Influenza immunisation

Males, 2011
71.6Males, 2010
71.9Males, 2009
69.9Males, 2008
69.8Males, 2007
70.6Males, 2006
73.3Males, 2005
74.8Males, 2004
75.4Males, 2003
76Males, 2002
75.7Females, 2011
73.2Females, 2010
73.2Females, 2009
74.4Females, 2008
72.6Females, 2007
73.7Females, 2006
76.6Females, 2005
74.6Females, 2004
75.4Females, 2003
75.1Females, 2002
75.6Persons, 2011
72.4Persons, 2010
72.6Persons, 2009
72.3Persons, 2008
71.4Persons, 2007
72.3Persons, 2006
75.1Persons, 2005
74.7Persons, 2004
75.4Persons, 2003
75.5Persons, 2002
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Supporting Text

NSW Population Health Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.

Actual estimates are shown in the graph and table.

The indicator shows self-reported data collected through Computer Assisted Telephone Interviewing (CATI). Estimates were weighted to adjust for differences in the probability of selection among respondents and were benchmarked to the estimated residential population using the latest available Australian Bureau of Statistics mid-year population estimates.

Mobile phone numbers were included in the 2012 survey (using an overlapping dual-frame design) because of diminishing coverage of the population by landline sampling frames (<85 % since 2010). Associations between mobile-only phone users and some health indicators, even after adjusting for age, sex and region, were observed in 2012. Thus significant differences that were observed between 2011 and 2012 should be reported with caution, as they will reflect both real and/or design changes.

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Methods for indicator: Immunised against influenza or pneumococcal disease

Because influenza immunisation significantly reduces morbidity and preventable mortality, it is recommended and funded for all people aged 65 years and over, Aboriginal and Torres Strait Islander people aged 15 years and over, pregnant women, and people aged 6 months or over with conditions predisposing to severe influenza.

The indicator includes those aged 65 years and over who have been immunised against influenza in the last 12 months. The questions used to define the indicator were: Were you vaccinated or immunised against flu in the last 12 months? 

NSW Population Health Survey

The NSW Ministry of Health has conducted the Adult Population Health Survey (since 1997) and the Child Population Health Survey (since 2001) through the New South Wales Population Health Survey, an ongoing survey of the health of people in NSW using computer-assisted telephone interviewing (CATI). The main aims of the surveys are to provide detailed information on the health of adults and children in NSW and to support planning, implementation and evaluation of health services and programs in NSW.

Survey instrument

The survey instruments include question modules on health behaviours, health status, and other associated factors. The methods and all questions are approved for use by the NSW Population and Health Services Research Ethics Committee. The instrument is translated into 5 languages: Arabic, Chinese, Greek, Italian and Vietnamese.

Survey sample

The target population for the survey is all state residents living in private households. The target sample was approximately 1,000 persons in each of the health administrative areas (total sample 8,000-16,000 depending on the number of administrative areas).

From 1997 to 2010 the random digit dialling (RDD) landline sampling frame was developed as follows. Records from the Australia on Disk electronic white pages (phone book) were geo-coded using MapInfo mapping software. The geo-coded telephone numbers were assigned to statistical local areas and area health services. The proportion of numbers for each telephone prefix was calculated by area health service. All prefixes were expanded with suffixes ranging from 0000 to 9999. The resulting list was then matched back to the electronic phone book. All numbers that matched numbers in the electronic phone book were flagged and the number was assigned to the relevant geo-coded area health service. Unlisted numbers were assigned to the area health service containing the greatest proportion of numbers with that prefix. Numbers were then filtered to eliminate continuous non-listed blocks of greater than 10 numbers. The remaining numbers were then checked against the business numbers in the electronic phone book to eliminate business numbers.

From 2011 onwards the RDD landline sampling frame was developed as follows:  Australian Communications and Media Authority exchange district and charge zone prefixes were generated for each of the strata (that is Local Health Districts introduced in January 2011) using “best fit” postcode (ACMA 2011). All prefixes were expanded with suffixes ranging from 0000 to 9999. The sample was then randomly ordered within each stratum. The estimated numbers required for each stratum was then forwarded to Sampleworx, who used proprietary software to test each numbers current status (valid, invalid or unknown and business, non-business or unknown). The resulting valid non-business and valid unknown numbers were used for the survey.

