Communicable Disease Prevention Unit Bulletin

Introduction to the CDPU Bulletin

Welcome to the first edition of the Communicable Diseases Prevention Unit (CDPU) Bulletin. This bulletin provides the latest surveillance data, updates, insights, and resources relating to communicable diseases and the work of CDPU. 

The Communicable Disease Prevention Unit (CDPU) comprises three divisions: Immunisation, Health Intelligence, and Response including Infection Prevention and Control. The primary purpose of the CDPU is to prevent and control communicable diseases within Tasmania. We actively engage with the public and collaborate closely with stakeholders to prevent and respond effectively to notifiable diseases.

The CDPU has delegated statutory responsibility for aspects of the Public Health Act 1997 and for the Poisons Regulations 2018 relating to immunisation. We receive notifications of diseases from laboratories and medical practitioners as stipulated in the Guidelines for Notifying Diseases and Food Contaminants.

In this first edition of the bulletin in 2024, we focus on topical communicable disease updates concerning syphilis, pertussis (whooping cough), respiratory syncytial virus (RSV) immunisation, influenza immunisation in children, and residential aged care home acute respiratory illness outbreak resources. 

The Bulletin will be published three times a year in March, July and November.

Nikki Lane
Acting Nursing Director

Syphilis in Tasmania

Syphilis is a highly infectious sexually transmissible infection caused by the bacteria, Treponema pallidum. It can be transmitted to others mostly via unprotected sexual contact. If it is not treated syphilis can cause serious health problems. Critically, if a woman is infected while pregnant, syphilis can be transmitted to the unborn baby and cause serious harms. 

In 2011, an outbreak of syphilis was declared in Queensland.  Increases in syphilis notifications have since been observed across all states and territories in Australia. Tragically, from 2016 to 2023, there were 89 cases of congenital syphilis nationwide. 

In Tasmania, cases of syphilis have been increasing since 2022; there were 67 cases in 2022 and 97 cases in 2023. In 2023 there was one case of congenital syphilis. 

While the majority of cases are in males, cases in women of reproductive age are a particular focus due to the risk of infection in pregnancy and congenital syphilis. Cases in females of reproductive age have increased from four in 2021, to 12 in 2022 and 18 in 2023. 

Syphilis is most contagious in the first two years after infection and during this time is referred to as infectious syphilis. Cases of infectious syphilis have increased in all regions of Tasmania. In 2023 the highest rate was in the Southern region, 15.9 per 100 000 population, followed by the North, 8.3 per 100 000 and the North-West, 5.8 per 100 000. 

The changing epidemiology of syphilis in Tasmania is of public health significance and a public health response is underway.

More detailed data on the ongoing syphilis situation in Australia is available in the National Syphilis Surveillance Quarterly Reports. 

1. Figure 1. Syphilis notifications in Tasmania 2018 to 2023, by classification

    

Syphilis Outbreak Public Health Response – Tasmania

Syphilis numbers began to increase in Tasmania in early 2022, making Tasmania one of the last Australian jurisdictions to experience a syphilis outbreak.

Recognising the increase in numbers and outbreak early, with case numbers still manageable, Tasmania stood up an enhanced proactive response with the overall objectives to reduce the incidence of syphilis in Tasmania and eliminate congenital syphilis.

In mid-2023, the Communicable Disease Prevention Unit, formed a syphilis working group (WG), consisting of medical officers, clinical nurse consultants, epidemiologists, communications, policy and information management representatives. The WG planned, developed and implemented a patient-centred model of care, that ensures a timely, efficient and effective response, using flexible approaches to each case and contact. 

CDPU is now actively following up each syphilis case and conducting enhanced contact tracing, in collaboration with testing and treating clinicians. Improved access to pathology results from local laboratories, good governance, and an upgraded notifiable diseases database, all contribute to Tasmania meeting the objectives of the enhanced response.

The Response team has undertaken substantial capacity building to ensure best practice is maintained and a consistent and efficient public health response is provided. The capacity building has enhanced the collaboration between public health and treating clinicians and enabled more timely management of their patients and support for cases and contacts. 

CDPU will be represented at the upcoming International Union Against Sexually Transmitted Infections Conference with a poster presentation on the ongoing response to syphilis outbreak management in Tasmania. The conference will also provide an opportunity to meet, discuss and learn about the latest research and innovation in sexual and reproductive health from an international perspective.

Clinicians are reminded to include syphilis testing as part of any STI screening and to consider testing for syphilis in anyone presenting with symptoms suggestive of syphilis (chancre, lymphadenopathy, rash etc). Clinicians should also consider testing for mpox in the appropriate clinical context.

Clinicians can contact CDPU by ringing the Public Health Hotline on 1800 671 738 and ask to speak with a Clinical Nurse Consultant in CDPU for more information on the Syphilis public health response.

Toolkit for Acute Respiratory Illness Outbreaks in Residential Aged Care Homes 

CDPU has issued updated local guidance (the ‘toolkit’) to residential aged care homes (RACHs) to assist in the management of acute respiratory illness (ARI) outbreaks. 

All respiratory viruses may present in a similar way, and robust systems for preventing, detecting, and managing ARI outbreaks safely are a key feature of any response in RACH. It is generally not possible to distinguish the causative organism of an acute respiratory infection based on clinical presentation alone. Additionally, influenza, RSV, and COVID-19 can occur together in the same setting.

Health Services and RACHs have knowledge and skills to respond to the challenges posed by COVID-19, influenza, RSV and other respiratory viruses. The toolkit helps support this knowledge.

