Online version of the 2012-13 Department of Health and Ageing Annual Report

Chief Medical Officer's Report

Page last updated: 29 October 2013

The Image is of Professor Chris Baggoley, Chief Medical Officer.

Several key health indicators demonstrate the current health status of Australia. This report for 2012-13 highlights the success of Australia’s National Immunisation Program and the reduction in vaccine preventable disease. It discusses the threats posed by emerging new viruses and antimicrobial resistance, and Australia’s preparedness in the event of an outbreak. The impact of early diagnoses of non-communicable diseases, such as cancer, through screening and imaging technologies, is also discussed.

Immunisation

Australia’s comprehensive and successful National Immunisation Program (NIP) contributes to our low infant mortality and high life expectancy rates. The NIP aims to increase national immunisation coverage rates and reduce the incidence of morbidity and mortality due to vaccine-preventable diseases in the Australian community.

The ongoing success of the NIP is demonstrated through the reduction of cases of many vaccine-preventable diseases. For example, since the introduction of the haemophilus influenzae type b (Hib) vaccine in 1993, there has been a 97% reduction in notified cases of Hib in Australia, and we now have one of the lowest rates of Hib in the world.

Australia is achieving good childhood immunisation coverage rates nationally – at or above 90% average coverage for children at one, two and five years of age, although some geographical areas do report significantly lower coverage, which is of significant concern.

Historically, the lowest coverage rate has been for five-year-olds, but coverage for this age group has steadily increased over the past few years, from 89% in 2010-11 to more than 91% in 2012-13. This increase is particularly marked among Indigenous children at five years of age where coverage in 2012-13 was 92.1% compared to 91.5% among all five-year-olds.

Emerging New Viruses and Diseases

Emerging infectious diseases continue to pose threats to the health of Australians.

Avian influenza A (H5N1), first shown to cause human disease in 1997, continues to pose a threat as a potential pandemic influenza strain. In early 2013, an avian influenza strain A (H7N9) which was not previously reported in people, was identified in China.

Figure 1: Number of deaths from diseases now vaccinated against in Australia, by decade, 1926-20052This figure is a vertical column chart. The Y-axis denotes the number of deaths from diseases now vaccinated against in Australia with a range from 0 to 4,500. The x-axis denotes the number of deaths for Diptheria, Pertussis, Tetanus and Poliomyelitus between 1926-35 and 1996-2005. For each disease a down arrow indicates the decade the vaccination program commenced. For Diptheria, vaccination commenced in 1926-35 (deaths at 4,073 in that decade) with a decline in disease statistics to 1956 65 after which the chart shows no record of the disease. For Pertussis, statistics are shown for 1926-35 but vaccination commenced in 1935-45 (deaths at 1,693 in that decade), with a steady decline to 1966-75 after which, the chart shows no record of the disease. For Tetanus, statistics are shown for 1926-35 but vaccination commenced in 1935-45 (deaths at 655 in that decade), with a steady decline to 1986-95 after which, the chart shows no record of the disease. For Poliomyelitus, statistics are shown from 1926-35 with vaccination commencing in 1956-65 (deaths at 123 in that decade), after which, the chart shows no record of the disease.

Note: the down arrow indicates the decade when vaccination program began

A (H7N9) causes severe respiratory infection. The disease is of concern because most patients have been severely ill, with a death rate of about 30%.

Avian influenza A (H7N9) activity declined with the beginning of the Northern Hemisphere summer with sporadic cases reported in July 2013. The Department is maintaining a careful watching brief and can escalate nationally coordinated efforts in response if the virus re-emerges.

Ten years after the severe acute respiratory syndrome, or SARS, virus was first identified and caused severe infections in more than 8,000 people around the world, another related novel virus was identified in September 2012. This virus, now named Middle East Respiratory Syndrome (MERS) coronavirus, resulted in more than 130 laboratory-confirmed cases as of 25 September 2013, with around 40% of those cases dying. Patients presented with severe acute respiratory symptoms, but a number have shown mild flu-like illnesses or have been asymptomatic. All cases had a history of residence in or travel to the Middle East, or contact with travellers returning from these areas.

The source of MERS coronavirus infection and the way it transmits is not known, but it is likely to be of animal origin. However, it is known to have spread on a number of occasions between people who have had close contact, including to health care workers from patients.