From 2012 onwards mobile only phone users were included into the surveys using an overlapping dual-frame design, which incorporates three groups of respondents: landline only users, mobile only users and landline and mobile users.

The RDD mobile sampling frame was developed by Sampleworx and included using all known Australian mobile prefixes. Sampleworx used proprietary software to test each number to identify valid and invalid numbers. A random sample of valid mobile numbers was then provided for use for the survey.

The introduction of this design was prompted by the increasing numbers of mobile-only phone users in the general population. Because this design increases the representativeness of the survey sample the production of unbiased estimates over time is also improved. The improvement has been confirmed by an analysis of unweighted estimates, which indicated that a greater proportion of younger people, of males, and of people born overseas participated in the mobile sample compared with the landline sample. Further, comparison of the demographic characteristics of the survey sample for the first quarter of 2012 with the NSW population showed that the NSW Population Health Survey was more representative of the NSW population than the previous sample (Barr et al. 2012).

Due to this change in design, the 2012 NSW PHS estimates reflect both changes that have occurred in the population over time and changes due to the improved design of the survey. 

When considering significant differences over time excluding the 2010 and 2011 data points ensures that all of the estimates are from sampling frames that had adequate coverage of the population, that is 85% or more.

When the Australia on Disk electronic white pages became available, reliable introductory letters were sent to the selected households (1997 to 2008). Households were contacted using random digit dialling. Depending on the frame either one person from the household was randomly selected or the mobile phone holder was selected for inclusion in the survey.


Interviews are carried out continuously between February and December each year. An 1800 freecall contact number and website details are provided to potential respondents, so they can verify the authenticity of the survey and ask any questions regarding the survey. Trained interviewers at the Health Survey Program CATI facility carried out interviews. Up to 7 calls were made to establish initial contact with a household, and up to 5 calls were made in order to contact a selected respondent.

Data analysis

For analysis, the survey sample was weighted to adjust for differences in the probabilities of selection among respondents. Post-stratification weights were used to reduce the effect of differing non-response rates among males and females and different age groups on the survey estimates. These weights were adjusted for differences between the age and sex structure of the survey sample and the Australian Bureau of Statistics latest mid-year population estimates (excluding residents of institutions) for each health administrative area.

Call and interview data were manipulated and analysed using SAS version 9.2 (SAS). The Taylor expansion method was used to estimate sampling errors of estimators based on the stratified random sample. The 95 per cent confidence interval provides a range of values that should contain the actual value 95 per cent of the time.

Estimates were smoothed using least-squares spline transformation (CEE, Adult survey methods: web page).

Further information on the methods and weighting process is provided elsewhere (CEE, Child survey methods: web page).


Australian Communications and Media Authority (ACMA). Communications report 2010-11 series: Report 2 – Converging communications channels: Preferences and behaviours of Australian communications users. Commonwealth of Australia, 2011. Available at

Barr ML, Ritten JJ, Steel DG, Thackway SV. ‘Inclusion of mobile phone numbers into an ongoing population health survey in New South Wales, Australia: design, methods, call outcomes, costs and sample representativeness’. BioMed Central: Medical Research Methodology 2012, 12:177 (22 November, 2012). Available at

Centre for Epidemiology and Evidence. NSW Adult Population Health Survey Methods. CEE, NSW Ministry of Health.

Centre for Epidemiology and Evidence. NSW Child Population Health Survey Methods. CEE, NSW Ministry of Health.

Software used

PitneyBowes Software. MapInfo (software). PBS as MapInfo Corporation: version 1997. Available at

Sampleworx Pty Ltd. Available at

SAS Institute. The SAS System for Windows version 9.2 (software). Cary, NC: SAS Institute Inc., 2009. Available at

United Directory Systems. Australia on Disk (software). UDS: version 2004. Available at



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Related Indicators

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Influenza and pneumonia hospitalisations

Number and rate by sex, age and year. Includes person-based hospitalisations.

