outbreak and guidance on clinical care;
  • Public Health Laboratory Network: advice and expertise on pathology and laboratory services, including Point-of-Care Testing (PoCT) and improved access to laboratory data; and
  • Blood Borne Viruses and Sexually Transmissible Infections Standing Committee: advisory body on strategic policy, programs, social policy activities relating to BBV and STI, including education and awareness.

Enhanced Response Unit

A dedicated unit, the STI Enhanced Response Unit (ERU) has been established in the Australian Government Department of Health, within the Indigenous Health Division to coordinate and progress the Commonwealth’s enhanced response to the syphilis outbreak.

Community Engagement and Health Resources

The Australian Government is funding the South Australian Health and Medical Research Institute (SAHMRI) to deliver a multi-strategised Aboriginal and Torres Strait Islander community awareness, education and testing campaign for syphilis and other STI and BBV.

SAHMRI’s campaign is assisting in:

  • targeting Aboriginal and Torres Strait Islander people aged 15–29 years living in regional and remote communities of Queensland, Northern Territory, Western Australia and South Australia; and
  • promotion, through television and radio advertising, engaging with local community groups, social media and the Young Deadly Free website.

The Young Deadly Free website offers a range of resources for young people in remote Aboriginal communities, as well as resources for Elders, parents, youth workers and other community leaders – with tips on how the whole community can work with young people to encourage STI and BBV testing, and knockout STIs and BBVs.

The website also offers resources for clinicians working in remote communities, providing links to testing and treatment guidelines and practical tips on engaging with young people on difficult topics such as sex, sexuality, and drug and alcohol use.

Reports

A full report titled Infectious and congenital syphilis notifications associated with an ongoing outbreak in northern Australia was published in the March 2016 edition (Volume 40 Number 1) of the Communicable Diseases Intelligence.

MJSO Surveillance Reports

The MJSO Surveillance Reports, formerly the MJSO Communique, summarise the epidemiological data from the outbreak for the period. For historical epidemiological data and MJSO activities refer to the MJSO Communiques.

2019 Surveillance Reports

2018 Surveillance Reports

MJSO Communiques

The MJSO meeting Communiques summarise the epidemiological data from the outbreak and the activities of the group for the period. For the latest epidemiological data refer to the MJSO Surveillance Reports.

2016 - 2018 Consolidated Communiques

Further information

National

Northern Territory

Queensland

Western Australia

South Australia

Case definition

Cases defined as per the Multijurisdictional Syphilis Outbreak (MJSO) syphilis outbreak case definition:

Nationally, an infectious syphilis outbreak case is defined as: any person who is newly diagnosed with confirmed or probable infectious syphilis according to the CDNA national surveillance case definition for infectious syphilis,

AND, is an Aboriginal or Torres Strait Islander person who resides in any of the following outbreak declared regions as defined and documented by that jurisdiction, at or after the dates indicated: Qld - North West Hospital and Health Service area (from 1 January 2011), Torres and Cape Hospital and Health Service area (from 1 December 2012), Cairns and Hinterland Hospital and Health Service area (from 1 August 2013), Townsville Hospital and Health Service area (from 1 January 2014); NT - Alice Springs Rural and Urban or Barkly district (from 1 July 2013), Katherine district (from 1 May 2014), East Arnhem district (from 1 November 2015), Darwin Rural and Urban (from 1 January 2017); WA - Kimberley region (from 1 June 2014), Pilbara region (from 1 February 2018), Goldfields region (from 1 January 2019); SA - Far North and Western and Eyre regions (from 15 November 2016), Adelaide (from 1 February 2018) (category 1 outbreak cases)

OR, is a sexual contact of a confirmed outbreak case (category 2 outbreak cases).