So far, there have been no cases of either avian influenza A (H7N9) or MERS coronavirus in Australia.

For both outbreaks, the Department has undertaken a range of planning and response measures in conjunction with the Communicable Diseases Network Australia. This includes issuing advice to health professionals, issuing situation updates, planning surveillance and communications materials and liaising with the Department of Foreign Affairs and Trade on travel advice.

These two international outbreaks highlight that Australia’s continued enhancement of national capabilities has us well-placed to respond to new and emerging communicable disease threats should they occur in Australia.

Antimicrobial Resistance

Antimicrobial resistance (AMR) is a critical issue impacting on Australia’s health. AMR occurs when a micro-organism becomes resistant to an antimicrobial medicine to which it was originally susceptible. The level of AMR has been increasing globally for a number of years, and there are now some bacterial infections for which there are only a very limited number of antibiotic treatments available. The WHO describes AMR as a looming crisis in which common and usually treatable infections could become life threatening.

If the AMR trend is not reversed, it has the potential to take us to a post-antibiotic era, where life-saving procedures such as chemotherapy, organ transplantation, insertion of medical devices such as catheters, heart valves and hip joints, may no longer be viable treatment options as they depend on antibiotic cover.

Along with many other countries, Australia is taking action to combat the problem. In 2011, an AMR steering committee, comprising clinical experts, researchers and those involved in regulation of antimicrobials as well as safety and quality experts, was formed. In February 2013, we established the Australian Antimicrobial Resistance Prevention and Containment Steering Group. The Steering Group is jointly chaired by the secretaries of the Department of Health and the Department of Agriculture; and the Chief Veterinary Officer and the Chief Medical Officer are members. In recognition that AMR extends across both animal and human health, we are working together to develop a comprehensive, whole-of-system National AMR Prevention and Containment Strategy for Australia.

Impact of Early Diagnosis and Screening for Cancer

Cancer is a major cause of illness and death in Australia and has a significant impact on individuals, families and the health care system. In 2011, 29.8% of deaths were due to cancer. Early detection of cancer greatly increases the chances for successful treatment.

In Australia, BreastScreen Australia, the National Cervical Screening Program and the National Bowel Cancer Screening Program have shown that screening can detect early signs of the disease, increase the chances of successful treatment and reduce mortality from these cancers. It should be noted that screening tests are not yet available for all cancers.

BreastScreen Australia

  • Mortality from invasive breast cancer for women aged 50-69 years has decreased over time in Australia, from 68 deaths per 100,000 women in 1991 to 43 deaths per 100,000 women in 2010. This represents a decrease of 36.5% since the BreastScreen Australia program began in 1991, and is attributable to a number of factors including the early detection of breast cancer through BreastScreen Australia, along with advances in managing and treating invasive breast cancer.3
  • In Australia, five-year survival rates from breast cancer have increased from 72% between 1982-1987 to 89% between 2006-2010.4 Current five-year survival rates are among the best in the world.

Cervical Screening

  • Cervical cancer incidence in 20-69 year olds remains at a historical low of nine new cases per 100,000 women. This has fallen by approximately 48% (from 17.2 per 100,000 women) since the introduction of the National Cervical Screening Program (NCSP) in 1991.5
  • The prevalence of vaccine preventable HPV type infections in cervical specimens of females aged 18-24 years decreased significantly from 29% to 7%, four years after the female vaccination program began. This will lead to a reduction in the burden of illness and death due to cervical cancer over time.6
  • Deaths are also low, historically and by international standards, at two deaths per 100,000 women. The mortality rate has fallen 50% since the introduction of the NCSP in 1991 (four per 100,000 women).

Bowel cancer screening

  • Under the National Bowel Cancer Screening Program, Australians turning 50, 55, 60 or 65 years of age are invited to a population-based screening program that aims to help detect bowel cancer early and reduce the number of Australians who die each year from the disease.7
  • In Australia, five-year relative survival rates for bowel cancer have increased from 48% in 1982-1987 to 66.2% in 2006-2010.
  • Program reporting8 and independent research9 have indicated that the program has resulted in the detection of earlier stage cancers. The program participants diagnosed as a result of a positive screening test have a higher five-year survival rate than patients presenting with symptoms.

Professor Chris Baggoley
Chief Medical Officer
October 2013