Influenza and pneumonia hospitalisations by Aboriginality

Number and rate by Aboriginality and year.
Key points: Communicable diseases

Vaccine Preventable Diseases

In 2013 there were:

• 9 invasive Haemophilus influenzae type b notifications, of which five were in children aged less than 5 years

• 2,338 pertussis notifications, the lowest since 2007 when a highly sensitive test became widely used. There were no infant pertussis deaths.

• 34 measles notifications, of which 16 were imported from overseas, 8 were linked to imported cases, and one case was acquired in Victoria. 9 locally acquired measles cases were reported with no known source of infection. 8 cases were notified from the Sydney Local Health District. The largest single outbreak, of 6 cases, was in Northern NSW Local Health District associated with an imported case at a school.

• 46 meningococcal disease notifications, a dramatic decrease from 65 in 2012. Of these, 26 were due to serogroup B (57%), 8 were due to serogroup Y (17%), 6 were due to serogroup W135 (13%), 3 were due to serogroup C (7%), and 3 were of an unknown serogroup (7%). Of the 3 cases of meningococcal C disease, 2 were in adults aged over 50 years, and 1 was reported in a teenager who was vaccinated against meningococcal C disease (the 3rd vaccine failure identified in NSW since vaccine introduction in 2003).

• 90 mumps notifications, a decrease from the 105 reported in 2012. The highest notifications were in metropolitan areas and in under-vaccinated persons aged 15–19 years (15 cases), followed by those aged 30–34 years (12 cases).

• 12 rubella notifications, including a cluster in the North Coast Local Health District (6 cases).

• 469 invasive pneumococcal disease notifications, a marked decrease compared with 581 in 2012. In children less than 5 years, 65% of notifications were due to non-vaccine related serotypes; serotype 19A was the predominant vaccine related serotype in this age group.


Blood Borne Viruses

In 2013 there were:

• 357 cases of newly diagnosed HIV infection, a 13% decrease compared with 2012 (409 cases). Of these 357 cases, 278 (78%) were reported as men who have sex with men (MSM).  This compares with 330 MSM related new diagnoses in 2012, a 16% decrease in the notifications in this major risk group. 40% of patients newly diagnosed with HIV infection in 2013 had evidence of early stage infection, a lesser proportion than that reported for new diagnoses in 2012 (47%) and 2011 (50%).  Overall HIV testing increased by 6% in 2013 compared to 2012, with almost 450,000 tests performed.

• 2,478 notifications of unspecified hepatitis B, an 8% increase compared with 2012 (2,288 cases) and about the same as the average of the previous five years (2,458 cases). 54% of cases were males. Hepatitis B is notified as “unspecified” when the time of infection is unknown (most notifications) or is known to be longer than two years prior to diagnosis.

• 34 newly acquired hepatitis B case notifications, an increase of 17% compared with 2012 (29 cases), but similar to the average of the previous five years (n=35). 65% of cases were males.  Newly acquired hepatitis B is notified when there is evidence that the infection was acquired within two years of diagnosis.

• 3.462 notifications of unspecified hepatitis C, 7% higher than in 2012 (3,245 cases) but 2% lower than the average of the previous five years (3,519 cases). Sixty-six percent of cases were males.

• 44 newly acquired hepatitis C case notifications, 14% lower than in 2012 (51 cases) but 10% higher than the average of the previous five years (40 cases). 55% of cases were males and 50% were aged between 15 and 29 years. Newly acquired hepatitis C is notified when there is evidence that the infection was acquired within two years of diagnosis.


Sexually Transmissible Infections

In 2013 there were:

• 20,821 chlamydia case notifications, a decrease of 2% compared with 2012 (21,305 cases). 55% of cases were females and 56% were aged between 15 and 24 years.

• 4,243 gonorrhoea case notifications, an increase of 3% compared with 2012 (4,127 cases). 82% of cases were males and 42% were aged between 20 and 29 years.