Over the last four years, the toolkit has progressed through 14 editions, initially with the purpose of assisting aged care providers with the prevention, control, and public health management of COVID-19, but now including public health management of influenza, RSV, and other ARI outbreaks in RACH in Tasmania. It has been adapted to the Tasmanian context from the following national guidelines:

• COVID-19, Influenza, Respiratory Syncytial Virus, and Other Acute Respiratory Infection Outbreaks in Residential Aged Care Homes

The information about ARIs in the toolkit is concise with links to key documents. We recommend that staff involved in planning, preparing, and responding to ARI outbreaks in RACH review the linked documents regularly.

1. CDPU also continues to work with RACHs when they have an outbreak to ensure effective and efficient management of any respiratory illness outbreak to minimise the impacts on residents and staff in the homes. 
2. If clinicians or staff on RACH’s require more information they can contact CDPU by ringing the Public Health Hotline on 1800 671 738 and ask to speak with a Clinical Nurse Consultant in CDPU. 

This toolkit is primarily for RACHs but can also be used for disability residential care facilities and other residential settings.

Respiratory Syncytial Virus (RSV) Immunisation Update

The RSV landscape has been rapidly evolving in 2024 with new vaccines and long-acting monoclonal antibody now available in Australia. RSV infection can cause severe disease and hospitalisation, particularly in very young and older people, and vaccination is recommended for certain groups who are at higher risk of severe illness.

The Australian Immunisation Handbook now contains an RSV chapter which outlines the RSV immunisation products available, and recommendations and clinical guidance for these products. In Australia, no RSV vaccines are currently (July 2024) funded under the National Immunisation Program (NIP), however the vaccines Arexvy and Abrysvo are now available via private purchase.

There are currently no RSV vaccines available for infants for active immunisation, however RSV monoclonal antibody injections (Nirsevimab) can protect infants through passive immunisation.

In Tasmania, a high-risk infant RSV monoclonal antibody immunisation program is underway for those infants at highest risk of severe RSV. The program is being co-ordinated by Public Health Services and implemented through the Tasmanian Health Service in collaboration with paediatricians.

More information:  

• Respiratory syncytial virus (RSV) | The Australian Immunisation Handbook 

Influenza Vaccination in Young Children - Help Boost Uptake

As of 7 July 2024, the influenza season is well established, with recent increases observed in all age groups across the state. Influenza infection can cause serious illness in young children, including those who are usually healthy. Influenza vaccination reduces the risk of serious illness and is recommended and funded under the NIP for all children aged six months to less than five years of age and can be co-administered with the infant’s routine scheduled vaccinations. 

Unfortunately, influenza vaccination coverage in the under five year age group remains low. As of 7 July 2024, in Tasmania, only 26 percent of those under five years of age in Tasmania are vaccinated for influenza despite this age group being at higher risk of hospitalisation and increased morbidity. Research has demonstrated that a health care provider recommendation for influenza vaccination is highly effective in increasing vaccination uptake. We encourage health care workers to discuss the importance of influenza vaccination with parents of young children.

More information: 

• Influenza (flu) | The Australian Immunisation Handbook
• RespTas Report | Tasmanian Department of Health

Pertussis (Whooping Cough) – Increasing Activity in Tasmania

Pertussis (commonly known as whooping cough) is a highly contagious infection caused by Bordetella pertussis bacteria and affecting the respiratory system. It affects people of all ages but can be especially serious in babies. Epidemics of pertussis usually occur every few years as immunity wanes. The last epidemic in Tasmania occurred mid-2018 until early 2020. Pertussis activity typically follows a seasonal trend, with higher activity in the Spring and Summer months.

In the first six months of 2024 (1 January to 30 June), there have been 91 cases of pertussis notified in Tasmania. This number is higher than the 3-year average from 2021 to 2023 (inter-epidemic years) for the same 6-month period (mean = 2 cases), but lower than the 3-year average for the same 6-month period from 2018 to 2020 (epidemic years, mean =153 cases). Pertussis notifications began to increase at the beginning of 2024 and are unseasonably high for this time of year (Figure 2). The weekly number of notifications has exceeded the 3-year average for epidemic years (2018-2020) since week 19 (12 May) (Figure 2).

Of cases notified this year, over half of cases (n = 53, 58%) were female. School aged children aged 5-11 years (n=37, 40%), and 12-17 years (n=26, 29%), represent the age groups with the highest number of notifications, which is similar to previous epidemic years and current national trends. As of 30 June 2024, there have been no cases in infants aged <6 months old this year. The majority of cases were from the South (n=70, 77%), followed by the North-West (12, 13%), and North (n=9, 10%). Of cases that reported indigenous status (n=84, 92%), 12 cases were of Aboriginal and/or Torres Strait Islander origin.  

Figure 2. Pertussis notifications by l week of onset in 2024 (to 30 June) and average notifications by week of onset, 2018-2020 (epidemic years) and 2021-2023 (inter-epidemic years), Tasmania.

Pertussis is a vaccine preventable disease and pertussis vaccine is recommended and funded for children at six weeks, four and six months of age, with booster doses at 18 months, four years and in Year 7 as part of the school-based immunisation program.

Vaccination is recommended and funded for pregnant women in each pregnancy between 20 and 32 weeks. This provides protection to the mother and the baby in their early months of life before they can receive their own vaccine from six weeks of age.

Further information 

More information on pertussis is available from: 

• Whooping cough (Pertussis) fact sheet 
• Special Focus Report – Pertussis (Whooping cough) 
• National Communicable Disease Surveillance Dashboard