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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.
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.
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 being the current health administrative areas) 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 strata. The estimated numbers required for each strata was then forwarded to Sampleworx for them to use proprietary software to test each numbers current status (valid, in-valid or unknown and business, non-business or unknown). The resulting valid non-business or unknown numbers were then 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 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 RDD mobile sampling frame was developed by Sampleworx using all known Australian mobile prefixes and then using proprietary software each number was tested to identify valid and in-valid numbers. A random sample of valid mobile numbers was then provided for use for the survey.
In 2012, a total of 13,269 respondents participated in the adult survey. A third (31.6%) of respondents were in the mobile sample and two thirds (68.4%) were in the landline sample (landline or landline and mobile). Unweighted estimates indicate that a greater proportion of younger people, of males, and of people born overseas participated in the mobile sample compared with the landline sample. Comparison of the demographic characteristics of the survey sample for the first quarter of 2012 with the NSW population shows that the NSW Population Health Survey is now more representative of the NSW population (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 the Australia on Disk electronic white pages became available and 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.
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 www.acma.gov.au/webwr/_assets/main/lib410148/report2-convergent_comms.pdf
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 www.biomedcentral.com/1471-2288/12/177.
Centre for Epidemiology and Evidence. NSW Adult Population Health Survey Methods. CEE, NSW Ministry of Health. Available at www.health.nsw.gov.au/PublicHealth/surveys/methods_adult.asp
Centre for Epidemiology and Evidence. NSW Child Population Health Survey Methods. CEE, NSW Ministry of Health. Available at www.health.nsw.gov.au/PublicHealth/surveys/methods_child.asp
PitneyBowes Software. MapInfo (software). PBS as MapInfo Corporation: version 1997. Available at www.pbinsight.com.au
Sampleworx Pty Ltd. Available at www.sampleworx.com.au.html
SAS Institute. The SAS System for Windows version 9.2 (software). Cary, NC: SAS Institute Inc., 2009. Available at www.sas.com
United Directory Systems. Australia on Disk (software). UDS: version 2004. Available at www.uniteddirectorysystems.com
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Key points: Communicable diseases
Among the most frequently reported notifiable conditions in 2012 were:
Note: The rates quoted above are age adjusted rates.
Conditions in 2012 with the most marked declines compared to previous years included:
Conditions in 2012 with the most marked increases compared to previous years included:
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 understanding of 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 continues to present a challenge in public health and requires 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 http://www.legislation.nsw.gov.au/maintop/view/inforce/act 127 2010 cd 0 N
Interventions: Communicable diseases
Response to notifications under Public Health Act 2010
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.
In 2012 NSW Health:
• maintained high immunisation coverage rates for children at 1, 2 and 5 years of age. While coverage rates in Aboriginal and non-Aboriginal children are comparable at 2 and 5 years of age, coverage in Aboriginal children is markedly less at 1 year of age. Aboriginal children are more likely to be vaccinated late at any age
• funded a pilot program to employ Aboriginal Health Workers to work collaboratively with existing services to promote timely vaccination of Aboriginal children through targeted interventions
• developed an immunisation awareness campaign to inform the community and providers about the importance of ensuring that children are fully vaccinated on time• successfully implemented the transition from Prevenar 7 to Prevenar 13 vaccine for children at 2, 4 and 6 months of age, and a supplementary program for children who had commenced Prevenar 7 vaccination to provide greater protection against pneumococcal disease
• introduced a more focused pertussis control strategy by offering new mothers free pertussis vaccine in the maternity unit after the birth of their child or via their general practitioner within 2 weeks post-birth
• increased immunisation coverage rates for adolescents in the NSW School-Based Vaccination Program for all vaccines offered to students in Years 7 and 10
• facilitated the provision of free seasonal influenza vaccine to people at high risk of severe influenza complications. The NSW Health Population Health Survey estimated that 31% of all respondents interviewed during August and September 2012 had received a seasonal influenza vaccine in the previous 12 months, a slight decrease in vaccine uptake compared with the estimate for the same period in the previous year (33%). In respondents aged 65 years and over, that is in one the identified high-risk groups, the estimated vaccination rate was 72%, which was similar to previous years.