• 624 infectious syphilis case notifications, a 21% increase compared with 2012 (514 cases). Almost all cases (95%) were men.  The most commonly affected age groups were between 30 and 39 years (30%) and 40 and 49 years (29%).

• 27 lymphogranuloma venereum (LGV) case notifications, a decline from 29 in 2012. All cases were men. Almost half of the cases (48%) were aged between 25 and 34 years, and a further 44% were between 35 and 44 years. The number of LGV notifications has decreased each year since 2010 following an outbreak early in that year.


Enteric Diseases

In 2013 there were:

• 7,598 enteric disease case notifications, a 9% increase compared with the average annual count for the previous five years, but 1% lower than the total enteric disease notifications for 2012

• 3,438 salmonellosis case notifications, a 16% increase compared with 2012 and 13% higher than  the average annual count for the previous five years

• 39 outbreaks of probable foodborne disease affecting 417 people, a decrease compared with 61 outbreaks affecting 662 people in 2012

• 687 outbreaks of probable viral gastroenteritis in institutions affecting 10,069 people, a decrease compared with 803 notifications affecting 13,842 people in 2012

• 9 point-source outbreaks of Salmonella Typhimurium infection affecting 109 people, most likely associated with the consumption of sauces, smoothies, and desserts prepared with raw eggs

• 29 listeriosis cases. There was a cluster of three listeriosis cases in NSW public hospitals in April 2013 associated with consumption of chocolate profiteroles. One patient died and a further two cases recovered after serious illness. Following this incident Health Protection NSW, worked closely with the Camperdown PHU, the NSW Food Authority, and NSW Health Service Support, (providers of food services to NSW public hospitals), to tighten requirements about Listeria control in foods served to patients and to improve communication protocols.


Respiratory Disease

In 2013 there were:

• 101 Legionnaires’ disease case notifications compared with 102 cases in 2012. A total of 54 cases were due to Legionella pneumophila infection, compared with 64 cases in 2012. Public health investigations did not identify any common sources for these L. pneumophila cases and they were evenly spread throughout the year. Notifications due to L. longbeacheae infection increased slightly (36 compared with 29 cases in 2012).

• 8,401 notifications of patients with laboratory confirmed influenza, a slight increase compared with 7,993 notifications in 2012. Both influenza A and B activity was highest in late August. Approximately 64% of laboratory-confirmed influenza was influenza A, with the influenza A(H1N1)pdm09 strain predominating. The number of influenza B notifications was higher than for any of the previous 5 years and accounted for 36% of laboratory confirmed influenza cases overall. Laboratory-confirmed influenza notifications represent only a small proportion of cases in the community. There was a large increase in the number of people presenting to emergency departments with influenza-like illness from June to September, with a peak in presentations in late August. There were fewer reported outbreaks of respiratory illness in aged-care and other residential care facilities in 2013 compared to previous years, and the rate of deaths attributed to influenza and pneumonia was low (a pattern seen previously influenza A(H1N1)pdm09 predominates.

• continued influenza prevention campaigns that focused on three key respiratory disease prevention messages: Cover your face when you cough or sneeze; Wash your hands; and Stay at home if you're sick so you don't infect others. The campaign also included distribution of The Spread of Flu is Up to You campaign posters, vaccination & pregnancy brochures, and infection control signage to health care facilities, aged care facilities and a range of other sectors.

• 430 notifications of tuberculosis, a steady decrease from the 451 and 511 cases reported in 2012 and 2011, respectively

• 8 cases of multi-drug resistant tuberculosis (MDR-TB). Eight cases were reported in 2010, 2011 and 2012 combined

• in collaboration with an expert sub-committee of the NSW Tuberculosis Advisory Committee, continued activities to strengthen tuberculosis prevention and control in Aboriginal communities in northern NSW, through a range of measures to increase screening, and increase early diagnosis.


