Vaccine Preventable Diseases Surveillance Clinical Vaccinology Update 5 June 2015 Kylie Carville Communicable Diseases Epidemiology & Surveillance Health Protection Branch, Victorian Government Dept of Health and Human Services
Summary Surveillance of VPDs State, National, Global levels - Communicable Diseases Epidemiology and Surveillance, DHHS - Communicable Diseases Network of Australia (CDNA) - National Notifiable Diseases Surveillance Scheme (NNDSS) Successes of the national immunisation program Vaccine-preventable diseases surveillance in Victoria - Measles - Invasive meningococcal disease - Invasive pneumococcal disease - Pertussis
Communicable Diseases Epidemiology & Surveillance Monitor, prevent and control current and emerging communicable diseases within the Victorian community through the implementation of targeted strategies based on a partnership approach Legislative Framework: Public Health & Wellbeing Act 2008 Public Health & Wellbeing Regulations 2009 Emergency Management Act 1986 Quarantine Act 1908
Why follow-up vaccine preventable diseases? Public Health Followup Actions: understand the epidemiology determine the effectiveness of vaccination programs prevent secondary cases (or outbreaks) through contact tracing control outbreaks
Notifiable conditions
Victorian Infectious Diseases Epidemiology and Surveillance http://ideas.health.vic.gov.au/surveillance/tabulated-summaries.asp
Communicable Diseases Network of Australia (National Department of Health)
National Notifiable Diseases Surveillance System (NNDSS) http://www9.health.gov.au/cda/source/cda-index.cfm
Global surveillance for VPDs
National immunisation program successes
Diphtheria Notifications per 100 000 population 450 400 350 300 250 200 150 100 50 0 1932 - diphtheria vaccination commenced 1917 1921 1925 1929 1933 1937 1941 1945 1949 1953 1957 1961 1964-65 1968-69 1972 1976 1980 1984 1988 1992 1996 2000 1953 - DTP vaccination introduced
Tetanus Notifications per 100 000 population 2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 1917 1921 1925 1929 1933 1937 1941 1945 1949 1953 1957 1961 1964-65 1968-69 1972 1976 1980 1984 1988 1992 1996 2000 1953 - DTP vaccination introduced
Poliomyelitis Notifications per 100 000 population 45 40 35 30 25 20 15 10 5 0 1956 - mass vaccination with IPV commenced 1917 1921 1925 1929 1933 1937 1941 1945 1949 1953 1957 1961 1964-65 1968-69 1972 1976 1980 1984 1988 1992 1996 2000 1966 - OPV introduced
Haemophilus influenzae type b disease Notifications per 100 000 population 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00 1992 - First Hib vaccines approved 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 1993 - National Hib vaccination program commenced
Pertussis Notifications per 100 000 population 900 800 700 600 500 400 300 200 100 0 1942 - Mass vaccination with pertussis vaccine commenced 1917 1921 1925 1929 1933 1937 1941 1945 1949 1953 1957 1961 1964-65 1968-69 1972 1976 1980 1984 1988 1992 1996 2000 1953 - DTP vaccination introduced
Vaccine-preventable diseases surveillance in Victoria
Jan 01 Apr 01 Jul 01 Oct 01 Jan 02 Apr 02 Jul 02 Oct 02 Jan 03 Apr 03 Jul 03 Oct 03 Jan 04 Apr 04 Jul 04 Oct 04 Jan 05 Apr 05 Jul 05 Oct 05 Jan 06 Apr 06 Jul 06 Oct 06 Jan 07 Apr 07 Jul 07 Oct 07 Jan 08 Apr 08 Jul 08 Oct 08 Jan 09 Apr 09 Jul 09 Oct 09 Jan 10 Apr 10 Jul 10 Oct 10 Jan 11 Apr 11 Jul 11 Oct 11 Jan 12 Apr 12 Jul 12 Oct 12 Jan 13 Apr 13 Jul 13 Oct 13 Jan 14 Apr 14 Jul 14 Oct 14 Jan 15 Apr 15 Number of notified cases Measles - cases 60 Notified cases of measles by month, Victoria, 1 Jan 2001 to 27 May 2015 50 40 30 20 10 0 Month of notification
Measles follow up Group A disease - urgent notification by telephone - Interview treating doctor - Arrange testing at Reference Lab confirmation required - Ascertain vaccination status - Determine onset of illness - Interview patient for thorough history of illness, travel - Perform contact tracing to prevent secondary cases - Vaccinate and/or arrange immunoglobulin - Provide information to case/contacts - Exclude cases/unimmunised contacts from school/work