In 2012 Health Protection NSW:
• initiated a range of control measures to contain the measles outbreak, including sending letters to health care providers, issuing media alerts, developing measles alert posters and other materials for health care facilities and local GPs, and holding free local vaccination clinics in areas with high rates of measles infections
• continued an influenza prevention campaign 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 included distribution of The Spread of Flu is Up to You campaign posters, vaccination and pregnancy brochures, and infection control signage to health care facilities, aged care facilities and a range of other sectors
• with local Public Health Units and an expert sub-committee of the NSW Tuberculosis Advisory Committee, continued to develop and implement strategies to eliminate transmission of tuberculosis in Aboriginal communities in NSW. This work involves better understanding of barriers to early presentation to health services and non-compliance with treatment for latent tuberculosis infection, and investigation of strategies to raise awareness and increase early diagnosis of tuberculosis. The Northern NSW and Mid North Coast Local Health Districts have employed two Aboriginal Community Engagement Consultants to work directly with Aboriginal communities in the Northern and Mid North Coast regions in awareness-raising and prevention activities
• continued the NSW Arbovirus Surveillance Program, which included testing for both alphaviruses (Barmah Forest, Ross River and Sindbis virus) and flaviruses (Alfuy, Edge Hill, Kokobera and Stratford) in mosquitoes trapped at 20 coastal, inland and metropolitan locations, and testing of chickens for antibody seroconversion to Murray Valley encephalitis virus and Kunjin virus at 10 sites in inland NSW from November to April. During the 2011–2012 season inland areas had seen considerable arboviral activity with 67 isolates from mosquitoes and 15 seroconversions for Murray Valley encephalitis virus in chickens. Inland areas have also seen extremely high numbers of mosquitoes due to excessive precipitation and flooding. Coastal and Sydney metropolitan areas had low vector abundance and minimal arboviral activity
• issued statewide media releases in January, March and December, warning about the increased risk of mosquitoborne infections and how to prevent them. In addition, advice on mosquito control in flood-affected areas was provided to councils and the general public in March. These were supplemented by the information on the Ministry of Health website, development of guiding principles for environmental health officers, distribution of Fight the Bite posters and brochures, radio advertising and a range of local media messaging by public health officials.
Prevention Activities for Enteric Diseases
Enteric diseases are viral and bacterial infections of the gastointestinal tract. Many are caused by pathogens found in food and water.
NSW Health works with OzFoodNet nationally and the NSW Food Authority (NSW FA) locally to investigate and control food borne outbreaks and food contamination incidents, and to make prevention recommendations. Further information about enteric diseases can be found in OzFoodNet reports at http://www.health.nsw.gov.au/Infectious/foodborne/Pages/ozfoodnet-rpt.aspx
Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468376
National Health and Medical Research Council and Natural Resource Management Ministerial Council. Australian Drinking Water Guidelines 6, 2011.
Natural Resource Management Ministerial Council; Environment Protection and Heritage Council. Australian Health Ministers’ Conference. Australian Guidelines for Water Recycling: Managing Health and Environmental Risks (Phase 1). 2006. Available from: http://www.ephc.gov.au/sites/default/files/ WQ_AGWR_GL__Managing_Health_Environmental_Risks_ Phase1_Final_200611.pdf
NSW Department of Health. Drinking Water Monitoring Program. December 2005.
For more information: Communicable diseases
Useful websites include:
NSW Department of Health Infectious Diseases web page at http://www.health.nsw.gov.au/publichealth/infectious/index.asp
Australian Government. Department of Health and Ageing. National Notifiable Diseases Surveillance System, available at http://www.health.gov.au/internet/main/publishing.nsf/content/cda-surveil-nndss-nndssintro.htm
and Communicable Diseases Intelligence at http://www.health.gov.au/internet/main/publishing.nsf/content/cda-pubs-cdi-cdiintro.htm
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
HealthInsite at http://www.healthinsite.gov.au
Public Health Act 1991 and Public Health Act 2010. Available at http://www.legislation.nsw.gov.au/maintop/view/inforce/act 127 2010 cd 0 N
National Immunisation Program Schedule at http://www.health.gov.au/internet/immunise/publishing.nsf/content/nips2
NSW Ministry of Health Immunisation web page at http://www.health.nsw.gov.au/publichealth/immunisation/index.asp