Vector Borne Disease

In 2013 there were:

• 503 Ross River virus infection (RRV) notifications, a decrease from 604 in 2012. While the largest number of RRV cases was reported in the Hunter New England LHD (130 cases), Northern NSW LHD had the highest rate of notifications by population, followed by the Mid North Coast LHD.

• 431 Barmah Forest virus infection notifications, a 21% increase compared with the 357 notifications in 2012. This increase should be interpreted with caution as the use of a less specific serological test in 2013 is thought to have resulted in some false positive notifications. The geographical distribution of cases was similar to RRV, with the highest number of cases reported from residents of the Northern NSW, Mid North Coast and Hunter New England LHDs.

• 298 dengue fever case notifications, a small increase compared with the 289 notifications in 2012. The majority of the cases in 2013 were linked to international travel: Indonesia was the most commonly reported exposure site (40%), followed by Thailand (20%), India (6%) and the Philippines (6%). One case was acquired in NSW through exposure to the dengue virus in a research laboratory.

• no notifications of Kunjin virus, Murray Valley encephalitis virus, or other non-dengue flavivirus infections

• 24 Chikungunya virus infection notifications, a marked increase over the two cases reported in 2012. All were acquired overseas with thirteen cases acquired in Indonesia and five acquired in India.

• 87 malaria notifications, compared with 70 cases in 2012. All were acquired overseas. Travel to India was again the most commonly reported exposure site (26%), followed by Nigeria (11%).


Zoonotic Diseases

In 2013 there:

• was an increase in Q fever case notifications (168 compared with 123 in 2012). Q fever was the most commonly notified zoonotic disease in 2013.

• was a decrease in leptospirosis notifications (12 compared with 22 in 2012)

• was a slight decrease in brucellosis infections (3 compared with 6 in 2012). 2 cases were overseas-acquired and 2 infections were in feral pig hunters in Northern NSW.

• was an outbreak of Hendra virus (HeV) infection in horses on the north coast of NSW in June and July 2013. HPNSW worked closely with Lismore PHU and the NSW Department of Primary Industries (DPI) to respond to the outbreak, including conducting risk assessments of human contacts. None of the 16 identified contacts were assessed as “high risk” and none developed symptoms of HeV infection. Overall, 4 horses were confirmed with HeV infection and either died from the infection or were euthanised. A companion animal to one of the infected horses became the first documented natural clinical HeV infection of a dog and was also euthanised.

• were two outbreaks of highly pathogenic H7N2 avian influenza (AI) in animals on neighbouring poultry farms near Young in October 2013. HPNSW worked closely with Goulburn PHU and DPI to respond to the outbreak. There were 55 identified high-risk human contacts and public health staff employed a novel method of contact tracing via a web-based SMS transmission system. The purpose of the SMS was to remind identified contacts to self-monitor for influenza-like symptoms until the AI incubation period expired, plus prompt them to take daily prophylactic anti-influenza medication, where prescribed.

• was continued close work with the NSW Department of Primary Industries to manage zoonoses including developing and releasing joint factsheets on HeV and Australian Bat Lyssavirus and revising HeV quarantine procedures to include provision for companion animals.

Introduction: Communicable diseases

Definition and burden of disease in Australia

Bacteria, viruses or parasites infect humans as a result of contact with other infected humans, animals or the environment. Certain communicable diseases are of high priority for health departments around the world, because they are highly infectious, can result in serious illness or death, or can be prevented by immunisation or other actions.

Only in the last 200 years or so has the germ theory and the importance of some of the most important yet basic public health measures, such as availability of running water and hand-washing, been recognised. The development of immunisation, first against smallpox, and later for a growing number of other diseases including diphtheria, pertussis, tetanus, polio, and measles, led to massive declines in morbidity and mortality associated with these conditions.

The potential for serious outbreaks and emerging or re-emerging infectious diseases continue to present a challenge in public health and require planning and constant vigilance. Each year, over 200,000 individual notifications of communicable diseases are reported in Australia. These trigger a considerable amount of public health action so that cases are treated, the spread of disease is limited, the source of infection is removed or minimised and outbreaks are controlled or prevented.  