Measles cluster 21M Burwood East Rash onset 1 Mar Travel: India 27M Box Hill South Rash onset 17 Mar Same flight Unknown intermediary 25F Northcote Rash onset 6 Apr No travel 21M Greensborough Rash onset 8 Apr No travel 39M Roxburgh Park Rash onset 9 Apr No travel 29F Oak Park Rash onset 9 Apr No travel 35M Malvern Rash onset 18 Apr No travel 41F Roxburgh Park Rash onset 21 Apr No travel 30M Oak Park Rash onset 21 Apr No travel
14 12 10 8 6 4 2 0 (2008) 1 59 (2009) 1 59 (2010) 1 59 (2011) 1 59 (2012) 1 59 13 17 21 25 29 33 37 41 45 49 13 17 21 25 29 33 37 41 45 49 13 17 21 25 29 33 37 41 45 49 13 17 21 25 29 33 37 41 45 49 13 17 21 25 29 33 37 41 45 49 Number of cases genotyped Weekly distribution of measles genotypes identified at VIDRL 2008-2012 Genotype data reviewed 354 cases positive by RT-PCR 293 cases genotyped as wt measles; 16 vaccine strains Measles detected all year round Multiple genotypes detected B3 D4 D5 D8 D9 G3 H1 Untypable Untyped (Year) Week number Slide from Thomas Tran (VIDRL), presented at Communicable Disease Control Conference, Brisbane, 1-2 June 2015
Number of notified cases Invasive meningococcal disease Confirmed and probable invasive meningococcal disease notifications by serogroup, Victoria, 1 Jan 1995 to 3 Jun 2015 250 200 MenCCV 12mo dose (from Jan 2003) catch-up 1-19yo's (2003-2006) Unknown 29E Group Y Group W135 Group C Group B Group A 150 100 50 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015* Year of notification
Clearance antibiotics for meningococcal disease CDNA National Guidelines for Public Health Units - Updated April 2015 Clearance antibiotic use - Childcare: at least 4 hours/day on average or 20 hours in total in the 7 days prior to the onset of the case s illness. - Healthcare workers: only those who have come into direct contact with the nasopharyngeal secretions of a case during a procedure such as intubation without wearing a surgical mask or mouth-to-mouth resuscitation http://www.health.gov.au/internet/main/publishing.nsf/content/cdna-song-imd.htm
Invasive pneumococcal disease (IPD)
Number of cases IPD notifications aged <5 years, by vaccine type and date of notification, Victoria 25 13 valent vaccine Non-typable 20 15 7 valent vaccine Unknown Non-conjugate vaccine ST 13vPCV excl 7vPCV 7vPCV 10 5 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Quarter and year of notification
Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Number of cases Cases of IPD aged <5 years caused by sertoypes contained within the 13- valent conjugate vaccine (excluding 7-valent serotypes) 16 13 valent vaccine 14 12 7 valent vaccine 10 8 6 4 7F 6A 19A 4 3 1 2 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Quarter and year of notification
13v serotypes in 65 years and older 7 valent PCV on NIP 13 valent PCV on NIP
Jan 97 Apr 97 Jul 97 Oct 97 Jan 98 Apr 98 Jul 98 Oct 98 Jan 99 Apr 99 Jul 99 Oct 99 Jan 00 Apr 00 Jul 00 Oct 00 Jan 01 Apr 01 Jul 01 Oct 01 Jan 02 Apr 02 Jul 02 Oct 02 Jan 03 Apr 03 Jul 03 Oct 03 Jan 04 Apr 04 Jul 04 Oct 04 Jan 05 Apr 05 Jul 05 Oct 05 Jan 06 Apr 06 Jul 06 Oct 06 Jan 07 Apr 07 Jul 07 Oct 07 Jan 08 Apr 08 Jul 08 Oct 08 Jan 09 Apr 09 Jul 09 Oct 09 Jan 10 Apr 10 Jul 10 Oct 10 Jan 11 Apr 11 Jul 11 Oct 11 Jan 12 Apr 12 Jul 12 Oct 12 Jan 13 Apr 13 Jul 13 Oct 13 Jan 14 Apr 14 Jul 14 Oct 14 Jan 15 Apr 15 Number of notified cases Pertussis 1200 1000 800 25+ 18 to <25 15 to <18 5 to <15 1 to <5 <1 Notified cases of pertussis by month and age group, Victoria, 1 January 1997 to 26 May 2015 600 400 200 0 Month of notification
Pertussis cases aged <6mo
Pertussis notifications by age group
Further information? www.ideas.health.vic.gov.au www.health.vic.gov.au/immunisation Communicable Diseases Phone: 1300 651 160 (Afterhours): 1300 790 733
Acknowledgements Laboratory notifiers primary labs Medical practitioner notifiers Reference laboratories: - Microbiological Diagnostic Unit (MDU) - Victorian Infectious Diseases Reference Laboratory (VIDRL) Public Health Officers and Immunisation staff in the Health Protection Branch, Department of Health