Public Health Act 2010

Under the Public Health Act 2010 (and previously under the Public Health Act 1991), laboratories, hospitals, medical practitioners, schools and child care centres must notify NSW Health of diagnoses of certain diseases. For some diseases a notification triggers a public health response by the public health unit, such as immunisation or prophylactic treatment of contacts. Notifications also provide valuable information that is used for planning and evaluation of prevention programs.

The number of notifications received for any particular condition is almost always an underestimate of the number of cases that actually occur. For a condition to be notified a patient must seek medical help, be diagnosed with the condition, in some cases must have the appropriate laboratory tests done and then the diagnosis must be reported to NSW Health. Nonetheless, communicable disease notifications provide valuable information on disease patterns in NSW.


Public Health Act 1991 and Public Health 2010. Available at 127 2010 cd 0 N

Interventions: Communicable diseases


Immunisation remains the backbone of communicable disease control. Most preschool immunisations (>85%), are provided by general practitioners and a small proportion are provided by councils in NSW. Public health units provide high school based vaccination clinics. In 2013, NSW Health continued to facilitate high immunisation rates among children and adults through activities including:

• the Save the Date to Vaccinate awareness campaign (including television, radio, smartphone app and printed resources). The campaign evaluated well and there are plans to commence phase 2 of the campaign in 2014

new legislation to strengthen the immunisation requirements for enrolment into childcare in NSW. This included the development and distribution of an immunisation enrolment toolkit, parent brochure and advice on the NSW Heath website.

• an improvement in immunisation rates in Aboriginal children at 12 months of age from 85.9% in 2012 to 86.4% in 2013. The immunisation rate for Aboriginal children at 60 months (93.9%) was higher than for the general population (92.0%).

• the introduction of HPV vaccination for boys in Years 7 and 9. In the first year of this program, coverage for Year 7 males was only slightly below coverage in the established female vaccination program. 

• the development of a single consent form for Year 7 vaccinations to improve the parents’ experience, record management and data collection

• a new NSW Immunisation Schedule from 1 July 2013, including the introduction of two new vaccines (measles-mumps-rubella-varicella vaccine and Haemophilus influenza type b (Hib)-meningococcal C vaccine) into the schedule, and development and distribution of an Immunisation Provider Kit to explain the changes

• commencement of the Aboriginal Immunisation Health Worker Pilot with the employment of staff and completion of work plans aiming to identify and overcome barriers to immunisation in Aboriginal children 

• a new web-based vaccine ordering system, to provide greater efficiencies in the operations of the state vaccine centre, more reporting functionality for NSW Health and real-time feedback to immunisation providers when they place an order.


Blood Borne Virus

In 2013, NSW Health:

• developed the NSW HIV Support Program (HSP) to provide advice and support for doctors when they have newly diagnosed a patient with HIV infection.  By assisting doctors provide 5 Key Support Services to a newly diagnosed person, the person is supported to manage their infection and avoid transmitting HIV to another person. The 5 Key Support Services are: Appropriate clinical management; Psychosocial support; Counselling about HIV treatment and prevention of transmission of HIV to others; Contact tracing assistance; and Linkage to relevant specialist, community and peer support services. The HSP commenced on 9 May 2013 and by 31 December 2013 over 100 doctors inexperienced in HIV had been supported. The program was well received with most doctors indicating they found the support valuable. The HSP is continuing to evolve as Local Health Districts share experiences on models of implementation and resources and tools are developed.  A formal evaluation of the HSP will commence in 2014.

• commenced quarterly reporting on key HIV statistics, 6 weeks after the close of each quarter for monitoring the implementation of the HIV Strategy.

• strengthened surveillance of HIV infection by collecting information on viral load and HIV treatment uptake at the time of diagnosis. For the first time, information was available on HIV treatment coverage among people newly diagnosed with HIV in NSW. This is critical for tracking progress towards the goals set out in the NSW HIV Strategy 2012-2015. Of 355 NSW residents newly diagnosed with HIV in 2013, 140 (39%) had commenced HIV antiretroviral treatment around the time of diagnosis.


Enteric Diseases

NSW Health continues to work closely with the NSW Food Authority to investigate reports of potential food borne infection.

Salmonella Online Survey

In early 2013 a Salmonella Online Survey (SOS) was trialled to:

  • explore online surveys as a tool for rapid collection of salmonellosis risk factors
  • assess the suitability of using an online survey for disease follow up
  • reduce the time interval between onset of illness and public health follow-up.

    Over 300 people were invited to participate via a letter including a link to an online survey. A response rate of 22% was achieved. The survey responses frequently revealed foods or meals that were a likely source of the salmonellosis so advice could be given on safer alternatives, e.g. informing a case that smoothies containing raw egg are a particularly risky practice for salmonellosis.  An evaluation found the SOS to be both a useful and acceptable form of public health follow up for salmonellosis cases and HPNSW aims to refine the methodology of the SOS and trial it again in 2014.


    Enterovirus Outbreak Surveillance

    Although most enterovirus infections cause mild or no symptoms, they are also associated with a wide range of clinical diseases from hand-foot-and-mouth (HFM) disease to aseptic meningitis and acute flaccid paralysis. Transmission of enteroviruses, which includes the poliomyelitis virus, may occur directly via the faecal-oral route, contaminated environmental sources, or respiratory droplet transmission. Enterovirus infections (apart from poliomyelitis) are not notifiable in NSW.

    In early March 2013, paediatricians from the Northern Beaches area of Sydney alerted the Northern Sydney Local Health District Public Health Unit to an increase in the number of young children presenting with severe neurological manifestations of enterovirus infection. The Sydney Children’s Hospital Randwick confirmed human enterovirus 71 (EV71) in some of these cases and suspected infection in others.

    Human enterovirus 71 (or EV71) is a major cause of HFM disease worldwide, and in the last 15 years has caused large outbreaks in South East Asia associated with severe neurological disease and deaths. Large outbreaks have been rare in Australia but have been reported from Victoria, Western Australia, and in Sydney in 2000-01.

    NSW Health alerted clinicians and issued alerts to the community locally and statewide. The Sydney Children’s Hospital Network circulated advice to clinical staff on the diagnosis and management of patients with suspected neurological complications of enterovirus infection. Enhanced surveillance for current and recent cases of severe enterovirus infections in young children was implemented at both of Sydney’s Children’s Hospitals, and through the public hospital real-time emergency department surveillance system (PHREDSS) which demonstrated a gradual community spread of the infection to other parts of Sydney and outside Sydney. Over one hundred suspected cases were identified, which were found to be due to either EV71 or one of a number of other enteroviruses. The outbreak peaked in March and had declined by June 2013. While the enhanced hospital case surveillance was stopped in June, emergency department surveillance through PHREDSS continued.

    In November 2013 paediatricians at Children’s Hospital Westmead reported an increase in presentations of very young infants with fever, rash, and irritability. Testing showed that the infants were infected with parechovirus genotype 3, which has been recognised as causing similar outbreaks amongst infants in Europe, North America and Asia, but had not previously been recognised in Australia. In collaboration with public health units and clinical staff in the three tertiary paediatric hospitals active surveillance was established and alerts were disseminated to paediatricians and emergency departments. Overall, in the period from October 2013 to February 2014, 183 cases were confirmed in infants, from all parts of the state. PHREDSS surveillance was found to be a sensitive tool to track the outbreak, and the indicator (admission of infants presenting with fever/unspecified) continues to be monitored.

    For more information: Communicable diseases

    Useful websites include:

    NSW Communicable Diseases Reports web page at 

    NSW Infectious Diseases web page at

    Australian Government. Department of Health and Ageing. National Notifiable Diseases Surveillance System, available at

    and  Communicable Diseases Intelligence at

    Australian Bureau of Statistics at

    Australian Institute of Health and Welfare at

    HealthInsite at

    Public Health Act 1991 and Public Health Act 2010. Available at 127 2010 cd 0 N



    National Immunisation Program Schedule at

    NSW Ministry of Health Immunisation web page at